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Milada Zemanova



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    EP1.04 - Immuno-oncology (ID 194)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-21 - Chronic Inflammation as Potential Predictive Factor of Nivolumab Therapy in Non-Small Cell Lung Cancer (Now Available) (ID 167)

      08:00 - 18:00  |  Author(s): Milada Zemanova

      • Abstract
      • Slides

      Background

      To investigate potential associations between clinical and standard peripheral blood biomarkers and clinical outcome in patients with non-small cell lung cancer (NSCLC) treated with nivolumab.

      Method

      A total of 120 patients with advanced NSCLC treated at seven comprehensive cancer care centers were analyzed in this national retrospective study. Survival statistics were evaluated using Kaplan–Meier method and Cox analysis.

      Result

      Among clinical parameters, histology was significantly associated with progression-free survival. Univariate Cox-proportional hazards model indicated prognostic and predictive role of a panel of laboratory parameters reflecting chronic inflammatory pattern (elevated neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein and decrease in hemoglobin and albumin). Higher serum calcium concentration was also associated with nivolumab treatment effect.

      Conclusion

      Tumor histology was the only clinical parameter predicting the outcome of nivolumab treatment. Among the laboratory parameters, our analysis identified a laboratory panel reflecting chronic inflammation as potential predictive marker of nivolumab treatment.

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    P1.18 - Treatment of Locoregional Disease - NSCLC (ID 190)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.18-27 - Chemoradiotherapy of Inoperable Non-Small Cell Lung Cancer (NSCLC) with IGRT Technique Using TomoTherapy HD (ID 2273)

      09:45 - 18:00  |  Presenting Author(s): Milada Zemanova

      • Abstract
      • Slides

      Background

      Concurrent chemoradiotherapy (CCRT) of locally advanced NSCLC is considered a standard of care last two decades without important improvement except of adjuvant check-point inhibitor therapy. We present one-institutional results of chemoradiotherapy of inoperable NSCLC using daily 3D IGRT with TomoTherapy HD unit.

      Method

      A total of 39 patients with inoperable NSCLC staged by UICC7 and treated since April 2015 till September 2018 were included. Clinical data and radiation plans were retrospectively reviewed. Survival was analysed using Kaplan-Meier method, univariate analysis was done using Cox regression model. Our preferential chemotherapy regimen was cisplatin/vinorelbine three-weekly, carboplatin doublet with vinorelbine or paclitaxel was acceptable as well. Standard radiation dose was 66Gy/33fractions/6.5 weeks, daily MVCT was done. Minimal and median follow-up was 7/30 months, respectively.

      Result

      Patient characteristics were as follows: mean age 66 years, male 46%, stage II+IIIA/IIIB/locoregional recurrences 44%/33%/23%, respectively. PET/CT was done in 77% of patients. Histology: adenocarcinoma 41%, squamous 38.5%, NOS 20.5%. All patients had chemotherapy, 59% cisplatin-based, 41% carboplatin-based, full radiation dose of 66Gy was delivered to 69% of patients, mean size of PTV was 366ml. CCRT had 69% patients. Subsequently, only one patient passed radical surgery, check-point inhibitors were used in 5 patients as second line palliative therapy. We observed low treatment toxicity, radiation esophagitis grade 1-2 in 64%, grade 3 in one patient. Radiation pneumonitis of grade 1-2 started in 13% of patients. Median survival and median time to progression (TTP) was 35.3 and 22.3 months, 2-year survival and TTP 63% and 44%, respectively. The reason of progression was mainly distant metastases alone (26%) or with locoregional failure (15%). Only locoregional progression occurred in 8% of patients. Univariate analysis did not find any difference in survival or TTP by age, gender, tumour location, regimen and length of chemotherapy, or concurrent treatment delivery. Non-significant trend of better outcome of stage II+IIIA, squamous cancer, higher dose of radiation and shorter interval between chemotherapy and radiotherapy start was observed. Only significant variable was size of PTV. With cut-off 440ml the patients having greater size of PTV had significantly worse survival in compare with those with smaller one (HR 4.209, 95%CI: 1.519;11.665).

      Conclusion

      Chemoradiation of inoperable NSCLC with IGRT technique using TomoTherapy HD has excellent results with 77% of durable local control, 63% of 2-year survival and nearly 3-year median survival. Only negative prognostic factor was higher size of PTV.

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    P2.14 - Targeted Therapy (ID 183)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.14-34 - Tyrosine-Kinase Inhibitors (TKI) in First-Line Treatment of 470 Patients with Non-Small Cell Lung Cancer (NSCLC) from the Czech Republic (ID 422)

      10:15 - 18:15  |  Author(s): Milada Zemanova

      • Abstract
      • Slides

      Background

      From October 2013 there is a possibility to treat patients with NSCLC and with activated epidermal growth factor receptor (EGFR) mutations with three TKI in the Czech Republic. We have tried to find differences among patient groups treated with single TKI in 1st line of treatment.

      Method

      The TULUNG registry was used as a data source for this analysis. This clinical registry is focused on the collection of epidemiological and clinical data of patients with NSCLC treated with target therapy in the Czech Republic. A total of 959 patients treated with TKI inhibitors was enrolled in registry until December 31, 2018. Only patients with EGFR mutation and in which 1st line treatment started in October 2013 and later were included in analysis. With respect to defined inclusion criteria we analysed 470 patients. With gefitinib were treated 234, with afatinib 180 and with erlotinib 56 patients.

      Descriptive statistics and frequency tables were used to characterize the sample data set. Statistical significance of differences among three TKI inhibitors subgroups was assessed using the Fisher’s exact test or Kruskal-Wallis test for continuous variables.

      OS and PFS were estimated using Kaplan-Meier method and all point estimates include 95% confidence intervals (95% CI). Statistical significance of differences in survival between subgroups was assessed using the log-rank test. All statistical tests were performed at a significance level of α=0.05.

      Result

      There was statistically significant difference according to age (< 0.001) and PS (< 0.001), patients treated with gefitinib were statistically significant older and had significantly significant higher PS than patients treated with afatinib and erlotinib There was statistically significant difference in the occurrence of adverse events (p<0.001). Patients treated with gefitinib had a significantly lower incidence of adverse events than patients treated with afatinib and erlotinib.

      Between these three groups of patients there was no statistically significant difference in sex (p=0.863), in smoking habits (p=0.463, in type of EGFR mutation (p=0.103), in adenocarcinoma proportion (p=0.183). There was no statistically significant difference according to disease control (p=0.183), in response to treatment (p = 0.804), in OS and (p=0.053, in PFS (p=0.06).

      Conclusion

      Between these three groups of patients we found a statistically significant difference in age, PS segmentation and in occurrence of adverse events. We have not found any important statistically difference in sex, smoking, in histology type of EGFR mutation, difference in response to treatment, in disease control and OS.

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