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Noemi Reguart



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    MA03 - New and Revisited Prognostic Factors in Early Stage Lung Cancer (ID 119)

    • Event: WCLC 2020
    • Type: Mini Oral
    • Track: Early Stage/Localized Disease
    • Presentations: 1
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      MA03.08 - Impact of COVID-19 Pandemic in the Diagnosis and Prognosis of Lung Cancer (ID 3700)

      15:30 - 16:30  |  Author(s): Noemi Reguart

      • Abstract
      • Presentation
      • Slides

      Introduction

      COVID-19 pandemic has drastically changed the management of patients with cancer. The prioritization of the healthcare towards COVID-19 patients could interfere with the initial diagnosis, resulting in delayed treatment and worse outcome. We aimed to study the incidence of lung cancer new diagnosis, severity and clinical outcomes during Covid-19-period (during-COVID) compared to the same period in 2019 (before-COVID).

      Methods

      Bicenter retrospective cohort study of newly diagnosed non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients before (Jan-Jun/19) and during COVID-19 (Jan-Jun/20) in Spain. Clinical data were collected. We primarily assessed the difference on new lung cancer cases between both periods, and the disease severity considering: Performance status (PS), stage and any significant complication at diagnosis. Secondarily, we assessed the 30 days-mortality rate, progression-free survival (PFS) and overall survival (OS) by period.

      Results

      162 newly diagnosed lung cancer patients (68% NSCLC and 32% SCLC) were enrolled, with median age of 66 years, 70% were male, 33% smokers, 25% with PS ≥2. Advanced disease was diagnosed in 50% of NSCLC and 61% SCLC; 13% of NSCLC harbored driver alterations.

      During-COVID, the number of new cases diagnosed decreased by 38% (43 NSCLC; 19 SCLC), compared to before-COVID period (67 NSCLC; 33 SCLC). More symptomatic cases were new diagnosed during vs. before-COVID. The Table 1 summarized clinical data and complications of new lung cancer cases by period and histology.

      In NSCLC population diagnosed during-COVID, we observed more respiratory symptoms at diagnosis (30% vs. 23% before-COVID) with mainly locally-advanced/advanced disease (82% vs. 76% before-COVID). Among the cases hospitalized, the mortality during-hospitalization was 44% (2/9) vs. 17% before-COVID.

      In SCLC population diagnosed during-COVID, respiratory symptoms were more common (32% vs. 24% before-COVID), but no more aggressive disease observed in terms of stage, complications and hospitalizations. Among the 4 cases hospitalized at diagnosis, none died during-hospitalization vs. 18% before-COVID (2/11).

      Overall, during-Covid the mOS was 6.7 months [95% CI, 5.4-not reached] vs. 7.9 months [95% CI, 4.7-12] before-COVID. In NSCLC, the 30-days mortality was 49% vs. 25% before-COVID; in SCLC, it was 32% vs. 18% before-COVID. Updated data and treatment outcomes will be presented in the meeting.

      table 1.png

      Conclusion

      Lung cancer diagnosis has been affected during the COVID-19 pandemic with fewer cases diagnosed and more symptomatic disease compared to 2019, which seems to be associated with worse outcomes. This study is still ongoing.

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    OA01 - Established Drugs in Special Populations and New Drugs in Established Populations (ID 226)

    • Event: WCLC 2020
    • Type: Oral
    • Track: Immunotherapy (Phase II/III Trials)
    • Presentations: 1
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      OA01.01 - Chair (ID 4123)

      09:15 - 10:15  |  Presenting Author(s): Noemi Reguart

      • Abstract

      Abstract not provided

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    P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Health Services Research/Health Economics
    • Presentations: 2
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P09.15 - Severity of Lung Cancer Disease in Hospitalized Patients During COVID-19 (ID 3373)

      00:00 - 00:00  |  Author(s): Noemi Reguart

      • Abstract
      • Slides

      Introduction

      Covid-19 pandemic has drastically changed the management of patients with cancer; however, there is still limited data regarding the real impact of Covid-19 on patient’s outcomes due to delayed diagnosis and treatment of clinical complications. We aimed to assess the prevalence, severity and mortality of clinical complications and oncology emergencies in hospitalized patients in our institution during the Covid19 period vs. the same period of 2019.

      Methods

      We conducted a retrospective study of patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) who were admitted to the Department of Medical Oncology during Jan-Jun 2019 (before-Covid) and Jan-Jun 2020 (Covid-19 period). Clinical, pathological and biological data were collected. We assessed the clinical severity in both periods including: PS at admission, progression disease (PD), oncologic emergencies (%), start of a systemic therapy or switch to other therapy line. We also analyzed the differences on the 30-day mortality rate since hospitalization between both periods.

      Results

      229 admissions, 133 during and 93 before Covid-19 pandemic (N=180 patients) were enrolled; the median duration of the hospitalization was 9 days (4-16). Median age was 66 years, 35% were female, 88% with PS≥2, 27% were current smokers; 83% had NSCLC histology. Most of them (82%) had advanced disease at admission; 69% were under systemic therapy (chemotherapy 39%, immunotherapy 17%, targeted therapies 11%). Nine patients (4%) were active covid-19 cases (9 NSCLC, 0 SCLC).

      The table 1 summarized the most common clinical conditions by histology, in both periods.

      In NSCLC population, during-Covid, lower rate of admissions were observed (4 cases less per month), with no increase of oncologic emergencies. The PD during hospitalization was slightly higher during vs. before-Covid, but no differences were observed in 30-days mortality rate.

      In SCLC population, during-Covid, the rate of admissions was doubled (2 cases more per month), with more cases progressing during the hospitalization. (46% during vs. 34% before-Covid). In contrast to NSCLC, the 30-days mortality rate was higher during-Covid (38%) vs. before-Covid (20%). Updated data will be presented in the meeting.

      NSCLC (N= 190) SCLC (N= 39)

      During-Covid (2020)

      N=83 (44%)

      Before-Covid (2019)

      N=107 (52%)

      During-Covid (2020)

      N=13 (33%)

      Before-Covid (2019)

      N=26 (67%)

      Baseline characteristics

      Main reason of hospitalization

      Dyspnea

      Fever

      Pain

      Neurological symptoms

      Others

      27 (33%)

      20 (24%)

      9 (11%)

      11 (13%)

      16 (19%)

      26 (24%)

      22 (21%)

      16 (15%)

      20 (17%)

      23 (23%

      3 (23%)

      3 (23%)

      1 (8%)

      4 (30%)

      2 (16%)

      11 (42%)

      2 (8%)

      1 (4%)

      6 (23%)

      6 (23%)

      PS at admission

      0-1

      ≥2

      1 (1%)

      82 (99%)

      22 (21%)

      82 (79%)

      0 (0%)

      13 (100%)

      3 (12%)

      23 (88%)

      Stage at admission

      Locally

      Locally advanced

      Advanced

      7 (8%)

      7 (8%)

      69 (84%)

      7 (7%)

      9 (8%)

      90 (85%)

      0 (0%)

      4 (30%)

      9 (70%)

      2 (8%)

      4 (15%)

      20 (77%)

      N# mets. Sites at admission

      ≤2

      >2

      55 (67%)

      28 (33%)

      64 (60%)

      43 (40%)

      8 (62%)

      5 (38%)

      14 (54%)

      12 (46%)

      Line of therapy (only advanced disease)

      0-1

      ≥2

      55 (65%)

      28 (35%)

      69 (64%)

      38 (36%)

      10 (76%)

      3 (23%)

      21 (81%)

      5 (19%)

      Disease severity
      N# Admissions

      N= 83

      (14 per month)

      N=107

      (18 per month)

      N=26

      (4 per month)

      N=13

      (2 per month)
      N# Readmissions 21 (25%) 22 (21%) 1 (8%) 5 (19%)
      Median duration of hospitalization (range)

      8(1;47)

      10(1;104)

      8(1;22)

      9(1;67)

      Oncology Emergencies

      Yes

      No

      8 (10%)

      75 (90%)

      22 (20%)

      85 (80%)

      1 (8%)

      12 (92%)

      7 (27%)

      19 (73%)

      Progression during hospitalization

      Yes

      No

      32 (39%)

      51 (61%)

      35 (32%)

      72 (68%)

      6 (46%)

      7 (54%)

      9 (34%)

      17 (66%)

      Early death (30-days mortality rate)

      Yes

      No

      20 (24%)

      63 (76%)

      22 (21%)

      84 (79%)

      5 (38%)

      8 (62%)

      5 (20%)

      20 (80%)

      Conclusion

      We preliminary observed more aggressive disease with worse outcomes in patients with SCLC hospitalized during-Covid compared to the same period in 2019. No differences were observed in NSCLC. The final outcomes will be assessed in a larger and mature cohort still ongoing.

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      P09.28 - Access to Intermediate and Intensive Care for Patients With Lung Cancer During the COVID-19 Period (ID 3419)

      00:00 - 00:00  |  Author(s): Noemi Reguart

      • Abstract
      • Slides

      Introduction

      COVID-19 pandemic has dramatically impacted the health national systems, interfering with the access to standard care of other illnesses. However, the real impact of COVID-19 crisis on the cancer care remains unknown. We assessed the access to invasive procedures and critically ill patient units (intensive and intermediate care) in patients with lung cancer hospitalized during pandemic period (during-Covid) compared to the same period in 2019 (before-Covid).

      Methods

      Single-center retrospective study of lung cancer patients hospitalized before (Jan-Jun.2019) and during-Covid (Jan-Jun.2020). Clinical data, access to care and interventions were collected. Patients were also classified in 3 groups according to an estimated life expectancy (based on stage, histology, molecular profile and line-therapy): favorable group (FG) with median (m) overall survival (OS) >5 years, intermediate (IG) 1-5 years and poor (PG) <1 year. We primarily compared the number of admissions to intensive and intermediate-unit care (ICU and intermCU respectively), between both periods, and then stratified by prognostic group. We also assessed the invasive procedures in each period.

      Results

      229 admissions were registered (N=180 patients). Median age was 66 years, 64% were male, 67% with Performance status ≥2; 83% had non-small cell lung cancer and median length of stay was 9 days (1-104). Most of them (82%) had advanced disease; 63% were under systemic therapy. By prognostic groups: 17 patients were considered FG (7%), 161 as IG (70%) and 51 as PG (22%). Nine patients were admitted due to active COVID-19 infection.

      The table 1 summarized the clinical characteristics and interventions in both periods.

      During-Covid, only 2% (n=2) of patients was admitted in ICU vs. 6% (n=8) before-Covid, although, no differences were observed in access to intermCU. The number of invasive interventions was also lower (15%, n=15) vs. before-Covid (33%, n=43).

      By prognostic: 20% of patients in FG (n=2) and 9% in IG (n=6) were admitted to ICU/intermCU during Covid vs. none FG cases and 9% in IG (n=8) before-Covid. In contrast, in the PG lower admissions were observed during-Covid (6%, n=1) vs. before-Covid (20%, n=7)

      With a mOS since date of hospitalization of 3.3 months (95% CI 2.6-4.8), the 30-days-mortality rate was 23% overall; slightly higher during (26%) vs. before-Covid (20%). Updated data will be presented in the meeting.

      During-Covid

      (2020)

      (N, %)

      Before-Covid

      (2019)

      (N, %)

      Baseline characteristics

      Admissions

      N=96

      (16 per month)

      N=133

      (21 per month)

      Sex

      Female

      Male

      42 (44%)

      54 (56%)

      40 (30%)

      93 (70%)

      Age

      <65 years

      >65 years

      48 (50%)

      48 (50%)

      59 (44%)

      74 (56%)

      Performance Status at admission

      0-1

      ≥2

      1 (1%)

      95 (99%)

      25 (19%)

      105 (81%)

      Stage at admission

      Locally

      Locally advanced

      Advanced

      9 (9%)

      13 (14%)

      74 (77%)

      8 (6%)

      11 (8 %)

      114 (86%)

      Number of metastasis sites at admission

      ≤2

      >2

      69 (72%)

      27 (28%)

      72 (54%)

      61 (46%)

      Line of therapy (only advanced disease)

      0-1

      ≥2

      65 (68%)

      31 (32%)

      90 (68%)

      43 (32%)

      Prognostic groups

      Favorable (FG)

      Intermediate (IG)

      Poor group (PG)

      10 (10%)

      70 (73%)

      16 (17%)

      7 (5%)

      91 (69%)

      35 (26%)

      Access to care

      Intermediate Care

      Yes

      No

      7 (7%)

      89 (93%)

      7 (5%)

      126 (95%)

      Invasive Care

      Yes

      No

      2 (2%)

      94 (98%)

      8 (6%)

      125 (94%)

      N# Invasive interventions

      (e.g. pleural, pericardial punction…)

      14 (14%)

      38 (29%)

      Elective procedures

      1 (1%)

      5 (4%)

      Conclusion

      The access to critically ill patient units and invasive interventions for lung cancer patients seems to have been affected during-Covid vs. same period in 2019. The impact on outcomes will be assessed in a larger cohort ongoing.

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    P84 - Targeted Therapy - Clinically Focused - ALK (ID 261)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Targeted Therapy - Clinically Focused
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P84.03 - GLASS: Global Lorlatinib for ALK(+) and ROS1(+) Retrospective Study: Real World Data of 123 NSCLC Patients (ID 3172)

      00:00 - 00:00  |  Author(s): Noemi Reguart

      • Abstract
      • Slides

      Introduction

      Lorlatinib is a third-generation tyrosine-kinases inhibitor (TKI) targeting ALK/ROS1 fusions. The FDA has approved lorlatinib for TKI-pretreated ALK(+) NSCLC, while its approval for ROS1(+) is still pending. Here we present the largest real-world data of NSCLC patients harboring ALK/ROS1 rearrangements treated with lorlatinib.

      Methods

      This is an international, multicenter, retrospective study, which aimed to describe the efficacy and safety of lorlatinib in previously treated ALK/ROS1(+) NSCLC. All patients were treated through an early access program, when no other targeted therapy was available.123 patients were enrolled retrospectively (data cut-off 1/1/2019). Outcome and response were defined by each investigator upon RECIST 1.1 criteria.

      Results

      From March 2015 to January 2019, 106 ALK(+) and 17 ROS1(+) patients were recruited from 8 different countries. The ALK(+) cohort included 50% males, 73% never-smokers and 68% with brain metastases. Extracranial (EC) and intracranial (IC) response rates (RR) were 60% and 62%, with disease control rates (DCR) of 91% and 88% respectively. Mean duration of therapy (DoT) was 23.9±1.6 months and median overall survival (mOS) was 89.1±19.6 months. ROS1 cohort enrolled 53% males, 65% never-smokers and 65% had brain metastases. EC and IC RR were 62% and 67% with DCR of 92% and 78% respectively. Median DoT was 18.1±2.5 months and mOS of 90.3±24.4 months. OS and DoT in both cohorts were not significantly correlated with line of therapy nor other parameters.

      The most common adverse events of any grade were peripheral edema (48%), hyperlipidemia (47%), weight gain (25%) and fatigue (30%). CNS adverse events such as cognitive effect of grade 1-2 were reported in 18% of patients.

      Conclusion

      Lorlatinib shows outstanding extracranial and intracranial efficacy in ALK or ROS1(+) NSCLC. The observed mOS of 89±19 months in ALK(+) NSCLC supports previous reports, while mOS from of 90±24 months is unprecedented for ROS1(+) NSCLC.

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