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Daniel Enriquez



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    EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.16-43 - Combined Prognostic Value of CYFRA 21-1 and CEA in Overall Survival of Patients with III-IV Clinical Stage NSCLC (Now Available) (ID 2030)

      08:00 - 18:00  |  Author(s): Daniel Enriquez

      • Abstract
      • Slides

      Background

      Despite great advances in diagnostics and treatment, lung cancer still represents a fatal disease worldwide. Most biomarkers that have been described are not reliable neither applicable in clinical practice, however higher mortality has historically been associated to disease burden and blood biomarkers as CYFRA21-1 and CEA. Our aim was to evaluate the combined prognostic value of two known biomarkers (CEA and CYFRA21-1) among patients with III-IV clinical stage NSCLC in a private Peruvian institution (Oncosalud - AUNA).

      Method

      We analyzed data of 117 patients with III-IV clinical stage NSCLC, treated at Oncosalud-AUNA between 2011-2014 (Lima - Peru). The clinical-pathological data were collected from digital medical records. Tumor biomarkers (CYFRA 21.1 and CEA) were collected from blood routine test. Optimal cutoff value of CYFRA 21.1 (<3.3 and >3.3) and CEA (<9 and >9) were calculated using the maximally selected rank statistics. OS was determinate using Kaplan-Meier method and survival curves comparison were performed using log-rank or Breslow test. Cox model was used for multivariate analysis.

      Result

      The median age was 67 years (range: 40-84) and 49% of patients were women. The 22.4% had ≥2 ECOG scale, and 74.4% were CS IV, and the most frequent site of metastasis was bone (36%) and brain (22%), and adenocarcinoma (82.9%) was the most common histology. The 90.6% of patients received chemotherapy with or without radiotherapy and 9.4% have TKI as front-line of treatment. The median follow-up was 60 months (95%CI: 4.8-5.1), median survival was 1.4 months (95%CI: 1.1 - 1.7), and two and 5 years survival rate were 37% and 18.6%, respectively.

      The median survival for monotherapy -based treatment was 5.7 months and 17.2 months for combined treatment. In univariate analysis, ≥2 ECOG scale (p = 0.004), IV CS (p = 0.023), NLR >3.6 (p = 0.003), CYFRA 21.1 >3.3 ng/mL (p < 0.001) and CEA > 9 ng/mL (0.045) were associated with poor survival. Age, sex and LMR do not show significant effect. In the Cox model, high values of NLR (HR: 1.6, 95%CI: 1.1 - 2.5), CYFRA 21.1 (HR: 2.4, 95%CI: 1.4 - 4.1) and CEA (HR: 1.9, 95%CI: 1.1- 2.6) was associated with poor prognosis. The high values of CYFRA 21.1 or CEA increment the risk of death by 4 times more than in those with low values (HR: 4.3, 95%CI: 2.1-9.0).

      Conclusion

      Patients with combined values of CYFRA 21.1>3.3 and CEA > 9 were associated to high risk of death in our cohort, combined treatments were associated to longer survival.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-24 - Prognostic Value of RDW, NLR and CYFRA 21-1 in Overall Survival of Patients with Metastatic NSCLC (Now Available) (ID 2783)

      10:15 - 18:15  |  Author(s): Daniel Enriquez

      • Abstract
      • Slides

      Background

      Lung cancer remains as the main cause of death in many regions around the world. Unfortunately, most cases are diagnosed as advanced disease that determinates dismal outcomes. There is a lack of biomarkers in clinical practice and also high mortality rates not related to cancer. CYFRA 21-1 is an important biomarker related to burden of disease; neutrophils-to-lymphocyte ratio (NLR) and red blood call distribution width (RDW) represent systemic inflammatory biomarkers indirectly related to immune response, and nutritional components, which are critical factors that can increase the risk of death not related to cancer. Our aim was to evaluate the prognosis value of CYFRA 21-1, NLR, RDW and components of nutritional status (albumin, creatinine, and hemoglobin) in overall survival (OS) of metastatic NSCLC patients treated at a private institution (Oncosalud - AUNA).

      Method

      We analyzed data of 87 patients with metastatic NSCLC treated at Oncosalud-AUNA 2011 - 2014 (Lima - Peru). The clinical-pathological data were collected from digital medical records. The laboratory data (hemoglobin, albumin, RDW-CV, creatinine, neutrophil, lymphocyte, and monocyte) and CYFRA 21.1 were collected from blood routine tests. Optimal cutoff value of NLR (<3.6 and >3.6), LMR (<4.7 and >4.7), RDW-CV (<15% and >15%) and CYFRA 21.2 (<3.3 and >3.3) were determinate using the maximally selected rank statistics. OS was determinate using Kaplan-Meier method and survival curves comparison were performed using log-rank or Breslow test. Cox model was used to estimate the effect of nutritional components and tumoral biomarkers on overall survival.

      Result

      The median age was 68 years (range: 40-84) and 50.6% of cases were women. The 26.4% presented with 2-4 ECOG scale, the most frequent site of metastasis were bone (36%) and brain (22%), and the most common histology was adenocarcinoma (84%). Hemoglobin was low in 16% and 28.7% had abnormal albumin, 44.8% elevated RDW-CV, 24.1% abnormal creatinine, 47.1% elevated NLR, and 72.4% high CYFRA 21-1 value. The 88.5% of patients received chemotherapy and 11.5% had TKI as first-line treatment. The median follow-up was 60 months (95%CI: 44.4-74.6), median survival was 13.2 months (95%CI: 9.8 - 16.7), two and 5-years survival rate were 30.8% and 17.1%, respectively. In univariate analysis, only ³2 ECOG scale (p = 0.062), RDW-CV >15 (p = 0.011), NLR >3.6 (p = 0.019) and CYFRA 21.1 >3.3 ng/mL (p = 0.003) were associated with poor survival. We did not found significant differences with age, sex, Hb, albumin, and LMR. In the Cox model, low values of Hb (HR: 2.1, 95%CI: 1.01-4.5), high values of RDW-CV (HR: 2.6, 95% CI: 1.3 - 5.2), NLR (HR: 1.8, 95% CI: 1.1 – 3.2) and CYFRA21.2 (HR: 2.3, 95% CI: 1.1 - 4.6) were associated with poor OS.

      Conclusion

      Overall survival for our patients was similar to reports from other series. Patients with elevated RDW, NLR and CYFRA 21.2 have poor prognostic in our cohort.

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      P2.16-30 - Real World Data of Targeted Therapy Versus Chemotherapy Maintenance Among Patients with III-IV Clinical Stage Lung Cancer at Oncosalud – AUNA (ID 2853)

      10:15 - 18:15  |  Author(s): Daniel Enriquez

      • Abstract

      Background

      Lung cancer is still a prevalent and fatal neoplasm in developing countries where newer therapies usually had issues about economic toxicity and real clinical benefit in terms of overall survival. In the last decades, chemotherapy maintenance has occupy an important role in the treatment, as well as targeted therapies (tirosin kinase inhibitors and bevacizumab) in the frontline treatment. Our aim was to evaluate the survival impact of targeted therapy in advanced lung cancer at a private Peruvian institution (Oncosalud – AUNA).

      Method

      We analyzed retrospectively data of two cohort of patients with advanced NSCLC (III-IV clinical stage) treated at Oncosalud-AUNA during the period 2008 - 2013 (Lima, Peru). The clinical-pathological data were collected from digital medical records. After a clinical response obtained with a standard regimen based on chemotherapy (≥ stable disease), all patients were distributed in two groups. Group 1 received only maintenance chemotherapy and group 2 had maintenance with targeted therapy, either erlotinib or bevacizumab. OS was determinate using Kaplan-Meier method and survival curves comparison were performed using log-rank or Breslow test. Cox model was used for multivariate analysis.

      Result

      During the study period 58 cases were included, 30 and 28 cases were distributed in group 1 and 2, respectively. The median age was 65 years (range: 44-85) and male:female ratio was 1:1, less than 16% had ≥2 ECOG scale, and about two thirds were diagnosed as CS IV. No statistically difference was found between both two groups. More than 60% of patients received at least six cycles platins based chemotherapy, only five cases reached complete response (8%), partial response was 47% and stable disease 45%. In the group 2, 46% received combined treatment based on bevacizumab and 54% erlotinib as maintenance therapy. Progression rates were 87 and 86% in groups 1 and 2, respectively. The median follow-up was 3 years, median PFS were 10 months for group 1 and 17 months for group 2, and 2-years PFS rates were 17 versus 30%, respectively (p=0.008). Median OS were longer in the group with targeted therapy (3.7 versus 1.4 years, p=0.014). In multivariate analysis the use of targeted therapy (PFS: HR:0.47, 95% CI[0.26,0.85], p=0.013 and OS: HR:0.36, 95% CI[0.18, 0.74], p=0.005) and age <60 years (PFS: HR:0.41, 95% CI[0.19,0.9], p=0.027 and OS: HR:0.30, 95% CI[0.12, 0.73], p=0.008) were associated to better outcomes.

      Conclusion

      An important clinical benefit in terms of survival was obtained with the addition of targeted therapy to the standard of care in the treatment of lung cancer in our cohort.