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Francisco Arias Lotto



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    EP1.06 - Mesothelioma (ID 196)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.06-02 - Association of Inflammatory Biomarkers with Overall Survival in Patients with Advanced Malignant Pleural Mesothelioma (Now Available) (ID 1964)

      08:00 - 18:00  |  Author(s): Francisco Arias Lotto

      • Abstract
      • Slides

      Background

      The inflammation process has been proposed as a mechanism of immunoresistance in patients with cancer, promoting cancer growth and dissemination. Derived neutrophil to lymphocyte ratio (dNLR) greater than 3 and lactate dehydrogenase (LDH) level greater than upper limit of normal (ULN) are associated with poor outcomes in patients with advanced non–small cell lung cancer. The aim of this study is to determine whether pretreatment levels of dNLR and LDH as well as PD-L1 status are associated with overall survival in patients with malignant pleural mesothelioma.

      Method

      We conducted a retrospective study, which included all patients with malignant pleural mesothelioma diagnosed in a tertiary referral hospital from December 2009 to March 2019. PDL1 status, complete blood cell counts and LDH levels were collected. A descriptive analysis was carried out, followed by a survival analysis using the Kaplan-Meier estimator.

      Result

      We selected 25 patients. No correlation was found between dNLR and LDH levels. 5 patients (20%) had a dNLR greater than 3, of which 3 patients had stable disease and 2 patients received supportive care. Patients with a dNLR greater than 3 had a median overall survival (mOS) of 8,5 months, whereas patients with a dNLR less than 3 had a mOS of 17,0 months, with statistically significant differences (P:0.038). 2 patients (8%) had a LDH level greater than ULN, of which 1 patient achieved a partial response and 1 patient had stable disease. Regarding the LDH level no difference in overall survival was found.

      Regarding to the PD-L1 status, 10 (40%) of 25 patients had PD-L1 ≥ 1%, 8 (32%) had PD-L1 < 1% and 7 (28%) had unknown PD-L1. Patients with PD-L1 ≥ 1% had a mOS of 8,5 months, whereas patients with PD-L1 <1% had a mOS of 15,7 months, with no statistically significant association (P> 0.05).

      Conclusion

      In our sample, pretreatment levels of dNLR greater than 3 were correlated with worse overall survival in patients with malignant pleural mesothelioma. Furthermore, pretreatment levels of LDH greater than ULN and PD-L1 greater than or equal to 1% could be correlated with worse overall survival, although due to the size of our sample we are not able to conclude statistical significance. Further studies are needed to explore this relationship.

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      EP1.06-11 - Advanced Malignant Pleural Mesothelioma: A Single Institution Experience (Now Available) (ID 1993)

      08:00 - 18:00  |  Author(s): Francisco Arias Lotto

      • Abstract
      • Slides

      Background

      Malignant pleural mesothelioma is a rare and highly aggressive tumor that typically presents with advanced disease. The prognosis of patients with malignant pleural mesothelioma is poor and there is currently a lack of effective treatment options. The aim of this study is to analyze the experience of our center in the management of this pathology.

      Method

      We conducted a retrospective study, which included all patients with malignant pleural mesothelioma diagnosed in a tertiary referral hospital from December 2009 to March 2019. Data regarding baseline characteristics, treatment response and survival were collected. A descriptive analysis was carried out, followed by a survival analysis using the Kaplan-Meier estimator.

      Result

      We selected 25 patients. Table 1 summarizes the main sociodemographic characteristics, the histological subtype and the stage.

      Table 1 Nº (%)

      Sex: Male/Female

      19 (76%) / 6 (24%)

      Age (years):

      71 (51 – 89)

      Histology:

      – Epithelioid mesothelioma

      – Sarcomatoid mesothelioma

      – Mixed mesothelioma

      22 (88%)

      1 (4%)

      2 (6%)

      Stage:

      – Stage III

      – Stage IV

      4 (16%)

      21 (84%)

      22 (88%) of 25 patients received first line chemotherapy with platinum doublet with pemetrexed followed by pemetrexed maintenance and 3 (12%) received palliative care. The proportion of patients who received six cycles of platinum doublet with pemetrexed was 55%. 5 (20%) of 22 patients who received first line chemotherapy with platinum doublet with pemetrexed achieved a partial response, 15 (60%) had stable disease and 2 (8%) experienced disease progression.

      After a median follow-up duration of 15,17 months, 19 (76%) patients had died. The median progression free survival was 13,1 months (IC 95%: 6,7 – 19,5), and the median overall survival was 15,7 months (IC 95%: 11,3 – 20,0). The major cause of death was cancer in 18 patients (95%) and 1 patient dead of heart disease.

      Conclusion

      Demographics and baseline characteristics as well as the survival data obtained in our sample are consistent with the previously reported. Further studies are needed to determine other treatment options to improve the prognosis of these patients.

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    EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.18-28 - Neoadjuvant Therapy Among Patients Undergoing Resection for Non-Small-Cell Lung Cancer: A Single Institution Experience (Now Available) (ID 2002)

      08:00 - 18:00  |  Author(s): Francisco Arias Lotto

      • Abstract
      • Slides

      Background

      Lung cancer is the leading cause of cancer deaths worldwide. Surgery alone results in poor overall survival in patients with stage III non-small cell lung cancer (NSCLC). Neoadjuvant therapy offers the ability to treat micrometastatic tumor cell dissemination preoperatively and increased resectability due to tumor regression. The aim of this study is to analyze the experience of our center and to identify clinical and pathological characteristics related to greater relapse-free survival (RFS).

      Method

      We conducted a retrospective study, which included all patients with NSCLC treated with neoadjuvant therapy follow by surgery in a tertiary referral hospital from April 2013 to March 2019. Data regarding clinical and pathological characteristics, treatment response, type of surgery and survival were collected.

      Result

      We selected 10 patients. Table 1 summarizes the main sociodemographic characteristics, the histological subtype, the stage, the regimens of neoadjuvant therapy and the types of surgery.

      Table 1 Nº (%)
      Sex: Male/Female 6 (60%) / 4 (40%)
      Age (years): 62 (44 – 77)

      Performance status:

      – 0

      – 1

      6 (60%)

      4 (40%)

      Smoking:

      – No

      – Yes

      1 (10%)

      9 (90%)

      Weight loss before diagnosis:

      – High (≥5%)

      – Low (<5%)

      1 (10%)

      9 (90%)

      Histology:

      – Squamous cell carcinoma

      – Adenocarcinoma

      – Large-cell cancer

      3 (30%)

      6 (60%)

      1 (10%)

      Stage:

      – Stage IIIA

      – Stage IIIB

      6 (60%)

      4 (40%)

      Node status:

      – N0

      – N1

      – N2

      3 (30%)

      1 (10%)

      6 (60%)

      ALK translocation:

      – No

      – Yes

      – Unknown

      8 (80%)

      0 (0%)

      2 (20%)

      EGFR mutation:

      – No

      – Yes

      – Unknow

      8 (80%)

      0 (0%)

      2 (20%)

      Percentage of PD-L1 at diagnosis:

      – < 1%

      – 1 – 49%

      – ≥ 50%

      – Unknow

      5 (50%)

      1 (10%)

      2 (20%)

      2 (20%)

      Neoadjuvant therapy regimens:

      – Platinum – pemetrexed

      – Platinum – vinorelbine

      – Platinum – paclitaxel – bevicizumab

      – Platinum – vinorelbine – gemcitabine

      – Platinum – paclitaxel – nivolumab

      5 (50%)

      1 (10%)

      1 (10%)

      1 (10%)

      2 (20%)

      Types of surgery:

      – Lobectomy

      – Bilobectomy

      – Pneumonectomy

      6 (60%)

      1 (10%)

      3 (30%)

      Percentage of PD-L1 after neoadjuvant therapy:

      – < 1%

      – 1 – 49%

      – ≥ 50%

      – Pathological complete remission

      – Unknow

      2 (20%)

      1 (10%)

      4 (40%)

      2 (20%)

      1 (10%)

      Regarding tumour response rates after neoadjuvant chemotherapy, 2 (20%) of 10 patients achieved a complete response and 8 (80%) achieved a partial response. Furthermore, 5 (71%) of 7 patients with mediastinal lymph node involvement achieved a nodal downstaging. Using the Wilcoxon signed-rank test, there are statistically significant differences in the stage of the patients before and after the neoadjuvant chemotherapy (Z: -2,82, p:0,005).

      After a median follow-up duration of 38 months, 5 (50%) patients had relapsed. The median RFS was 22 months (IC95%: 2–41). We did a multivariate logistic regression analysis, in which no statistically significant associations were found between clinical and pathological characteristics studied and the RFS (p>0,05).

      Conclusion

      Neoadjuvant therapy followed by surgery should be considered as standard treatment for a selective group of patients with stage III of NSCLC, in our sample all patients yielded excellent results. In the multivariate analysis no statistically significant associations were found due to the small size of our sample.

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