Prognostic factors of patients with advanced lung cancer treated with anlotinib: a retrospective cohort study

Objective Our study aimed to evaluate the main factors affecting the efficacy of anlotinib to determine the therapeutically dominant populations. Methods The medical records of patients with lung cancer who were treated with anlotinib from July 2018 to February 2020 at Renji Hospital, School of Medicine, Shanghai Jiaotong University were retrospectively reviewed. The optimal cutoff prognostic nutritional index (PNI) value for predicting efficacy was determined according to receiver operating characteristic curves. Progression-free survival (PFS) and overall survival (OS) were calculated and compared using the Kaplan–Meier method and log‐rank test. The prognostic values of each variable were evaluated with univariate and multivariate Cox proportional hazard regression analyses. Results The overall disease control rate of 44 patients with lung cancer was 93.2% (41/44). The median PFS was 5.0 months (95% [confidence interval] CI: 2.2–7.8), and the median OS was 6.5 months (95% CI: 3.6–9.3). The multivariate analysis results indicated that hand–foot syndrome and high PNI values were independent protective factors of PFS and OS. Conclusions Anlotinib was effective in treating locally advanced or advanced lung cancer. High pretreatment PNI scores and the presence of hand–foot syndrome after treatment were independent prognostic markers for favorable OS and PFS.

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Efficacy and safety of sunitinib (SU) in patients (pts) with metastatic renal cell carcinoma (mRCC) and lung metastases (mets) only at baseline.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15098 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15098-e15098

Author(s):

Nobuo Shinohara ◽

Hideyuki Akaza ◽

Yoshihiko Tomita ◽

Takeshi Yuasa ◽

Hiroyuki Fujimoto ◽

...

Keyword(s):

Lung Metastases ◽

Objective Response ◽

White Blood Cells ◽

Progression Free Survival ◽

Rank Test ◽

Efficacy And Safety ◽

Kaplan Meier ◽

Common Grade ◽

Hand Foot Syndrome ◽

Grade 3

e15098 Background: The lungs may be the sole site of mets in RCC.In this retrospective analysis, we analyzed the efficacy and safety of SU in mRCC pts from a global phase (ph) III study and a Japanese ph II study who had lung mets only at baseline. Methods: In the ph III study, treatment (Tx)-naïve mRCC pts were randomized 1:1 to SU 50 mg/d on a 4-weeks-on-2-weeks-off schedule (n=375) or interferon-a (IFN) 9 MU subcutaneously TIW (n=360). In the single-arm ph II study, Tx-naïve (n=25) and cytokine refractory (n=26) mRCC pts received the same SU Tx. In the ph III study, progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier method, with median values compared by log-rank test. In both studies, objective response rate (ORR) was calculated with a two-sided 95% CI. PFS, OS, ORR, and safety were analyzed at final data cutoff. Results: In the ph III study, 31 (8%) and 42 (11%) pts in the SU and IFN groups, respectively, had lung mets only, compared with 12 (24%) in the ph II study. Baseline characteristics in lung mets pts were similar to all pts. In lung mets pts from the ph III study, ORR was higher with SU than with IFN (58.1% [95% CI: 39.1–75.5] vs. 19.0% [95% CI: 8.6–34.1]; P<0.001); there was a trend for longer median PFS with SU (14.1 vs. 7.8 months; HR: 0.531 [95% CI: 0.278–1.015]; P=0.0513); and median OS was comparable in both Tx subgroups (HR: 0.739 [95% CI: 0.335–1.628]; P=0.4507), although, at 25% of events, median OS was 22.9 months with SU vs. 15.8 months with IFN. In lung mets pts from the ph II study, ORR was 75.0% (95% CI: 42.8–94.5); at the time of analysis, median PFS and OS had not been reached; 4 pts (33%) had died due to any cause and 8 (67%) were alive without disease progression. The most common grade ≥3 SU-related AEs were fatigue, hand-foot syndrome, and diarrhea (all 19%) in the ph III study, and decreased platelets (100%), white blood cells (92%), and neutrophils (92%) in the ph II study. Conclusions: In the ph III study, Tx-naïve mRCC pts with lung mets only had significantly higher ORR and a trend for improved PFS and OS with SU compared with IFN. In the Japanese ph II study, ORR with SU was 75% in lung mets pts. Thus, 1st-line use of SU in mRCC pts with lung mets should be encouraged.

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Making Checkpoint Inhibitors Part of Treatment of Patients With Locally Advanced Lung Cancers: The Time Is Now

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_280807 ◽

2020 ◽

pp. e159-e170

Author(s):

Mark G. Kris ◽

Corinne Faivre-Finn ◽

Tiana Kordbacheh ◽

Jamie Chaft ◽

Jia Luo ◽

...

Keyword(s):

Lung Cancer ◽

Checkpoint Inhibitors ◽

Locally Advanced ◽

Local Therapy ◽

Progression Free Survival ◽

Standard Of Care ◽

Concurrent Chemoradiation ◽

Stage Iii ◽

Advanced Lung Cancer ◽

Lung Cancers

The PACIFIC trial of durvalumab administered for 1 year to patients with stage III lung cancers has set a new standard of care. PACIFIC established the role of immune checkpoint inhibitors (ICIs) for individuals with inoperable and unresectable locally advanced lung cancers that achieve disease control from concurrent chemoradiation. For patients with resectable and operable disease, ICIs administered before surgery, either alone (JHU/MSK, LCMC3, and NEOSTAR) or in combination with chemotherapy (Columbia/MGH and NADIM), have yielded high rates of major pathologic response in resection specimens, an outcome measure that correlates with improved progression-free survival and overall survival. These results have brought forth the dilemma of how to choose the optimal local therapy—either definitive concurrent chemoradiation or surgery—to use with an ICI for patients with stage III lung cancers that are both operable and resectable. Here, we review the data that support the use of each local therapy. Recent successes have also raised the possibility that using ICIs in patients with earlier stages of lung cancer will enhance curability. Randomized trials are underway; however, until they read out, physicians must choose between local and systemic therapies on the basis of the information we have today. Research demonstrates that using surgery, radiation, chemotherapy, and ICIs improve all efficacy outcomes and curability. All modalities should be considered in every patient with locally advanced lung cancer. It is imperative that a multimodality discussion that includes the possible addition of ICIs takes place to choose the best modality and sequence of therapies for each patient.

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Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre

ESMO Open ◽

10.1136/esmoopen-2020-000929 ◽

2020 ◽

Vol 5 (6) ◽

pp. e000929

Author(s):

Susana Roselló ◽

Claudio Pizzo ◽

Marisol Huerta ◽

Elena Muñoz ◽

Roberto Aliaga ◽

...

Keyword(s):

Pancreatic Cancer ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Progression Free Survival ◽

Rank Test ◽

Resectable Pancreatic Cancer ◽

Borderline Resectable ◽

Curative Intent ◽

Kaplan Meier ◽

Dismal Prognosis

IntroductionPancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoadjuvant chemotherapy (ChT) is being increasingly used in this setting.MethodsThis is a retrospective series of consecutive patients staged as BRPC or LAUPC after discussion in the multidisciplinary board (MDB) at an academic centre. All received neoadjuvant ChT, followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data about patient’s characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment were collected. Overall survival (OS) and progression-free survival was calculated with Kaplan-Meier method and log-rank test.ResultsBetween August 2011 and July 2019, 49 patients fulfilled the inclusion criteria, and all of them received neoadjuvant ChT. Fluorouracil+folinic acid, irinotecan and oxaliplatin was the most frequently used scheme (77%). The most prevalent grade 3 or 4 toxicities were neutropenia (26.5%), neurotoxicity (12.2%), diarrhoea (8.2%) and nausea (8.2%). 18 patients (36.7%) received ChRT thereafter. In total, 22 patients (44,9%) became potentially resectable and 19 of them had an R0 or R1 pancreatic resection. One was found to be unresectable at surgery and two refused surgery. A vascular resection was required in 7 (35%). No postoperative deaths were observed. Postoperative ChT was given to 12 (66.7%) of resected patients. Median OS of the whole cohort was 24,9 months (95% CI 14.1 to 35.7), with 30.6 months for resected and 13.1 months for non-resected patients, respectively (p<0.001).ConclusionA neoadjuvant approach in BRPC and LAUPC was well tolerated and allowed a curative resection in 38.8% of them with a potential improvement on OS.

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Total neoadjuvant chemo (ctx; TNT) for locally advanced gastric cancer (GC): The Memorial Sloan Kettering Cancer Center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.4046 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 4046-4046 ◽

Cited By ~ 1

Author(s):

Megan Greally ◽

Vivian E. Strong ◽

Sam S. Yoon ◽

Daniel G. Coit ◽

Joanne F Chou ◽

...

Keyword(s):

Locally Advanced ◽

Subtotal Gastrectomy ◽

Progression Free Survival ◽

Rank Test ◽

Cancer Center ◽

Surgical Morbidity ◽

Locally Advanced Gastric Cancer ◽

Kaplan Meier ◽

Significant Difference

4046 Background: Peri-op chemo (ctx) and surgery is a standard in the treatment of GC, based on the MAGIC (NEJM 2006; 355:11) and FLOT4 (J Clin Oncol 35:4004 [abstr]) studies. However, less than half of patients (pts) completed ctx in the MAGIC and FLOT4 studies, mainly from issues delivering post-op therapy. We assessed safety and feasibility of TNT, where all ctx is given pre-op. Methods: We reviewed GC pts who received TNT or peri-op ctx and had surgery; decision for TNT was by physician preference, based on clinical or radiographic benefit to justify completing ctx pre-op. Pt characteristics were compared using Fisher’s exact and Wilcoxon Rank Sum tests. Post-op length of stay (LOS) was calculated from date of surgery (DOS) to date of discharge and surgical morbidity was determined using the Clavien-Dindo classification. Progression free survival (PFS) and overall survival (OS) were calculated from DOS using Kaplan-Meier methods and compared between groups using the log-rank test. Results: 120 pts were identified, median age 63, 62.5% male, 98% ECOG 0/1. 93 pts (77.5%) received peri-op ctx and 27 (22.5%) received TNT. In peri-op pts, 19%, 43% and 38% received FLOT, platinum/fluropyrimidine (FP) and ECF/EOX respectively. In TNT pts, 56%, 37% and 7% received FLOT, platinum/FP and ECF/EOX respectively. 57% had subtotal gastrectomy. Surgical outcomes were similar between groups; median LOS was 6 and 7 days (p = 0.31) in peri-op and TNT pts respectively. There was no significant difference in Clavien Dindo grade I-II or III-IV morbidity between groups (p = 0.103). There were no deaths. TNT pts received higher proportions of planned treatment than peri-op ctx pts: 90% vs. 60% FP (0.001); 85% vs. 41% platinum ( < 0.001); 100% vs. 9% epirubicin (0.015) and 53% vs. 28% docetaxel (p = 0.169). At median follow-up of 19 months, median PFS and OS were not reached. There was no significant difference in PFS (p = 0.089) or OS (p = 0.59) between groups. Conclusions: TNT appears safe with no increase in post-op LOS or surgical morbidity observed. TNT pts had higher percentage drug delivery, suggesting potential benefit for administering all ctx before surgery. While longer survival follow-up is required, TNT may be considered in pts with locally advanced GC who are candidates for ctx.

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Clinical outcome for gastrointestinal cancers with polymerase epsilon mutations treated with immunotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.828 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 828-828

Author(s):

Limin Zhu ◽

Funda Meric-Bernstam ◽

Vijaykumar Holla ◽

Taebeom Kim ◽

Kenna Rael Shaw ◽

...

Keyword(s):

Mismatch Repair ◽

Locally Advanced ◽

Progression Free Survival ◽

Female Gender ◽

Rank Test ◽

Cancer Center ◽

Kaplan Meier ◽

Gi Cancers ◽

Mismatch Repair Status ◽

Md Anderson

828 Background: Predictive factors for immunotherapy benefit across gastrointestinal (GI) cancers are limited to those with deficient mismatch repair (dMMR). Mutations in DNA polymerase E (POLE) can cause a hypermutated phenotype irrespective of MMR status and may serve as a predictor factor for immunotherapy. Methods: All POLE-mutant GI cancers with tumor mutation burden (TMB) measured at MD Anderson Cancer Center were identified (N = 58) from 2014 to 2019 and those that had received immunotherapy (N = 18) were studied. TMB was measured by genomic profiling assays FoundationOne or STGA 2018. Samples were analyzed using Kaplan-Meier method and compared using log rank test, with a predefined high TMB threshold of 20 muts/mb. Results: Of the 58 POLE-mutant GI tumors a high TMB was present in 50% of the cases. 18 patients (median age 64, female gender 16.7%, median prior lines of therapy 2) with locally advanced (N = 4) or metastatic (N = 14) POLE-mutant GI cancers (13 colorectal, 1 small intestine, 1 esophageal, 1 pancreatic, and 2 gallbladder) were identified. Immunotherapy agents were PD-1/PD-L1 based in 17 and CTLA-4 based in 1. High TMB was present in 11 patients. dMMR was present in 7 patients, all with high TMB. Treatment response was seen in 3 patients (2 CR and 1 PR), all TMB high and dMMR. Progression-free survival (PFS) was significantly longer in those with high TMB (median: 10.1 months vs. 3 months, p = 0.048). Of the 11 pMMR patients median PFS was 9.3 months in high TMB and 3 months in low TMB (p = 0.246). Conclusions: POLE mutations in GI cancers were associated with a high TMB ( > 20muts/mb) in 50% of patients. Within POLE mutant GI cancers a high TMB may identify patients who benefit from immunotherapy irrespective of mismatch repair status.

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Predictive value of the Lung Immune Prognostic Index (LIPI) in locally advanced non-small-cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT) in the multicenter retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21076 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21076-e21076

Author(s):

Yuko Oya ◽

Go Saito ◽

Akihiro Tamiya ◽

Hayato Kawachi ◽

Daichi Fujimoto ◽

...

Keyword(s):

Predictive Value ◽

Advanced Nsclc ◽

Statistical Significance ◽

Locally Advanced ◽

Multivariable Analysis ◽

Prognostic Index ◽

Progression Free Survival ◽

Rank Test ◽

Kaplan Meier ◽

Locally Advanced Nsclc

e21076 Background: PD-L1 inhibitor, durvalumab has been approved since the PACIFIC study showed its efficacy as consolidation therapy after CCRT for locally advanced NSCLC. But predictive factor for the efficacy of CCRT on this post PACIFIC era have not been known. LIPI has been proposed as a new biomarker for the anti-PD-1 therapy of advanced NSCLC. In this study, we investigated the usefulness of LIPI as a predictive marker in multicenter cohort of patients with locally advanced NSCLC who received CCRT as initial treatment. Methods: 219 patients with available baseline LIPI were reviewed. The progression free survival (PFS) was estimated by the Kaplan-Meier method, and LIPI were calculated at baseline. Kaplan-Meier estimates of PFS and recurrence were compared using the log-rank test for trend. Multivariable analysis was conducted using the Cox and logistic regression models, respectively, adjusted for age, sex, ECOG-PS, smoking, histology, TNM stage, chemotherapy regimens, Body mass index (BMI), PD-L1 status, EGFR or ALK mutation, and baseline LIPI. Results: 62.5% (n = 137) of the patients had a good (0 factors) LIPI, while 37.5% (n = 82) had intermediate (1 factor) and poor (2 factors) LIPI respectively. In multivariable analysis, good LIPI (0 factors) were significantly associated with longer PFS (HR = 0.46, 95% CI 0.28-0.75; P < 0.01) as did ECOG-PS0 (P < 0.01), ≤stageIIIA (P < 0.01), being treated with durvalumab after CRT (P = 0.04). There were no difference in the patient characteristics between good LIPI and intermediate/poor LIPI, significantly. Higher LIPI (1 or 2 factors) were strongly prognostic factor for recurrence after CCRT in multivariate analysis (P = 0.04), along with ECOG-PS1≤ (P < 0.01), stage IIIB≤ (P < 0.01). Conclusions: The good LIPI predictive value for PFS and disease control in patients treated with CCRT was confirmed. Although a strong statistical significance, we needs to be confirmed further with longer follow-up and prospective study.

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Outcomes and Prognostic Factors Following High-dose Re-irradiation for Recurrent Lung Cancer

10.21203/rs.3.rs-251694/v1 ◽

2021 ◽

Author(s):

Keisuke Tamari ◽

Hiroshi Doi ◽

Hiroya Shiomi ◽

Ryoongjin Oh ◽

Kazuhiko Ogawa

Keyword(s):

Lung Cancer ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Treatment Options ◽

Locally Advanced ◽

Progression Free Survival ◽

Advanced Lung Cancer ◽

High Dose ◽

Significant Prognostic Factor ◽

Locally Advanced Lung Cancer

Abstract Background: Re-irradiation is one of the treatment options for recurrence after initial radiotherapy for locally advanced lung cancer. However, the safety and efficacy of high-dose re-irradiation for recurrent lung cancer has yet to be completely understood. This study investigated the outcomes of high-dose re-irradiation for patients with recurrent lung cancer at our clinic.Methods: Data were collected from 36 patients with lung cancer (median age, 68 years) who received high-dose re-irradiation using intensity-modulated radiotherapy for locoregional recurrence after initial radiotherapy in the locally advanced stage. Histology findings showed that 11 (30.6%), 14 (38.9%), and 11 (30.6%) patients had adenocarcinoma, squamous cell carcinoma, and small cell carcinoma, respectively. The interval from initial radiotherapy to re-irradiation was 23.4 months. Local control (LC), progression-free survival (PFS), and overall survival (OS) were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors, while late toxicities ≥grade3 were evaluated according to the CTCAE ver. 3.0.Results: The median follow-up was 14.6 months. The 1-year LC, PFS, and OS were 74.1%, 45.2%, and 78.7%, respectively. Multivariate analysis showed that histology was a significant prognostic factor for LC (p = 0.02), while histology (p = 0.04) and distant metastasis (p = 0.01) were significant prognostic factors for PFS. Grade 5 late toxicities occurred in 2 patients (5.6%) who exhibited esophageal perforation and bronchial perforation. No other ≥grade3 late toxicities occurred.Conclusion: High-dose re-irradiation for recurrent locally advanced lung cancer was effective and feasible. Lung adenocarcinoma might therefore be a good indication for re-irradiation.

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Clinical and molecular factors that impact the efficacy of first-line crizotinib in ROS1-rearranged non-small-cell lung cancer: a large multicenter retrospective study

BMC Medicine ◽

10.1186/s12916-021-02082-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yongchang Zhang ◽

Xiangyu Zhang ◽

Ruiguang Zhang ◽

Qinqin Xu ◽

Haiyan Yang ◽

...

Keyword(s):

Lung Cancer ◽

Retrospective Study ◽

Brain Metastasis ◽

Locally Advanced ◽

Progression Free Survival ◽

Driver Mutations ◽

Advanced Lung Cancer ◽

First Line ◽

Lung Cancers ◽

Chemotherapy Patients

Abstract Background ROS1-rearranged lung cancers benefit from first-line crizotinib therapy; however, clinical and molecular factors that could affect crizotinib efficacy in ROS1-rearranged lung cancers are not yet well-elucidated. Our retrospective study aimed to compare the efficacy of chemotherapy and crizotinib in the first-line treatment of ROS1-rearranged advanced lung cancer and evaluate various clinical and molecular factors that might impact crizotinib efficacy in real-world practice. Methods Treatment responses, survival outcomes, and patterns of disease progression were analyzed for 235 patients with locally advanced to advanced disease who received first-line chemotherapy (n = 67) or crizotinib (n = 168). Results The overall response rate was 85.7% (144/168) for first-line crizotinib and 41.8% (28/67) for chemotherapy. Patients treated with first-line crizotinib (n = 168) had significantly longer median progression-free survival (PFS) than chemotherapy (n = 67) (18.0 months vs. 7.0 months, p < 0.001). Patients harboring single CD74-ROS1 (n = 90) had significantly shorter median PFS with crizotinib than those harboring non-CD74 ROS1 fusions (n = 69) (17.0 months vs. 21.0 months; p = 0.008). Patients with baseline brain metastasis (n = 45) had a significantly shorter PFS on first-line crizotinib than those without brain metastasis (n = 123) (16.0 months vs. 22.0 months; p = 0.03). At progression, intracranial-only progression (n = 40), with or without baseline CNS metastasis, was associated with longer median PFS than those with extracranial-only progression (n = 64) (19.0 months vs. 13.0 months, p < 0.001). TP53 mutations were the most common concomitant mutation, detected in 13.1% (7/54) of patients with CD74-ROS1 fusions, and 18.8% (6/32) with non-CD74 ROS1 fusions. Patients with concomitant TP53 mutations (n=13) had significantly shorter PFS than those who had wild-type TP53 (n = 81) (6.5 months vs. 21.0 months; p < 0.001). PFS was significantly shorter for the patients who harbored concomitant driver mutations (n = 9) (11.0 months vs 24.0 months; p = 0.0167) or concomitant tumor suppressor genes (i.e., TP53, RB1, or PTEN) (n = 25) (9.5 months vs 24.0 months; p < 0.001) as compared to patients without concomitant mutations (n = 58). Conclusion Our results demonstrate that baseline brain metastatic status and various molecular factors could contribute to distinct clinical outcomes from first-line crizotinib therapy of patients with ROS1-rearranged lung cancer. Clinical trials registration CORE, NCT03646994

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High dose rate endobronchial brachytherapy in the management of advanced lung cancer - comparison according to the presence of lung atelectasis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210608090b ◽

2021 ◽

pp. 90-90

Author(s):

Marko Bojovic ◽

Nensi Lalic ◽

Tatjana Boskovic ◽

Miroslav Ilic ◽

Olivera Ivanov ◽

...

Keyword(s):

Lung Cancer ◽

Dose Rate ◽

Combined Treatment ◽

Locally Advanced ◽

Progression Free Survival ◽

High Dose Rate ◽

Treatment Modalities ◽

Advanced Lung Cancer ◽

High Dose ◽

Before And After

Introduction/Objective. Locally advanced lung cancer (LC) is often accompanied with atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients? quality of life (QoL), the length of the progression free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced LC or endobronchial metastasis of other malignancy were treated with the high dose rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients? clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p<0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without of atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the QoL of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Re-aeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

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Experiencia en el manejo de pacientes con Cáncer de Pulmón Avanzado ALK+ en el Instituto Oncológico Nacional de Panamá.

Revista Médica de Panamá - ISSN 2412-642X ◽

10.37980/im.journal.rmdp.2018766 ◽

2019 ◽

Vol 38 (3) ◽

Author(s):

Taysser Alezza Sowley Delgado ◽

Joel Moreno-Ríos ◽

Ruth Vergara ◽

Erik Arauz Romero

Keyword(s):

Lung Cancer ◽

Locally Advanced ◽

Stage Iv ◽

Progression Free Survival ◽

Phase Iii ◽

Advanced Lung Cancer ◽

First Line ◽

Free Survival ◽

Cáncer De Pulmón ◽

Age Of Diagnosis

[Experience in the Management of Patients with Advanced Lung Cancer Alk + at the National Oncology Institute of Panama.]Resumen Introducción: el rearreglo de ALK está presente en 3% - 7% de los pacientes con cáncer de pulmón avanzado. Los inhibidores de ALK constituyen el tratamiento de primera línea. El crizotinib fue el primer inhibidor aprobado. Metodología: Realizamos una revisión retrospectiva de los expedientes médicos de los pacientes con cáncer de pulmón ALK positivo desde febrero de 2014 hasta mayo de 2018. El objetivo era describir la incidencia, características clínico patológicas y determinar la supervivencia libre de progresión con el uso de crizotinib en primera línea. Resultados: De 406 pacientes evaluados, 26 resultaron positivos para ALK, obteniendo una incidencia de 6,4%. La edad media de diagnóstico fue 64 años (37 – 85) y 53,1% fueron mujeres. El 92,4% de los pacientes tenían ECOG 0 – 2. Un 43,2% con antecedente de tabaquismo. Todos los pacientes fueron diagnosticados con enfermedad al menos localmente avanzada y un 73,1% tenían enfermedad etapa IV. Al diagnóstico, 2 pacientes debutaron con metástasis cerebrales (10,3%) y ambos recibieron RTHC. Adenocarcinoma fue la histología predominante (96.3%). Un 86,9% de los pacientes iniciaron crizotinib de primera línea. La supervivencia libre de progresión fue 10.9 meses (IC 95% 7,69 – 14,12). Los efectos adversos más comunes fueron las náuseas, diarrea, disgeusia y transaminitis, en su mayoría G1. Sin toxicidad G3 o superior. La supervivencia global de los pacientes expuestos a crizotinib fue de 16.9 meses (IC 95% 11.29 – 21.50). Conclusión: Las características de los pacientes ALK positivo, así como la PFS asociada al crizotinib de primera línea en nuestra institución, es similar a la reportada en los estudios internacionales de fase III. Abstract Introduction: the rearrangement of ALK is present in 3% - 7% of patients with advanced lung cancer. ALK inhibitors constitute the first line treatment. Crizotinib was the first approved inhibitor. Methodology: We conducted a retrospective review of medical records of patients with ALK positive lung cancer from February 2014 to May 2018. The objective was to describe the incidence, clinical pathological characteristics and determine progression-free survival with the use of crizotinib First line. Results: Of 406 patients evaluated, 26 were positive for ALK, obtaining an incidence of 6.4%. The mean age of diagnosis was 64 years (37 - 85) and 53.1% were women. 92.4% of patients had ECOG 0-2. 43.2% had a history of smoking. All patients were diagnosed with at least locally advanced disease and 73.1% had stage IV disease. At diagnosis, 2 patients started with brain metastases (10.3%) and both received RTHC. Adenocarcinoma was the predominant histology (96.3%). 86.9% of patients started crizotinib first line. The progression-free survival was 10.9 months (95% CI 7.69 - 14.22). The most common adverse effects were nausea, diarrhea, dysgeusia and transaminitis, mostly G1. No toxicity G3 or higher. The overall survival of patients exposed to crizotinib was 16.9 months (95% CI 11.29 - 21.50). Conclusion: The characteristics of the positive ALK patients, as well as the PFS associated with the first line crizotinib in our institution, is similar to that reported in the international phase III studies.

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