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Kiran Munawar
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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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P09.44 - Outcomes of Covid-19 Infection in Lung Cancer Patients: Experience from a Large Tertiary Care Cancer Center (ID 3503)
00:00 - 00:00 | Presenting Author(s): Kiran Munawar
- Abstract
Introduction
SARS-COV-2 or Covid-19 has become a major contributor of significant morbidity and mortality around the world. Patients with cancer constitute a high risk group. Furthermore, presence of lung cancer, advanced stage and active immune-suppressive treatment has been associated with poor outcomes. We sought to evaluate the outcomes of lung cancer patients with PCR confirmed Covid-19 infection at a large tertiary care referral cancer center.
Methods
We identified all the patients with histologically confirmed diagnosis of lung carcinoma that tested positive for Covid-19 by RT-PCR at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan. We used our electronic medical records to retrospectively retrieve and analyze the data.
Results
Of the 7 patients identified that met our study criteria, 71.4% were males and 28.6% were females. 42.9% had metastatic disease. Age ranged from 26-67 years. Most patients did not have any co-morbidity except diabetes mellitus in 14.3% and essential hypertension in 28.6%. 42.9% of the patients were on active IV cytotoxic chemotherapy, 28.6% were on surveillance post treatment and 28.6% were on palliative care. Nil patient had received immunotherapy. Cough was the leading presenting complaint (71.4%) followed by fever (57.1%), and shortness of breath (42.9%). One patient (14.3%) was asymptomatic at the time of presentation. None of our patients reported contact exposure or recent travel history. After testing positive for COVID-19 by PCR, 28.6% of patients met the criteria for home isolation while 71.4% required hospitalization. Of those who were hospitlaized 80% were managed in the isolation COVID-ward. One patient required admission in the Intensive Care Unit (ICU). Mean length of hospital stay was 8 days. Of the 7 patients, three (42.9%) had hemoglobin less than 11gm/dl, and TLC greater than 11(x10^9/l). Ferritin level was found to be raised in all the four (57.1%) patients who were tested. D-Dimers were normal in 14.3%, high in 28.6% and not done in 57.1% patients. On radiographic imaging, 42.8% patients had consolidation and airspace disease while 28.6% showed no changes. Imaging was not performed in 1 patient. Those who were home isolated were given symptomatic treatment only. Of those who were hospitalized, all 5(100%) received symptomatic treatment and antibiotics in addition to therapeutic anticoagulation (2 patients, 40%), non-invasive ventilation (3 patients, 60%) and steroids (4 patients, 80%). Overall, four (57.1%) patients fully recovered while three patients (42.9%) died. Fatality rate for the hospitalized was 60% and nil for those who were home-isolated. 2/3rd of the patients on active chemotherapy and 1/3rd of patients with advanced stage of the lung cancer died of Covid-19 infection.
Conclusion
Our limited data suggests that covid-19 infection in lung cancer patients is a significant cause of morbidity and mortality. While overall infection rate in our lung cancer population is unknown, almost 2/3rd of confirmed cases required hospitalization and more than half of them died of complication of covid-19 infection. Patients on active chemotherapy particularly had a high mortality rate. Further studies are needed to elucidate the effects of covid-19 infection in lung 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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P76.75 - Clinical Outcome and Toxicity Profiles of Patients with EGFR-mutation Positive Non-Small-Cell Lung Cancer (ID 3381)
00:00 - 00:00 | Presenting Author(s): Kiran Munawar
- Abstract
Introduction
Activating mutations of EGFR in advanced lung adenocarcinoma and its inhibition with specific tyrosine kinase inhibitors has been shown to generate clinically significant tumor responses. Treatment outcomes of advanced EGFR mutant lung carcinoma in Pakistani population are not previously reported. We conducted a study using the Real World Data (RWD) in patients with EGFR mutant advanced lung cancer treated at our institution. We evaluated clinical features, toxicity profile and outcome of these patients and compared it with those who were unable to receive TKI due to resource limitations.
Methods
We identified 27 patients with advanced lung cancer harboring EGFR mutations that were treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from January 2013 till April 2020. EGFR mutation detection was achieved by real time PCR. Data were collected through electronic medical record. Five patients were excluded from the analysis as they did not start treatment and were lost to follow-up. Progression free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier curves and log-rank analysis.
Results
Of the 22 patients analyzed, 54.5% were males and 45.5% were females. Twenty patients (90.9%) presented with de novo stage IV disease. Age ranged from 34-84 years. Frequency of Exon 19 deletion, Exon 21 L858R mutation, Exon18G7196 mutation and Exon 20 mutation was 50%, 32%, 9% and 4.5% respectively. One patient had compound Exon18G719X and Exon20S7681 mutation. 18.2% of patients had CNS metastasis at initial presentation.
We identified 4 groups in our patient population. Group-1 consisted of patients who received first-generation TKI followed by third-generation TKI upon progression. Group-2 consisted of patients who received upfront first-generation TKI followed by chemotherapy upon progression. Group-3 consisted of patients who received upfront chemotherapy followed by a first-generation TKI upon progression and Group-4 consisted of patients who received upfront chemotherapy followed by second-line chemotherapy upon progression. These groups reflect the real world issues of TKI affordability in a Low Middle Income country (LMIC) such as Pakistan. Median PFS on first-line treatment (PFS1) was 10.7 months in the upfront chemotherapy group, versus 14.5 months in the upfront TKI group (p-value = 0.280). Median PFS on second-line treatment (PFS2) was 4.4 months in the chemotherapy group versus 23.7 months in the TKI group (p-value = 0.001).
Median OS in Group 2, 3 and 4 was 20.0, 85.6 and 26.0 months respectively and not yet reached in Group 1 (p = 0.271).
27.8% patients developed grade I-II skin rash and diarrhea, 5.6% developed grade III-IV anemia, grade I-II neutropenia, and grade III-IV hyperbilirubinemia
Conclusion
Within the constraints of a small sample size our real world data shows that the use of EGFR TKI in advanced EGFR mutant lung cancer is well tolerated in a Pakistani population. Use of EGFR TKI yields a superior PFS in both upfront and subsequent line of therapy which is consistent with the previously reported data. Preliminary overall survival favors superior outcome in the TKI group compared to chemotherapy alone or chemo-TKI combination groups.
