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Luciana Beatriz Mendes Gomes
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P04 - Early Stage/Localized Disease - Perioperative Therapy (Neoadjuvant Therapy, Surgery, Adjuvant Therapy) (ID 113)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P04.01 - Adjuvant Chemotherapy is not Associated with Worse Disease-Free Survival in the Elderly Population. (ID 3211)
00:00 - 00:00 | Presenting Author(s): Luciana Beatriz Mendes Gomes
- Abstract
Introduction
Adjuvant chemotherapy after complete surgical resection is currently the standard of care for patients with stage IB-IIIA (7th Ed. TNM) non-small-cell lung cancer. The applicability of this treatment to the elderly population however is not completely established. This retrospective study evaluated the indication of adjuvant treatment and the influence of age on survival in patients over 65 years with stage I-III non-small-cell lung cancer.
Methods
We analyzed 177 patients with resectable stage I-III non-small-cell lung cancer who underwent standard lung cancer surgery between 2005 and 2019 at A. C. Camargo Cancer Center, São Paulo, Brazil. Patients were divided in two age groups: <65 years-old and ≥65 years-old years. Indication of chemotherapy by age group and the influence of age on survival were studied. We used descriptive statistics (median and frequencies) to characterize the population. Frequencies were compared by the Pearson’s Chi-squared or Fisher’s exact test. Kaplan-Meier method was used to calculate survival curves. Overall survival (OS) was defined as the time in months from the date of surgery to the date of death by any cause. Survival curves were compared by the log-rank test. Disease-free survival (DFS) was defined as the time in months from the date of surgery to the date of disease relapse, diagnosis of second neoplasia or death by any cause. A p-value<0.05 was considered statistically significant for all tests.
Results
40.7% patients were older than 65 years. Median age at diagnosis was 72 years among the elderly and 55 years in the younger group. 15.8% were stage IB, 23.7% stage II and 21.5% stage IIIA. The majority of patients (55.9%) had ECOG 0 and 65% had a Charlson’s comorbidity score of 3 to 5. The elderly had statistically more comorbidities when compared to the young group (40.1% x 64.2%, p=0.0005). 38.4% of patients received adjuvant chemotherapy after surgery with no statistical difference between the two groups (53.1% x 41.9%, p=0.12). With a medium follow-up of 48.13 months, OS was significantly shorter in the elderly population (55.5mo x 39.2mo; 95%CI 41.09-55.16; p=0.002), nevertheless DFS did not differ significantly between groups (15.6mo x 15.3mo; 95%CI 12.7-17.8; p=0.93). Furthermore, when analyzed according to number of comorbidities, OS was significantly shorter in the group with ≥2 comorbidities (p=0.04).
Conclusion
Age was not employed as the sole criteria to withheld adjuvant chemotherapy in our center. Most of patients had multiple comorbidities and the elderly had considerably more. Despite the lower OS among the elderly, our data showed similar DFS, suggesting there is an excess of death in this group due to non-cancer related causes.
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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: 4
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.06 - CNS Metastasis Negatively Impact Overall Survival of Non-Small Cell Lung Cancer (NSCLC) Patients Treated with Immune Checkpoint Inhibitors. (ID 3314)
00:00 - 00:00 | Author(s): Luciana Beatriz Mendes Gomes
- Abstract
Introduction
Lung cancer is the leading cause of cancer‐related death worldwide. Unfortunately, most of patients are diagnosed with advanced NSCLC. Stage, performance status and central nervous system (CNS) metastases have been recognized as prognostic factors. Immune checkpoint inhibitors (ICI) have greatly improved survival outcomes and can result in deep and durable antitumor responses in lung cancer but survival rates vary among patients with metastatic disease.
Methods
We retrospectively collected data from patients diagnosed with NSCLC from 2005 to 2019 at A. C. Camargo Cancer Center, São Paulo, Brazil, and treated with ICIs. Demographics and clinical characteristics were described as medians and frequencies. Overall survival (OS) was defined as the time from the date of diagnosis to the occurrence of death by any cause. Survival curves were calculated by Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate Cox proportional hazards models were used to estimate hazard ratios (HR). All tests were considered statistically significant when p<0.05.
Results
A total of 81 patients were included in the final analysis. Median age was 62 (36-91) years; 54% were men and the majority of patients (75%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Approximately 67% were previous/current smokers and median tobacco consumption was 31 packs-year. Median Charlson Comorbidity Index (CCI) was 7. The majority of patients had lung adenocarcinomas (72%). More than half of patients (53%) had multiple sites of metastases. Eighteen (22%) patients had CNS metastasis. The median follow-up was 38.7 months and the estimated median OS was 29.5 months (CI 95%, 18.3 – 40.8) for patients treated with ICIs. Having multiple metastases was associated with inferior survival compared with ≤1 site of metastasis (median 14.8 vs. 121.0 months; p<0.001). Longer OS was observed in patients with ECOG PS 0 or 1 compared to those with ECOG PS ≥2 (median 29.6 vs. 14.8 months; p=0.02). CCI>7 (p<0.001). Regarding site of metastasis, median OS was significantly lower in patients presenting with CNS metastases (8.0 vs 30.4 months; HR 2.85; p<0.001). Gender and histological subtypes were not associated with OS. In multivariate analysis, CNS metastases (HR 2.27; p=0.028), ECOG PS≥2 (HR 2.47; p=0.02), multiple organ metastases (HR 3.32; p=0.002) and CCI>7 (HR 2.68; p=0.017) retained independent adverse prognostic impact.
Conclusion
Immunotherapeutic agents represent a new treatment strategy for lung cancer but their efficacy on patients with CNS metastases is still unknown and these patients are largely excluded from clinical trials. Therefore, CNS metastases remain a critical issue in the management of patients affected by lung cancer since they confer a poor prognosis and the treatment options are limited. Moreover, in our study, the number of metastatic sites and having more than one associated comorbidity were also correlated with survival in this population.
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P09.09 - Overall Survival in Elderly Metastatic Non-Small Cell Lung Cancer Patients Treated with Immune Checkpoint Blockade (ID 3483)
00:00 - 00:00 | Author(s): Luciana Beatriz Mendes Gomes
- Abstract
Introduction
Lung cancer is the leading cause of cancer death. Despite the high frequency of lung cancer among the elderly (patients ≥65 years-old), this population is underrepresented in clinical trials, including, though to a lesser extent, those investigating immunotherapy. The objective of this study was to describe the clinical-pathological profile of metastatic Non-Small Cell Lung Cancer (NSCLC) patients treated with immune checkpoint blockade (ICB) and analyze the overall survival (OS) according to age. We also compared the OS of metastatic elderly patients treated or not with ICB.
Methods
This was a retrospective cohort that included all metastatic NSCLC patients, diagnosed from August 1999 to December 2019, treated with ICB or other therapies at A. C. Camargo Cancer Center, São Paulo, Brazil. Demographics and clinical-pathological data were collected from electronic medical records. The variables evaluated were age, gender, race, smoking status, Charlson score, ECOG, histology, presence of EGFR or ALK driver mutations, number of metastasis sites and number of treatment lines. OS for patients treated with ICB as first, second or third line of therapy was evaluated according to age: ≥65 years-old (elderly) or <65 years-old (young patients). We used descriptive statistics (median and frequencies) to characterize the population. Frequencies were compared by Pearson’s Chi-squared or Fisher’s exact test. OS was defined as the time between the date of diagnosis to the date of death by any cause. Kaplan-Meyer method was used to estimate survival curves. Survival between groups was compared by the log-rank test. Tests with p<0.05 were considered statistically significant.
Results
Among the 81 patients that used ICB, 40.7% were ≥65yo, 54.3% were men, 79.1% were white and 54.3% were former smokers. 34.6% of all patients had a Charlson’s comorbidity score 7 or 8. 75.3% had ECOG 0-1 and 71.6% had adenocarcinomas. 44% had EGFR mutations or ALK rearrangements, 49.4% had 1 to 2 metastatic sites and 58.9% received up to 3 treatment lines. Clinical characteristics distribution among 471 patients not treated with ICB were similar to that observed in the population treated with ICB, except for the frequency of EGFR mutations and ALK rearrangements (65.6%), of patients with 1 to 2 metastatic sites (66.8%), and of patients who received up to 3 treatment lines (80.9%). At a median follow-up of 38.7 months for the population who used ICB, median OS was 29,5 months (95%CI 18.29-40.77). Median OS was 29.63 months for the elderly versus 28.87 months for the young patients (p=0.92). No difference was observed using 70yo as a cutoff, as well (p=0.63). For comparison, OS among elderly patients who were not treated with ICB was 21.22 months.
Conclusion
The elderly seems to derive the same benefit from ICB as younger patients. OS among elderly patients that received ICB was longer than among those who were not treated with ICB.
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P09.41 - Body Mass Index (BMI) Is Associated With Overall Survival in Patients With Metastatic Non-Small Cell Lung Cancer (ID 2268)
00:00 - 00:00 | Author(s): Luciana Beatriz Mendes Gomes
- Abstract
Introduction
Obesity is related to increased mortality in several types of tumors, including endometrium, postmenopausal breast cancer and bladder. Contradictorily, for lung cancer there seems to be an inverse relationship, and patients with higher body mass index (BMI), obese or overweight, have improved survival.
BMI is the ratio between the weight in kilograms and the height in meters squared and is commonly used as surrogate for body composition. Using the BMI, obesity is defined as a BMI ≥30 Kg/m2, of overweight as a BMI between 25 and 29,9 Kg/m², normal weight as a BMI from 18,5 to 24,9 Kg/m² and underweight below 18,5 Kg/m2.
The objective of this study was to analyze the BMI of the patients with Non-Small Cell Lung Cancer (NSCLC) and to investigate its impact on overall survival.
Methods
We conducted a retrospective analysis of patients diagnosed with metastatic non-small cell lung cancer diagnosed between 2000 and 2019, at AC Camargo Cancer Center, Brazil. Demographics, clinical-pathological characteristics, treatment patterns and outcomes data were obtained from electronic medical records.
We collected weight and height information to calculate the BMI. Other variables such as ECOG, Charlson’s comorbidity score, histological subtype, smoking load and number of metastasis were also analyzed. Overall survival was defined as the time between diagnosis and death by any cause. We used descriptive statistics to characterize the study population. Association between BMI and other variables was tested with Pearson’s Chi-Squared or Fisher’s exact tests. The Kaplan-Meyer method was used to estimate survival. Impact of BMI on survival was calculated with Cox regression method. P-values <0.05 were considered statistically significant.
Results
We analyzed data from 456 patients with metastatic NSCLC. About 52,9% were men, 73,9% were white, 21,9% were smokers, 42,1% were former smokers and 32,2% non-smokers. Most of the patients had adenocarcinoma (78,5%). 63,2% of patients had ≥2 sites of metastasis. Median Charlson’s score was 8 and 46,7% had ECOG 1.
Median BMI was 24,3 kg/m2 (13,0-50,8). Patients were dichotomized into two groups based on the median BMI: <24,3 (89,7%) and ≥ 24,3 (10,3%).
At a median follow up of 41,5 months, the median overall survival of the group who had lower BMI was 15,8 months versus 24,3 months in the group with higher BMI (HR=1,56; 95% IC 1,0-2,3; P-value=0,034).
Conclusion
According to our data, there is an inverse relation between BMI and risk of death in patients with metastatic NSCLC. Patients who had lower BMI had a worse overall survival. BMI is associated with survival and should be considered as a prognostic factor in patients with lung cancer.
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P09.43 - Familial History of Cancer and Overall Survival in NSCLC Patients. (ID 1994)
00:00 - 00:00 | Author(s): Luciana Beatriz Mendes Gomes
- Abstract
Introduction
Lung cancer is the most common cancer worldwide and has high rates of mortality. It is estimated that individuals with any familial history of lung cancer were more than twice as likely to be diagnosed with lung cancer as were those without familial history. A better understanding of how familial history of lung cancer and of cancer in general affects prognosis of NSCLC patients may be important for the development of personalized screening, diagnosis and treatment.
Methods
This retrospective cohort included NSCLC patients diagnosed at A. C. Camargo Cancer Center, São Paulo, Brazil, from 2000 to 2019, for whom we were able to recover information regarding familial history of cancer. Information regarding demographics, clinical characteristics and familial history of lung cancer and of cancer in general was recovered from medical records and summarized using descriptive statistics (medians and frequencies). Overall survival (OS) was defined as the time between the data of diagnosis and the date of death by any cause. The Kaplan-Meier method was employed to estimate survival curves. Univariate Cox model was used to compare survival between groups. Tests were considered statistically significant when p<0.05.
Results
Among the 642 patients included, 53.3% were male and 40.3% were white. Median age in the whole population was 63 years old. Globally, 77.9% had ECOG 0-1 and 68.1% were current or ex-smokers. The predominant histology was non-squamous NSCLC, representing 83.6% of patients. Driver genes most frequently altered were EGFR (24.9%), ALK (3.0%) and KRAS (4.4%). Most patients were diagnosed in stages IV (55.3%) and III (23,8%), according to the 8th edition of AJCC. Among 287 stage I-III patients, 70% had a first-degree relative diagnosed with cancer. We observed a significant difference in OS between patients with and without familial history of cancer (median OS: 12,8 months x not reached; p=0,021). 13,6% of patients had familial history of lung cancer. We did not observe a significant difference in OS between patients with and without lung cancer familial history (p=0,997). Among 355 stage IV patients, 66,8% had a first-degree relative diagnosed with any cancer and 16,9% had familial history of lung cancer. We did not observe a significant difference in the median OS between patients with and without familial history of (p=0,759) or lung cancer (p=0,139).
Conclusion
Familial history of cancer was associated with shorter OS, nevertheless effect was observed among non-metastatic NSCLC lung cancer patients only. On the other hand, OS was not associated with familial history of lung cancer.
