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Pamela Pizzutilo



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    FP06 - Palliative and Supportive Care (ID 160)

    • Event: WCLC 2020
    • Type: Posters (Featured)
    • Track: Palliative and Supportive Care
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      FP06.04 - Psychological Distress in Outpatients with Lymphoma, Lung and Breast Cancer During COVID-19 Pandemic (ID 3676)

      00:00 - 00:00  |  Author(s): Pamela Pizzutilo

      • Abstract
      • Presentation
      • Slides

      Introduction

      The psychological impact of the lockdown experienced during the COVID-19 pandemic has been found detrimental for the general population, but it has still not been evaluated in cancer patients. We have investigated the psychological status of outpatients receiving anti-neoplastic treatmentduring the lockdown in a non-COVID Cancer Center, with the following aims: to measure the levels of post-traumatic stress symptoms, depression and anxiety, to compare patients with different diagnosis. A further objective was to compare the anxiety and depression levels between cancer patients before and after the emergency assuming an increase in distress in cancer patients in this period due to the health emergency.

      Methods

      Outpatients attending the IRCCS "Giovanni Paolo II" in Bari for their therapy were asked to complete these questionnaires: The Hospital Anxiety and Depression Scale (HADs) and the Impact of Event Scale-Revised (IES-r).Worries regarding the COVID-19 on patients’ lives, socio-demographic and clinical details were investigated using a brief structured questionnaire.

      Results

      One-hundred seventy-six outpatients (n.59 with lung cancer, n.40 with breast cancer, n.77 with lymphoma) were enrolled. Mean age was 57.9 y.o. (SD ±14); 48% were male. We found that 54,4% of patients were above the cut-off (score≥16) for HADS general scale. The mean-IES-R score of patients was 25 (SD±17), with 22.8% indicating severe level of PTDS. The HADS-D has been found significantly correlated with IES-R (r= 0.35; p<0.005). The 70% of patients declared that their worries have increased during the pandemic; their bigger concerns were: the risk of getting infected while at hospital (51.4%); the risk of infecting relatives coming back home (38.7%), andthe risk of delaying therapy (35.3%).When comparing the level of anxiety and depression in different diagnosis it has been found that patients with lung cancer have higher distress(HADs-general scale) than patients with lymphoma (F=17.3, p<0.005) and breast cancer (F=8.86, p<0.005). Finally, cancer patients who experienced the health emergency showed higher levels of anxiety Hads-A, t (237) = 3.73 p<0.001), and general distress (Hads-G, t (237) = 2.51) than those measured 2 years ago (fig 1).

      Conclusion

      This study focused on the psychological aspects of cancer patients during the COVID-19 pandemic, finding that one quarter of patients has severe post-traumatic stress symptoms, and has psychological distress. Patients with lung cancer have higher distress compared to the other groups. This condition risks being overlooked by clinical concerns, so we underline the importance to place even more attention to the psychological needs of patients.

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    P40 - Risk Reduction and Tobacco Control (ID 172)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Risk Reduction and Tobacco Control
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P40.01 - Tobacco use in Adolescence and Associated Factors: Products, School, Family, Peers and Movies in Pandemic Period (ID 3507)

      00:00 - 00:00  |  Author(s): Pamela Pizzutilo

      • Abstract
      • Slides

      Introduction

      Tobacco smoking among adolescents is still frequent and stalling in the last decades, so the main purpose of this research is to know if the COVID‑19 pandemic had an impact on adolescents' perceptions regarding smoking. We investigated: 1) the prevalence of active cigarette smoking; 2) if smoking of parents and friends and school environment influences the choice to smoke; 3) if the students capture the presence of images of smoking in films; 4) the level of concern of the younger people regarding the association between Covid-19 disease and smoke.

      Methods

      719 students (65% boys, aged 13-19 years, from the high school, technical and professional institutes) filled an anonymous questionnaire (31-item), during Covid-lockdown.

      Results

      The students have been subdivided into the following categories: daily smokers (12.8%), occasional (30.3%), former (8.8%) and never smokers (48.1%). 52% of students have smoked at least once (n.s. for gender). Interestingly, over time the probability of starting to smoke decreases (fig1). Furthermore, the students who start smoking early tend to smoke daily (r=-0.13;p < 0.01) and more cigarettes (r=-0.30; p < 0.01). 83% of students start smoking out of curiosity and a spirit of adventure, consuming 1 to 4 cigarettes daily. Moreover 30% of them would want to quit but failed; 27% never thought about it; while 44% report that they will quit smoking in a few years. 59% consume manufactured cigarettes, 36% smoke rolling tobacco; 3% use HNB and 2% e-cigarettes. The type of cigarettes considered less harmful are electronic cigarettes. 68% of the student smokers have in turn someone in the family who smokes, on the contrary only 37.5% of non-smoking students have parent smokers. Considering only the students who smoked at least once, 65% replied that someone among friends smoke, while only 4% of no-smokers have smoking friends. Finally, the adolescents attending professional institutes smoke daily and more cigarettes (F (2, 368)=5.32; p<0.05) compared to the other. Moreover, it emerged that 48% do not pay attention to smoking scenes in the movies.

      About the coronavirus epidemic, 80% reported a upper-middle concern and 84% think that is very dangerous for smokers, while 76,3% consider that the respiratory symptoms of smokers Covid-19 patients could have a worse outcome and that being a smoker can become very dangerous for the clinical complications that can occur (84%). figure 1.jpg

      Conclusion

      These data, even more meaningful during COVID-19 pandemic, highlight the importance and the need of primary prevention as well as of suitable secondary prevention programs.

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    P75 - Immunotherapy (Phase II/III Trials) - Misc. Topics (ID 248)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Immunotherapy (Phase II/III Trials)
    • Presentations: 2
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P75.14 - Gender-Related Safety and Outcome in Advanced NSCLC Patients Treated with Immune Checkpoint-Inhibitors. A Real-World Experience  (ID 1940)

      00:00 - 00:00  |  Author(s): Pamela Pizzutilo

      • Abstract
      • Slides

      Introduction

      Immunotherapy is increasingly used today, given the important efficacy showed in lung cancer treatment.

      Previous data highlighted the role of the estrogen pathway to modulate the PD-1/PD-L1 axis , so possibly influencing response and toxicity of immune checkpoint inhibitors according to gender.

      In our population of subjects treated with immunotherapy, both in first line and in further treatment lines, we have evaluated the outcome and the safety of therapy in the female gender subgroup.

      Methods

      From August 2015 to January 2020, 212 patients (166 male, 46 female; median age 70 and 63.5 years old for males and females, respectively, globally ranging between 28 and 85) received immunotherapy (Pembrolizumab 96, Nivolumab 94 , Durvalumab 13, Atezolizumab 9 pts) for a total of 2.695 cycles . Most of patients received more than 6 cycles of therapy (50% in the female subgroup), with a total range between 2 and 84 administrations (median number of cycles in the female group: 8.3, range 2-33). ECOG PS was 0-1 in 187/212 patients, and ECOG 2 was recorded in 25/212 pts (5/46 female).

      Histotype was adenocarcinoma in 123 pts, while squamous cell carcinoma in 82 pts and other subtypes in 7 pts.

      Results

      The majority of patients received immunotherapy as second-further line of treatment (140/212: 66%; 29/46 : 63% of females); PDL-1Tumor proportion score and smoking status were equally distributed among men and women. The median Progression-free survival (5 months in the entire study population, range 0-46) was superior in the male group (6 vs 3 months) , while the median Overall survival (8 months in the entire group, range 0-47) was not different in the two gender subgroups. The treatment was generally well tolerated by the patients with mainly Grade 1-2 toxicities, while G3 side effects were observed in 44/212 pts (10/46 in the female subgroup).

      The more frequent G3 toxicity described in the female group was hepatic and pancreatic (4 women out of 8 cases in the whole population: 50% ) , while G3 skin tocicity in women occurred in 3/9 pts in the whole population: 30%)

      Conclusion

      Although the underrepresentation of women in the study group doesn't allow to draw adequately reliable data, the treatment outcome was not substantially different according to sex as well as to Performance Status ECOG. Despite the small number of G3 toxicities our findings underline the trend to a different toxicity profile related to gender, as generally reported in previous studies. Females seem to develop serious hepatic /gastrointestinal and skin immune-related side effects more frequently as compared to males and with a shorter time onset.

      Our observations support further investigation about gender-related outcomes in clinical trials , helping to better understand the impact of sex on eficacy and safety of immune checkpoint inhibitors treatment, thus improving the patients' management

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      P75.21 - Impact of Diagnosis and Treatment of Concurrent Infections during Immunotherapy in Advanced Lung Cancer: A Retrospective Cohort Study (ID 3508)

      00:00 - 00:00  |  Author(s): Pamela Pizzutilo

      • Abstract
      • Slides

      Introduction

      Checkpoint inhibitors immunotherapy (CPI) has revolutionized lung cancer treatment, significantly increasing overall survival (OS) of patients. Although immune-related adverse events (irAEs) are the main concern of these drugs, concurrent infections could affect their efficacy. Recent studies suggested that CPI is not associated with an increased risk of opportunistic infections; nevertheless, the impact of common ones on OS is still debated.

      In this report, concurrent infections occurred in lung cancer patients during CPIs are described and the impact on OS by an appropriate diagnosis and treatment of these complications has been evaluated.

      Methods

      From August 2015 to October 2019, 118 patients with advanced non–small cell lung cancer who received CPIs as first- or second-line therapy have been retrospectively evaluated.

      Clinical characteristics, treatments and outcomes including infection rate and OS have been analyzed, as well as the impact of appropriate management of infections.

      Results

      table 1.jpgtable 2.jpg

      74 patients in the Nivolumab group and 44 in the Pembrolizumab group were identified. In both groups, the main infection was pneumonia, followed by skin and soft tissue infections, urinary tract infections and gastroenteritis (Table 1). Crude mortality for first infection was 10.7%, followed by 25% and 40% for second and third recurrence, respectively (p for trend=.146). No opportunistic infections were recorded.

      The most important predictor of mortality (Table 2) was a higher baseline ECOG PS (p<.001), while an appropriate diagnosis and treatment of concurrent infections was associated with a higher probability of survival (aHR= 0.50; 95%CI=0.30 – 0.83, p<.001). By evaluating median overall survival by Kaplan-Meier curve, a prompt management of infections was associated with a better overall survival (p=.050)

      Conclusion

      In advanced lung cancer patients treated with CPI, a prompt management of concurrent infections could significantly improve OS. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting are warranted.

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    P78 - Immunotherapy (Phase II/III Trials) - Immune Checkpoint Inhibitor Single Agent (ID 255)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Immunotherapy (Phase II/III Trials)
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P78.12 - A Rare Case of Dermatomyositis as Late Immune-Related Toxicity During Anti-PD1 Treatment for Advanced Lung Cancer (ID 2251)

      00:00 - 00:00  |  Author(s): Pamela Pizzutilo

      • Abstract
      • Slides

      Introduction

      The treatment of advanced Non-Small Cell Lung Cancer (NSCLC) has been meaningfully modified by the introduction of the immune-checkpoint inhibitors . Among the immune-related adverse events, some less frequent autoimmune reactions may require a multidisciplinary management.

      Methods

      A 68 years-old never smoker female with advanced squamous lung carcinoma was diagnosed in December 2011 and pretreated with chemotherapy. Due to progressive disease the patient received 71 Nivolumab administrations achieving partial response without relevant toxicity, until in July 2018 a macular hitchy skin rash occurred.

      Results

      figure 2.jpg

      A heliotrope pink-violet skin rash spread at the eyelids and periorbital with figure 1.jpg midfacial erythema involving the nasolabial folds, extended on extensor surfaces, the upper chest (Figure 1) and back with photodistributed poikiloderma and in the buttocks. Some Gottron papules were present, besides a greater intensity of the pink-red inflammation over the metacarpophalangeal joints and proximal and distal interphalangeal joints as well as the proximal nail folds, with ragged cuticles.

      The skin rash clearly improved with prednisone but recurred after two months together with persistent fatigue and muscle weakness, so a skin biopsy was performed showing “neutrophilic dermatitis compatible with collagenopathy” (Figure 2).

      A slight increase of serum Creatine Kinase and C-reactive Protein was detected , with normal Aldolase serum levels.

      Blood tests detected Anti-Nuclear Antibodies (ANA) and SAE Auto-Antibodies, directed against “Small Ubiquitine like Modifier Activating Enzyme protein”, highly specific for dermatomyositis.

      Furthermore, an electromyography was performed strenghtening the suspicion of dermato-polymyositis

      The patient underwent radiologycal disease reassessment without evidence of tumoral progression, so supporting the hypothesis of immune-related dermatomiosytis, due to the long lasting treatment with Nivolumab.

      Conclusion

      Uncommon and atypical effects of immunecheckpoint inhibitors on neuromuscular system have been reported.

      This case, presenting with a skin rash associated to features attributable to an immune-mediated dermatomyositis, highlights the need for correctly manage rare and often misdiagnosed immune-related toxicities.

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