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Juan Luis Torres



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    EP1.12 - Small Cell Lung Cancer/NET (ID 202)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 3
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.12-20 - Retrospective Study About the Impact of Metastatic Site in Small Cell Lung Cancer (Now Available) (ID 1980)

      08:00 - 18:00  |  Author(s): Juan Luis Torres

      • Abstract
      • Slides

      Background

      Small cell lung cancer (SCLC) is a very aggressive type of lung cancer. It is characterized by a high cellular proliferation and an early development of widespread metastases (nearly 70% of patients presents macroscopic metastases at diagnosis). SCLC spread mainly to bone, brain and liver. In extensive disease, metastatic involvement of the liver, bone and central nervous system seems to have a worse prognosis comparing with other sites, though the studies are quite inconclusive.

      Method

      We conducted a descriptive and retrospective study including all patients diagnosed with metastatic SCLC between January 2012 and December 2018. A Kaplan Meier survival analysis (log-rank analysis) was carried out to study the impact of the metastatic involvement (depending on the localization) at diagnosis and at recurrence.

      Result

      Of the 58 patients included, 58.6% presents liver involvement at diagnosis. These patients present a worse overall survival (OS), with a mean of 1.9 months, and a clear trend to worse progression-free survival (PFS, with a mean of 5.6 months (P=0.56). Bone involvement was presented in 41.4% of the patients. No difference was observed neither in OS (with a median of 6 vs 7.9 months) nor PFS (3.9 vs 3.3 months). Lastly, only the 19% present brain metastases at diagnosis, and it didn’t show significant differences in OS (8.3 vs 6.7 months) but it did in SLP (2.6 vs 5 months). When the tumor relapses, it usually does in multiple localizations (51.3%) and the main organ involved is the lung (78.3%). It didn´t show any difference in prognostic between sites.

      Conclusion

      SCLC is a very aggressive tumor. Due to its biological behavior, a large proportion of the patients presents an advanced staged at diagnosis. In extensive disease, the number of organ sites involved is related to prognosis, but it´s not clear which localizations have a greater impact on survival rates. In our studies, liver and bone metastases are related to worse prognosis and short survival. Surprising, in our series, brain metastases don´t seem to impact in patient’s prognosis. When the tumor relapses, tumor extent (limited vs extensive) is a factor that affects the prognosis. However, in our experience, there are not clear differences between one or another, all of them related to poor prognosis. More studies will be needed to be able to clarify the prognostic impact of the metastases site, both at diagnosis and relapse.

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      EP1.12-26 - Retrospective Study About the Impact of Brain Metastases and Cranial Irradiation in Small Cell Lung Cancer (Now Available) (ID 1987)

      08:00 - 18:00  |  Author(s): Juan Luis Torres

      • Abstract
      • Slides

      Background

      Small cell lung cancer (SCLC) is a very aggressive type of lung cancer. Due to this behavior, it presents early development of metastases. Brain metastases (BM) are very common and are related with a great impact on both survival and quality of life. Prophylactic cranial irradiation (PCI) is used for patients without detectable brain metastases, improving survival and decreasing the incidence of brain relapses (BR). Cranial irradiation (CI) for affected patients are usually used in patients with clinical BM, but its benefits are less clear.

      Method

      We conducted a descriptive and retrospective study including all patients diagnosed with SCLC tumor between January 2012 and December 2018 (both localized and metastatic). We study the impact of PCI and CI in both patients with/without BM at diagnosis. A Kaplan Meier survival analysis (log-rank analysis) was carried out to study the overall survival and the impact of the radiotherapy treatment.

      Result

      Of the 98 patients included, 60.2% presents extensive-stage, while 39% were locally advanced. Of the advanced stages, only 18.4% presented brain involvement at the diagnosis. 34.7% of the patients received RT at the diagnosis (37.5% PCI and 50% of the patients with BM received CI).

      Over the course of the disease, 35.1% of the patients present BR. 67.6% of the patients treated with RT at diagnosis (both PCI and CI) relapsed in the brain, meanwhile, the 54.8% in the group without RT (no significant differences). However, in the RT group, 69.5% of patients relapse outside the brain (mainly the lung). Chemosensitive didn´t show any relation with the incidence of BR (30.4% RT group vs. 35.7% in no-RT group). Overall, there were no significant differences in survival (p 0.19) between the group treated with RT (both PCI and CI) and the group which didn´t.

      Conclusion

      SCLC presents early dissemination. Brain is one of the main organs involved. PCI for patients without detectable BM decrease the incidence of brain relapses and improve survival. The impact of CI is less clear in patients that already have BM. Surprisingly, in our series, we didn´t find any difference with PCI or CI in overall survival and BR. A high proportion of the patients in both groups (with/without BM at diagnosis) didn´t receive radiotherapy, due to a very poor clinical status (which can may lead to bias). More studies will be needed to be able to clarify the prognostic impact of these metastases and the effectiveness of this treatment nowadays.

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      EP1.12-29 - Retrospective Study About Small Cell Lung Cancer: Our Experience in a Spanish Hospital (Now Available) (ID 1976)

      08:00 - 18:00  |  Author(s): Juan Luis Torres

      • Abstract
      • Slides

      Background

      Incidence of small cell lung cancer (SCLC) has been decreased during the last decades. This neoplasm appears almost exclusively in smokers and it is characterized by aggressive biology and early development of metastases. Due to this aggressiveness, a large proportion of patients present a poor performance status at the time of diagnosis. Though the tumor is initially highly responsive to therapies, most of the patients will relapse after treatment. The prognosis is generally poor, even in limited stage disease.

      Method

      We conducted a descriptive and retrospective study including all patients diagnosed with SCLC tumor between January 2012 and December 2018 (both localized and metastatic forms were included). A Kaplan Meier survival analysis (log-rank analysis) was carried out to study the overall survival.

      Result

      diagnosed in advanced stages (60.2%), while 29.6% were locally advanced and only 8.2%, localized. In metastatic stage, the main organ affected was the liver (35.7%), followed by the bone (24.5%). Only 12% presented brain metastases at the diagnosis. The vast majority were smokers (68.4%) or ex-smokers (27.6%), with only one patient that had never smoked.

      The 78.4% of the patients received chemotherapy (36.7% with concomitant radiotherapy). After the initial treatment, up to 55.4% of the patients recurred, mainly involving various localizations (50%). Only 39% received a second line of chemotherapy, and 24% a third line.

      At the end of the study, 84.6% of the patients had died (median of 19.7 months since diagnosis). Log-rank analysis (Kaplan-Meier estimates) showed significant differences (p<0.05) between tumor stages and platinum-sensitive status. On the contrary, there wasn´t significant difference related to sex, smoke status, type of recurrence or type of chemotherapy chosen in second line.

      Conclusion

      SCLC is heavily related with smoke. Most of them exhibit an aggressive behavior, with an advanced stage at diagnosis (in our study, up to 60.2%, and 29.6% locally advanced). Thought usually presents high chemosensitivity, most of the patients recur. At this point, the prognosis is poor, with a low benefit with the treatment, in our series regardless of the drug. Unlike the previous series, we haven´t seen a worse outcome related to sex or smoke status. More studies will be needed to be able to clarify the prognostic impact of factors such as the smoke status, sex, type of relapse or second line treatment.

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    EP1.14 - Targeted Therapy (ID 204)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.14-31 - Retrospective Study About EGFR Mutations in Lung Cancer: Our Experience in a Spanish Hospital (Now Available) (ID 1995)

      08:00 - 18:00  |  Author(s): Juan Luis Torres

      • Abstract
      • Slides

      Background

      Mutations in the epidermal growth factor receptor (EGFR) tyrosine kinase are observed in approximately 15% of lung adenocarcinomas and usually occur in nonsmokers. The detection of these mutations can be detected either in liquid biopsies or solid tissue biopsies. EGFR mutations are a predictive biomarker for high response and longer survival (both progression-free and overall) with tyrosine kinase inhibitors (TKIs), namely gefitinib, erlotinib, afatinib and osimertinib.

      Method

      We conducted a descriptive and retrospective study including all patients diagnosed with EGFR mutations between January 2007 and September 2018 (both locally advanced and metastatic forms were included).

      Result

      Of the 67 patients, the mean age was 67.2 years. The majority were adenocarcinoma (82.5%), with only 7.9% of squamous and 6.4% large cell carcinoma. The main mutations registered were exon 21 deletion (41%) and exon 19 deletion (4.9%). Only 24.6% had history of smoking. 71.6% of patients present stage IV disease at diagnosis. The main organ involved was the bone (45.8%), followed by the lung (44.1%) and brain (25.4%). Also 13.6% presents pleural, 10.2% liver, 5.1% adrenal and 5.6% lymph node involvement.

      84.1% of the patients were treated with TKIs (erlotinib 49.2%, gefitinib 16% and afatinib 19%) while 16% were treated with chemotherapy. With first line treatment, 94.7%presented disease control (41.8% partial response, 41.9% stable disease and 11% complete response). With a mean of 23.6 months, 56.9% of them progressed, mainly involving the lung (28.6%) and the bone (20.6%). Only 9.5% presented brain progression. At the end of the study, 34% had died (overall survival´s mean of 27.5 months).

      Conclusion

      In patients with oncogenic driver mutations in EGFR, treatment with TKIs results in a better outcome than standard chemotherapy. This mutation predicts sensitivity to EGFR (our study shows up to 94.7% presents some type of response). Also, this response is longer (23.6 months in our experience) and better tolerated than chemotherapy. Overall survival of these patients is longer too, in our series, round to 27.5 months of overall survival, and mainly related to the tumor stages. More studies will be needed to be able to clarify the prognostic impact of factors such as the smoke status, sex, type of relapse or second line treatment.

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