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Rafael Lopez Castro
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FP07 - Pathology (ID 109)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP07.06 - Lung Immune Prognostic Index (LIPI) in Advanced NSCLC Patients Treated with Immunotherapy, Chemotherapy and both Combined Upfront. (ID 823)
00:00 - 00:00 | Author(s): Rafael Lopez Castro
- Abstract
Introduction
The Lung Immune Prognostic Index (LIPI) that combines the neutrophils/[leucocytes minus neutrophils] ratio (dNLR) and lactate dehydrogenase (LDH), is associated with outcomes in pretreated advanced NSCLC patients receiving single agent immune checkpoint inhibitors (ICI). However, its role in first line treatment of advanced NSCLC patients has not been explored yet. We assessed the value of baseline LIPI in the first line setting, for ICI-monotherapy, ICI-combination or platinum-based chemotherapy alone (CT).
Methods
We retrospectively collected data of patients treated with first-line ICI between 2016 and 2019 as single agent if PD-L1 ≥50% (ICI-cohort), or in combination with a CTLA4-inhibitor (ICI+ICI cohort), or with chemotherapy (ICI+CT cohort), from 18 centers worldwide. A control cohort of patients treated with platinum-based CT (CT-cohort) was also collected between 2011 and 2019 from 2 centers. Baseline LIPI was calculated as previously reported and correlated with overall survival (OS) and progression-free survival (PFS) in each treatment cohort.
Results
Overall, 930 patients were enrolled, 561 in the ICI-cohort, 186 in the combo ICI+CT, 55 in the ICI+ICI and 128 in the CT-cohort. Median (m) follow-up was 12.5 months. In the whole cohort, median age was 66 years, 70% male, 80% had non-squamous histology, and 84% had PS ≤1. Based on LIPI (available for 792 patients): 305 (38%) were considered good, 331 (42%) intermediate and 156 (20%) poor group.
Treatment outcomes according to LIPI scores are depicted in Table 1. The LIPI poor population had significantly worse OS compared with other LIPI groups, in the whole cohort (P<0.001) as well as in the ICI monotherapy and combo ICI+CT cohorts (both P<0.0001); and in the CT cohort (P=0.004). In term of PFS, we observed correlation between LIPI groups and outcomes in the whole cohort (P<0.001) and in the ICI- monotherapy cohort (P=0.008); however, no differences were observed in the cohorts of patients receiving chemotherapy regimens, alone (P=0.08) or combined with ICI (P=0.08). The analysis by PD-L1 expression in 756 patients with available data will be presented in the Congress.
Table 1: Median OS and PFS according to LIPI subgroups. NR = non reached.
ConclusionOutcomes
LIPI
subgroups
Overall cohort
N= 925
ICI-cohort
N=558
ICI + CT-cohort
N= 185
ICI + ICI cohort
N= 55
CT-cohort
N=127
Median OS
(95% CI)
All
16.3 (14.7-18.8)
21.0 (17.1-NR)
24.7 (16.9-27.1)
20.5 (14.1-NR)
9.79 (8.3-14.4)
LIPI good, 38.5%
19.8 (17.2-25.7)
NR (NR-NR)
25.7 (25.6-NR)
33.6 (14.7-NR)
14.42 (8.9-17.9)
LIPI interm, 41.8%
15.8 (14.3-20.3)
21.2 (17.1-NR)
20.3 (12.8-NR)
14.6 (5.5-NR)
9.30 (7.0-14.5)
LIPI poor, 19.7%
6.96 (5.6-12.5)
8.5 (3.4-13.7)
6.1 (4.9-NR)
14.1 (10.3-NR)
6.1 (5.0-NR)
Global LogRank P value
<0.0001
<0.0001
<0.0001
0.4
0.004
Overall cohort
N= 909
ICI-cohort
N=543
ICI + CT-cohort
N= 185
ICI + ICI cohort
N= 54
CT-cohort
N=127
Median PFS
(95% CI)
All
6.5 (5.9-7.1)
6.3 (5.0-7.6)
8.9 (6.80-10.9)
7.2 (5.7-30.6)
5.7 (5.3-6.4)
LIPI good, 38.7%
7.0 (5.9-8.5)
6.4 (4.5-10.8)
9.8 (7.8-13.0)
9.2 (5.7-NR)
6.0 (5.3-7.8)
LIPI interm, 41.6%
6.6 (6.1-7.6)
6.6 (5.6-8.1)
10.4 (6.4-12.4)
5.5 (2.5-NR)
6.1 (4.3-7.6)
LIPI poor, 19.7%
3.6 (3.1-5.6)
3.3 (1.9-6.7)
4.5 (2.8-8.2)
7.1 (2.56- NR)
3.7 (3.4-NR)
Global LogRank P value
<0.0001
0.008
0.08
0.4
0.08
Pretreatment LIPI was prognostic in untreated advanced NSCLC patients regardless of the type of therapy. However, LIPI was associated with PFS only in patients receiving ICI-monotherapy, with no statistically significant differences in CT-containing cohorts (alone or combined with ICI). This value of LIPI to guide treatment selection should be further explored in prospective studies.
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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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P09.28 - Access to Intermediate and Intensive Care for Patients With Lung Cancer During the COVID-19 Period (ID 3419)
00:00 - 00:00 | Author(s): Rafael Lopez Castro
- Abstract
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.
ConclusionDuring-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%)
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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P52 - Staging - Prognosis and Staging (ID 186)
- Event: WCLC 2020
- Type: Posters
- Track: Staging
- Presentations: 2
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P52.08 - Thoracic Tumors Registry (RTT): Analysis of Clinical Features and Survival in Patients with mNSCLC in Spain. (ID 3022)
00:00 - 00:00 | Author(s): Rafael Lopez Castro
- Abstract
Introduction
The lung cancer is the leading cause of death due to cancer in Western countries, the prognosis it depends on the tumor stage and the clinical, histological and molecular characteristics. The Thoracic Tumors Registry (RTT) of the Spanish Lung Cancer Group is a database who include the data of patients with lung malignant neoplasms.
Methods
The objective of this retrospective study is to descriptive the clinical and epidemiological aspects of non-small cell lung cancer (NSCLC) in the Spanish population.
Results
The total of patients included in the RTT is 12.897 (Aug 2016 - Jan 2020) and this report is based in the analysis of 5.049 of them. The clinical and demographic data are described in the table 1. Adenocarcinoma (72,2%), squamous cell carcinoma (SCC) (18,6%), others types. The sites of metastasis: contralateral lung (34.3%), bone (31%), liver (12.8%) and CNS (6.02%). The first-line of treatment was chemotherapy (CT) in 66,54%, oral target therapy 13,45%, immunotherapy (IO) 8,62% and CT+IO 2,46%. The median of PFS of 7.4 months (7.13-7.6 months) in all population with an estimated at 6, 12, 24, and 60 months of 58.3% (95%CI 56.81% - 59.74%), 29.97% (95%CI 28.56% - 31.4%), 13.4% (95%CI 12.2% - 14.6%) and 2.6% (95%CI 1.98%-3.5%) respectively. The median of OS was 15.5 months (14.8-16.4). According to the histological type (SCC vs non-SCC), the median (in months) of PFS was 6.67 (6.1- 7.1) vs 7.53 (7.3-7.9) (HR 0.78, 95% CI 0.72 - 0.85) and OS 13.8 (12.6-15.6) vs 16.9 (15.7 - 18) in non-SSC, p <0.001. The analysis of survival in patients with or without liver metastasis showed a median OS of 15 months (14.3-16m) vs 18.1 months (16.1- 19.9m), HR 0.88, 95%CI 0.79-0.98 (p<0.05).
N=5049
Age, Median
68,29-y (25-96)
Sex
M: 71,16% - F: 28,83%
Smoking habit
Smoker
Former smoker
Never smoker
42,42%
41,06%
15,56%
Asbestos exposure
2,14%
Patient history of cancer
13,5%
Family history of cancer
40,82%
Conclusion
The results of our study show a similarity in the clinical characteristics of patients with NSCLC in the Spanish population with the data in the western population previously describe. Both the histological subtype and the presence of liver metastases are predictive factors for survival.
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P52.10 - Profile of Comorbidities and Cancer History in Patients with mNSCLC in the Spanish Population (Thoracic Tumors Registry). (ID 3024)
00:00 - 00:00 | Author(s): Rafael Lopez Castro
- Abstract
Introduction
Lung cancer is the most commonly diagnosed cancer worldwide and places a considerable burden on public health. The prognosis depends on the tumor stage and the clinical, histological and molecular characteristics. However, the comorbidities are also an important factor, not only in the diagnostic procedures but on the oncologic treatment strategies. The Thoracic Tumors Registry (RTT) of the Spanish Lung Cancer Group is a database that includes the data of patients with lung malignant neoplasms
Methods
The objective of this retrospective study is to describe the profile of comorbidities and cancer history in patients with NSCLC in the Spanish population.
Results
The total of patients included in the RTT is 12.897 (Aug 2016 - Jan 2020) and this report is based in the analysis of 5.049 of them. The median of age was 68,9-y (25-96). The most prevalent histology was the adenocarcinoma (72,2%) followed by the squamous cell carcinoma (SCC) (18,6%), others types include sarcomatoids, large cell, neuroendocrine and NOS carcinoma. Seventy-one percent of patients were male and 28,83% female and, according to the smoking habit, 42,42% were smoker, 41,06% former smoker and 15,56% never smoker. The asbestos exposure was informing in 108 cases (2,14%). A total of 4153 patients (82.25%) had comorbidities and these including: hypertension (50,13%), dyslipemia (34,36%), diabetes mellitus (22,9%), COPD (21,04%), heart disease (16,23%), depressive syndrome / anxiety (7,89%), vasculopathy (6,79%), obesity (4,94%), among others. 681 patients had a previous history of cancer (13,49%), the mains include the bladder and urinary tracts (14,39%), head and neck (10,43%), colorectal (10%), breast (8.08%), non-melanoma skin (6,31%), lung (2,5%), lymphoma (2,5%), among others.
Conclusion
Our study shows the real comorbidity profiles of patients with NSCLC in Spain. The cardiovascular and pulmonary diseases and the metabolic disorders are the most common pathologies in our patients. Theses comorbidities may have determined the selection of the treatment and influence the prognosis in lung cancer as well as and pose a major clinical challenge in the care of cancer patients.
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P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)
- 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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P76.42 - OsimertinibTreatment in Non-Small Cell Lung Cancer (NSCLC) EGFR-T790M+. Activity in Patients with CNS Metastases. OSIREX (ID 1860)
00:00 - 00:00 | Author(s): Rafael Lopez Castro
- Abstract
Introduction
Based on the lack of real-life results the Spanish Lung Cancer Group (SLCG) proposed to organize a retrospective study in which we can describe the experience in efficacy and safety of osimertinib in p with NSCLC EGFRm T790M and central nervous system CNS) metastases.
Methods
Observational, non-interventional, multicentre, one-arm, non comparative, retrospective study in T790M positive NSCLC p with advanced or metastatic disease. A total of 155 p were included. The observation period was from August 2016 to December 2018 in 30 Spanish hospitals. This corresponds to a total period of 29 months.
Results
155 p were included (108 women (69.7%), median age: 67 (37-88), 64% (99/155) were non-smokers and 99 % (154/155) had adenocarcinoma. Most p had received at least one prior treatment (97.4%, 151/155): 76.8% previous EGFR-TKIs, and 20.6% had received prior cytotoxic chemotherapy. At data cutoff, median duration of follow-up was 11.7 months (0.4-32).
A total of 155 p were evaluable for response analysis, 87(56%) as 1st and 2nd line therapy and 68 as ≥3rd line. 45 patients (30%) had CNS metastases at baseline. PFS was inferior en patients with CNS metastases than in those without (median, 7.2 months (95% CI, 3.9 to 10.6) vs 10.3 months (95% CI, 7.8 to 12.8) HR: 1.54 (95% CI, 1.03 to 2.32).
Conclusion
This retrospective study to assess the real-world clinical impact of osimertinib in p with advanced NSCLC and CNS metastases. Osimertinib had demonstrated greater penetration of blood brain barrier than gefitinib or erlotinib and these results could recommend us to use in first line.
