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Satya Mantha Padmaja
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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: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.48 - Experience and Outcome of COVID-19-Positive Lung Cancer Patients from a Eastern Indian Hospital (ID 3357)
00:00 - 00:00 | Presenting Author(s): Satya Mantha Padmaja
- Abstract
Introduction
The COVID-19 pandemic has caused unprecedented crisis in the care of non-Covid patients all across the globe and care for lung cancer patients is no exception. Lung Cancer patients are at increased risks of COVID due to increased mortality from dual aggressive pathology in the lungs. Our aim was to examine the impact of COVID-19 on lung cancer therapy and factors responsible delay in optimal care during the pandemic.
Methods
This study included all patients with a diagnosis of lung cancer being treated at our Institute, a tertiary level referral hospital in eastern part of India during on going pandemic. Seven developed COVID-19, confirmed by RT-PCR method (Table 1).
Results
The mean age of the patients was 49 years. All the patients had metastatic lung cancer. All males had history of smoking. Hypertension was present in only one patient. Four patients (57%) died from concomitant COVID-19 at our institution.Three patients who recovered from COVID were stable. One of them (positive for ROS1) was switched over to Crizotinib and other patient resumed chemotherapy only after he had recovered from COVID-19. Most of the patients acquired COVID-19 infection during the process of evaluatio/chemotherapy and that further delayed the treatment.
Demographic characteristics, Clinical parameters, Treatments, and Outcomes of Lung Cancer patients with COVID-19
ConclusionDetails
Case-1
Case-2
Case-3
Case-4
Case-5
Case -6
Case-7
Age
66 years
46 years
36 years
22 years
65 years
61 years
48 years
Sex
Male
Female
Male
Female
Female
Male
Male
Diagnosis
Neuroendocrine cancer of lung
Poorly differentiated carcinoma
Poorly differentiated carcinoma with CD 31 positive
Adenocarcinoma lung TTF1 positive
Nnosmall cell lung cancer
Adenocarcinoma lung
Adenocarcinoma lung
Stage
4
4
4
4
4
4
4
ECOG score
2
2
2
1
4
1
1
Treatment received
Cisplatin and etoposide
Not given
Not given
Crizotinib
Not given
Carboplatin and pemetrexed
Carboplatin and pemetrexed
No of cycles
Two
NA
NA
4 cycle of Carboplatin and pemetrexed
NA
One
6
Mutation status
Nil
Not done
Not done
ROS 1 positive
NA
EGFR – NEGATIVE
EGFR Negative
COVID status
severe
severe
Severe
Mild
Severe
Moderate
Mild
Outcome
Patient expired
Patient expired
Patient expired
Patient discharged after 8 days of isolation
Patient expired
Patient discharged after 8 days of isolation
On observation
Hospitalisation Duration
12 days
24 days
12 days
8 days
6 days
8 days
nil
Outcome
death
death
Death
On Crizotinib treatment
death
On platinum doublet
On Maintenance Pemetrexed
The results were disappointing because more than half of lung cancer patients died due to COVID-19. The disease course of COVID-19 has been more severe in patients with lung cancers with Chemotherapy. There have been delay in resuming treatment among survivors by few weeks. Fear of aggressiveness of disease was the key factor for interruption or delay in chemotherapy. Other variable factors like stage of cancer, palliative intent of chemotherapy, ECOG status were key determinants for interruption of treatment. The decision to temporarily suspend chemotherapy while waiting for recovery from SARS-CoV-2 and then restart, was not easy due to the risk of cancer progression.
The findings amplify the importance of optimizing of lung cancer care in the context of the COVID-19 prevalence. The decisions need to be taken on the basis of individual cases rather than rely on a generalized approach. In resource limited country like India diverting the existing resources to an emergency leads to compromise of routine outpatient care, especially patients with chronic illness. We need to be flexible in restarting of services guided by local COVID prevalence, while awaiting a definite management plan for COVID-19.
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P29 - Palliative and Supportive Care - Clinical Trial in Progress (ID 162)
- Event: WCLC 2020
- Type: Posters
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P29.01 - Therapeutic Thoracentesis vs Iodopovidone Pleurodesis in Malignant Pleural Effusion Secondary to Lung Cancer–Randomizedtrial (ID 2293)
00:00 - 00:00 | Presenting Author(s): Satya Mantha Padmaja
- Abstract
Introduction
Pleurodesis is a standard practice in management of malignant pleural effusion (MPE). However, improvement in dyspnea is not universal and delayed recurrence of effusion after pleurodesis is reported. Furthermore, resolution of MPE without pleurodesis is described with personalized therapy in lung cancer. Therefore, we aim to assess the impact of as needed therapeutic thoracentesis versus chest tube pleurodesis on the level of dyspnea in patients with MPE secondary to lung cancer.
Methods
This is an ongoing single center open label, parallel group, non–inferiority, randomized controlled trial including adults aged ≥18 years (ECOG 0-3, baseline dyspnea index (BDI) <6) diagnosed with MPE secondary to lung cancer. Computerized randomization was performed to either thoracentesis or pleurodesis groups. Pleurodesis was performed by 10% povidone iodine (20 ml) via 24F chest tube. Dyspnea was assessed by BDI, transitional dyspnea index (TDI) and visual analogue scale (VAS) dyspnea score. Quality of life was assessed by EQ5D-3L questionnaire. A change of +1 in TDI was considered as minimally clinically important difference (MCID) score. Data is expressed as either mean (SD) or median (range) as applicable. Statistical analysis was performed in SPSS software with a per protocol analysis for primary outcome data . Written informed consent was obtained from all participants and the study was approved by institutional ethics committee. Results
Out of 121 patients screened till date 66 were excluded due to various reasons and 55 patients (mean age 56.09±12.97 years ,31 females)were randomized to either thoracentesis (27 patients) or pleurodesis (28 patients) groups. The baseline characteristics of the study population is summarized in Table 1. Mean VAS dyspnea score at 63 days(9 weeks) in thoracentesis and pleurodesis groups (12.35 ± 11.35 mm vs 13.06 ± 20.43 mm, p = 0.896) were similar. The median TDI [9 {5.25 to 9}vs 9{9 to 9}] and mean EQ5D-3L index values (0.73±0.17 vs 0.81±0.13 , p = 0.16) between the thoracentesis and pleurodesis groups were similar at 9 weeks. Median effusion free survival in thoracentesis and pleurodesis groups were 150 days{IQR-36.5to 270}and 120 days{IQR- 28 to173} respectively. A total of 19 (9 in thoracentesis and 10 in pleurodesis groups) died during the follow up.
Table.1: Baseline characteristics of study participants according to treatment groups
*One patient died prior to treatment, BMI – body mass index, BDI – baseline dyspnea index
ConclusionParameters Thoracentesis group
n (%)Pleurodesis group
n (%)p value No of Subjects 27 28 Age in years (mean ± SD) 55.66±14.10 56.5±12.02 0.81 Female Sex 14 (52) 17 (61) 0.50 BMI in kg/m2 (mean ± SD) 23.75±2.91 24.56±3.73 0.37 Smoking status
Smokers
6 (22)
8 ( 29)
0.58ECOG score
≤2
3
26(96)
1 (4)
25(89)
3 (11)
<0.001LENT Score
Low risk (0-1)
Moderate risk (2-4)
High risk (5-7)
0
23(85)
4(15)
0
24(86)
4(14)
NSSize of the effusion
Massive
Moderate
14(52)
13(48)
22(79)
6 (21)
0.03Lung cancer type
Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma
27 (100)
0
0
26 (93)
1 (3.5)
1(3.5)
NSMutations*
EGFR mutation
ROS mutation
ALK1 mutation
13(48)
0
1(4)
8(29)
1(4)
0
NSEQ5D3L BASELINE (Mean±SD) 0.600±0.12 0.566±0.09 0.252 VAS DYSPNEA BASELINE (mm)
Mean±SD61.8±27.58 70.6±25.21 0.224 Median BDI 0{0 TO 3} 0{0 TO 3} 0.06 Treatment
Conventional chemotherapy
Tyrosine kinase inhibitors/Targeted therapy
12(44)
15(56)
12*(43)
13(46)
NSMedian length of stay in Days (IQR) 10 {6 to 17.5} 25{16.5 to 30} <0.001
Symptom driven therapeutic thoracentesis is as good as chest tube insertion and pleurodesis in relieving dyspnea and improving the quality of life at nine weeks in patients with MPE secondary to lung cancer. Hospital length of stay is substantially reduced in thoracentesis group.
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P38 - Pathology - Pathology/Staging (ID 108)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P38.14 - Demographic and Molecular Epidemiologic Profile of Primary Lung Cancer in Eastern India (ID 1990)
00:00 - 00:00 | Presenting Author(s): Satya Mantha Padmaja
- Abstract
Introduction
Lung cancer is one of the commonest cancers and a leading cause of cancer related deaths worldwide as well as in India. While there are direct links with smoking, there has been an increased prevalence of lung cancer in non-smokers worldwide.
The clinico-pathological profile of lung cancer has also changed considerably over the last few decades. The epidemiology has changed over time from a predominantly squamous histology to adenocarcinoma which is now the most common. Published literature as well as unpublished data indicate that the features of lung cancer in India like prevalence, incidence, etiopathogenesis and presentation vary significantly from that in the western countries.
We performed a retrospective analysis to evaluate the unique demographic and epidemiologic features of lung cancer in India, with emphasis on smoking and histopathological trends.
Methods
We performed a data analysis of thoracic tumours managed in the department of Pulmonary Medicine and Radiation Oncology between June 2014 and Feb 2020 to study the demographic and clinic-pathological profile of lung cancer patients. Data were collected directly from patients’ inpatient and outpatient records. All patients of histologically proven lung cancer were included.
Results
A total of 1039 patients were included in the database, of which 36 patients were excluded because of non-primary lung cancer or incomplete data. There were 694 men and 309 women with a male:female ratio of 2.2 . Mean age at presentation was 57.869 ± 12.36 (male 59.62 and female 53.92). Ten (1 %) cases were below 30 years of age and 3% cases were below 35 years of age.
Among those where tobacco smoking history was available, over half of the (52 %) patients were non-smokers while (48%) patients were active or past smokers. Among smokers, Bidi (rolled tobacco) and cigarette smoking was the common mode of smoking.
More than 90% patients presented with metastatic disease. Among the patients with a definitive histological diagnosis, the prevalence of adenocarcinoma was highest (63.43%) followed by squamous (17.2%), small cell (5.2%) and NSCLC NOS (6.9%). Among those where mutation studies were done, positive EGFR (epidermal growth factor receptor) mutation was seen in in 52.7% cases with predominant Exon 19 deletion in 38% and Exon 21 in 10.5% cases. ALK mutation was seen in only 6% cases. Five patients had concomitant EGFR and ALK mutations.
Conclusion
The demographic profile of patients with lung cancer in eastern India has higher proportion of never smokers, especially in women. Most patients present with metastatic disease with significant epidemiological trends towards a predominant adenocarcinoma histology.The positivity for EGFR mutation is higher than other geographical areas of India and Asian countries India. Further studies are required to analyse the plausible aetiology of lung cancer in non-smokers especially among non-smoking women.
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P88 - Targeted Therapy - Clinically Focused - ROS1 (ID 265)
- 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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P88.03 - Asymptomatic COVID-19 in a ROS1 positive Non Small Cell Lung Cancer. (ID 3806)
00:00 - 00:00 | Author(s): Satya Mantha Padmaja
- Abstract
Introduction
COVID-19 pandemic has led to reconsider the traditional management approach in lung cancer. Oral tyrosine kinase inhibitors (TKIs) are being preferred in oncogene addicted advanced non-Small Cell Lung Cancer.
Methods
A young never-smoker woman presented with left hilar mass with left pleural effusion in February 2020. There was an incidental detection of thrombus in right main and descending pulmonary artery. She was diagnosed to have ROS1 rearranged advanced NSCLC with pulmonary embolism. She was initiated on conventional chemotherapy with carboplatin and pemetrexed along with anticoagulation. After fourth cycle of chemotherapy, although there was clinical improvement attributed to reduction of amount of effusion and disappearance thrombus, RECIST 1.1 criteria suggested the progression of disease in view of appearance of adrenal metastasis. Meanwhile, she had a history of high risk exposure with a patient of COVID- 19 in July 2020. Although she was asymptomatic, RT- PCR for SARS-COV2 came out to be positive.
Results
She remained asymptomatic for next 10 days during hospitalization. Then she was started on Crizotinib and was discharged with advice on further follow up.
Conclusion
Although patients on cancer chemotherapy are at high risk of severe COVID-19 diseases, asymptomatic cases can happen. The patients preferably should be shifted to or started on oral TKIs as per available expert recommendations.
