Browsing Over 783 Presentations
259O - Treatment patterns and outcomes in older patients with mantle cell lymphoma in an Asian population (ID 369)
- Xinyi Yang (Singapore, Singapore)
Abstract
Background
Significant progress have been made in the treatment outcomes of mantle cell lymphoma (MCL) since the introduction of cytarabine and rituximab in modern regimens. However, older patients may not readily tolerate these agents nor derive benefit. We investigated the impact of age on treatment patterns and clinical outcomes of MCL patients in an Asian population.
Methods
A retrospective study was conducted on patients (n=66) diagnosed with MCL at the National Cancer Centre Singapore between 1998 and 2018. The median follow-up duration was 40 months. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models.
Results
The median age of the cohort was 59 years (range, 26-84), with a male predominance (73%). The majority (86%) had advanced stage 3-4 disease at diagnosis. Compared with younger patients, older patients aged ≥ 60 years (n=32; 48.5%) presented more frequently with B-symptoms (75% vs 38%, p=0.0028), anaemia (75% vs 35%, p=0.0013), and carried higher prognostic risk scores (sMIPI high risk 84% vs 56%, p=0.016). Non-cytarabine-based induction chemotherapy was more commonly administered in older patients (76% vs 32%, p=0.0012). The 5-year overall survival (OS) and progression-free survival (PFS) was 68% and 25% respectively. In a multivariable model, older age (HR 3.42, 95%CI 1.48-7.92, p=0.004) and anemia (HR 2.56, 95%CI 1.10-5.96, p=0.029) were independently associated with poorer OS while older age (HR 2.24, 95%CI 1.21-4.14, p=0.010) and hypoalbuminemia (HR 2.20, 95%CI 1.17-4.13, p=0.014) were independently associated with poorer PFS. In an exploratory analysis, maintenance rituximab following induction chemotherapy improved PFS in younger patients, with median PFS of 131 months and 45 months with and without maintenance therapy respectively (HR 0.39, 95%CI 0.16-0.93, p=0.0346). In contrast, no survival benefit was observed in older patients.
Conclusions
We demonstrated in an Asian cohort that older patients with MCL remain challenging to manage given their adverse clinical features and inability to derive benefit from contemporary treatment advances.
Legal entity responsible for the study
The authors.
Funding
National Medical Research Council of Singapore (TCR12DEC005) Tanoto Foundation Professorship in Medical Oncology New Century Foundation Limited Ling Foundation Singapore National Cancer Centre Research Fund SHF-Foundation SingHealth Duke-NUS Academic Medical Centre and Oncology ACP.
Disclosure
All authors have declared no conflicts of interest.
Leptomeningeal metastasis (ID 16)
- Ulrich Herrlinger (Bonn, Germany)
Q&A and Closing (ID 1192)
303MO - Single-cell analysis reveals the interaction between M2 macrophages and NK cells underlying immune types associated with cancer immunotherapy response (ID 1011)
- Anlin Li (Zhanjiang, China)
Abstract
Background
This study aimed to characterize tumor microenvironment (TME) profile to predict clinical outcomes of cancer immunotherapy and to identify potential cellular mechanisms driving immunotherapy response and resistance.
Methods
This study analyzed single-cell or RNA sequencing data of 396 immunotherapy-treated patients from the phase II IMvigor210 trial and Gene Expression Omnibus, and also included 4,547 patients from The Cancer Genome Atlas. Using unsupervised hierarchical clustering, we combined immune checkpoints, human leukocyte antigens, and immune cells to construct a novel TME classification.
Results
The clustering in IMvigor210 trial resulted in three immune subtypes, with the greatest overall survival (OS) benefit in Immune-Active Class (HR 0.69; 95% CI 0.56 to 0.84; P < 0.001), which was validated in TCGA cohort across multiple cancers (HR 0.86; 95% CI 0.80 to 0.92; P < 0.0001). The three immune subtypes exhibited distinct metabolic patterns, especially in the hypoxia signaling pathway; patients in Immune-Active Class had lowest hypoxia score (P<0.0001). Further single-cell profiling revealed that in patients who did not respond to immunotherapy, M2 macrophages increased after treatment but there was no significant difference in natural killer (NK) cells between pre- and post- immunotherapy treatment. Conversely, among responders, M2 macrophages showed little change but NK cells significantly increased after immunotherapy. Among non-responders, M2 macrophages had higher expression of hypoxia signature after treatment, but this change in responders was not evident. In agreement, IMvigor210 data showed longer OS in patients with low versus high M2 macrophages (HR 0.58; 95% CI 0.42 to 0.80; P < 0.001), and in patients with high versus low NK cells (HR 0.74; 95% CI 0.56 to 0.97; P = 0.03).
Conclusions
This study developed novel TME-based subtypes to facilitate cancer immunotherapy delivery. Additionally, M2 macrophages might induce immunotherapy resistance by causing NK cell exclusion or dysfunction via hypoxia-related pathways.
Legal entity responsible for the study
Herui Yao.
Funding
This work was supported by the National Science and Technology Major Project (grant number 2020ZX09201021); the National Natural Science Foundation of China (grant numbers 81572596, 81972471, U1601223); the Natural Science Foundation of Guangdong Province (grant number 2017A030313828); the Guangzhou Science and Technology Major Program (grant number 201704020131); the Sun Yat-Sen University Clinical Research 5010 Program (grant number 2018007); the Sun Yat-Sen Clinical Research Cultivating Program (grant number SYS-C-201801); the Guangdong Science and Technology Department (grant number 2017B030314026); and the Special Funds for the Cultivation of Guangdong College Students’ Scientific and Technological Innovation (grant number pdjh2019a0212); National Students’ Innovation and Entrepreneurship training program (grant number 201910571001); and Guangdong Medical University College Students’ Innovation Experiment Project (grant number ZZZF001).
Disclosure
All authors have declared no conflicts of interest.
134P - Effect of preoperative tumour under-staging on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (ID 700)
- Mi Lin (Fuzhou, China)
Abstract
Background
This study aimed to evaluate the effect of preoperative tumour staging deviation (PTSD) on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (RGGC).
Methods
Clinicopathological data of 2 346 patients who underwent RGGC were retrospectively analysed. The preoperative tumour-lymph node-metastasis (TNM) under-staging group (uTNM) comprised patients who had earlier preoperative TNM than postoperative TNM, and the no preoperative under-staging group (nTNM) comprised the remaining patients.
Results
There were 1 031 uTNM (44.0%) and 1 315 nTNM cases (56.0%). Cox prognostic analysis revealed that PTSD independently affected the overall survival (OS) after surgery. The 5-year OS was lower in the uTNM group (41.8%) than in the nTNM group (71.6%). Analysis of surgical and pathological factors showed that among patients with pT2, pT3+4, and pN+, all patients in group nTNM underwent D2 lymph node dissection (LND), whereas 15.1%, 1.3%, and 5.5% patients in group uTNM underwent D1 + LND, respectively. Among patients with pN0, the lymph node noncompliance rate was higher in the uTNM than in the nTNM group. Logistic analyses revealed that high BMI, tumour size <2 cm, early gross typing, and differentiated tumours in the upper stomach independently affected uTNM (P < 0.05).
Conclusions
Underestimated tumour staging is not rare, which possibly results in inadequate LND and affects the long-term survival for patients undergoing RGGC. D2 LND should be carefully performed in patients who are predisposed to this underestimation.
Legal entity responsible for the study
The authors.
Funding
Scientific and Technological Innovation Joint Capital Projects of Fujian Province.
Disclosure
All authors have declared no conflicts of interest.
211P - The impact of low muscle mass to overall survival in bladder cancer patients undergoing chemotherapy: A systematic review and meta-analysis (ID 432)
- Karunia V. Japar (Tangerang, Indonesia)
Abstract
Background
Bladder cancer belongs to one of the top ten most common cancers in the world with approximately 550,000 cases annually. The general 5-year survival rate for people with bladder cancer is 77%. The overall 10-year survival rate is 70% and the overall 15-year survival rate is 65%. Low muscle mass is prevalent in these patients receiving chemotherapy. In this meta-analysis, we aim to assess the impact of low muscle mass on overall survival in bladder cancer patients undergoing chemotherapy.
Methods
A systematic review was performed according to PRISMA guidelines. A literature search using confidence method, was conducted by two independent reviewers on all of the studies that include low muscle mass in bladder cancer patients undergoing chemotherapy using Google Scholar, PubMed, and PubMed central databases. Outcome of interest in this study is the overall survival. Data synthesis and statistical analysis were carried out using Review Manager Software.
Results
A total of 4 studies were eligible for meta-analysis including a total of 370 bladder cancer patients undergoing chemotherapy. All of the studies were observational studies. Meta-analysis revealed that there are no association between low muscle mass and overall survival (HR 1.24; 95% CI 0.71-2.19; P< 0.45). The quality of this study was assessed with Newcastle Ottawa Scale (NOS) shows “good” quality in all included studies.
Conclusions
Our meta-analysis shows that low muscle mass is not associated with the overall survival of bladder cancer patients undergoing chemotherapy. Further study need evaluate in better patient selection and adjusting the confounder.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Perspectives in systemic therapy (ID 66)
- Michael L. Friedlander (Randwick, Australia)
Pancreatic cancer in Japan: from the current to the potential future treatment landscape (ID 1244)
LIVE Q&A (ID 1065)
- Sung-Bae Kim (Seoul, Korea, Republic of)
408P - Integrated chemotherapy with EGFR receptor tyrosine kinase inhibitors in patients with non-small cell lung cancer harboring EGFR mutation (ID 755)
- Julia Maevskaya (Moscow, Russian Federation)
Abstract
Background
Lung cancer is the leading cause of cancer-related mortality worldwide. Chemotherapy and EGFR TKI combinations may be possible treatment options for patients with NSCLC and activating EGFR mutations. Many clinical trials have shown the potential benefits of these combinations.The addition of chemotherapy to first - and second - generation tyrosine kinase inhibitors significantly improved PFS compared with tyrosine kinase inhibitors monotherapy in treatment- naive patients with EGFR-mutated advanced NSCLC.We undertook the open prospective non-randomized multi -center study in a similar patient population.
Methods
We recruited patients with advanced NSCLC harboring EGFR mutations. Initially there were two months of treatment by gefitinib 250 mg daily. Then, after a 2-week drug-free period, 3 cycles of paclitaxel 175 mg / m2 and carboplatin AUC5 were administrated at days 71-113. Thereafter, gefitinib was re-started on day 135 and continued until disease progression. The primary endpoint was progressive free survival (PFS) time.
Results
From May 2016 to May 2018, 54 patients with advanced (IIIB / IV stages) NSCLC, with activating mutation of the EGFR gene in exon 19 or 21, were included in the study. The objective response rate (ORR) was 55,5%. Serious adverse events were reported by 4 (7,4%) of 54 patients. 2-year PFS in all patients group included in the study at the time of the preliminary analysis was 38.9%, median PFS was 20,0 months (16.0–23,9CI 95%). Median overall survival was not reached.
Conclusions
Integrated chemotherapy with first - and second - generation tyrosine kinase inhibitors is a viable first-line option for patients with non-small-cell lung cancer with EGFR mutation-positive disease, wich can help overcome acquired resistance to tyrosine kinase inhibitors. Tretment benefit of integrated chemotherapy compared with monotherapy of tyrosine kinase inhibitors 1-2 generations is obvious when comparing the results of our study with the data of randomized trials devoted to this problem.
Legal entity responsible for the study
K. Laktionov.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
28P - Breast cancer care services at Nilai Medical Centre: A Malaysian experience (ID 496)
- Ratnavelu Kananathan (Nilai, Negeri Sembilan, Malaysia)
Abstract
Background
Introduction and Rationale. Nilai Medical Centre was established on 1999 in Nilai Negeri Sembilan. In a partnership with Malaysian Health Travel Council data was collected prospectively using the HPMRS platform. HPMRS is a locally developed data base system to measure health care performance and reporting. For the purpose of measuring breast cancer performances, we mostly adopted the performances measures developed and used by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comphressive Cancer Network and National Accreditation Program for Breast Cancer.
Methods
Data Data was reported to HPMRS by year of reporting according to the centre participating in MHTC’s PHTE program. A total of 226patients were reported from 2010 till 2014. 76 patients were ineligible for inclusion while 53 patients had incomplete data for analysis and were excluded from analysis.
Results
The Aged ranged from 33 to 79 with a mean of 51years, 43% were aged <50years. 41% Chinese, 38% Malays and 20% Indians. 41% Early Breast Cancer, 35% Locally Advanced Cancer and 16% metastatic Breast Cancer. Receptor states were 55% positive for ER,43% PR and 31% for HER2. 19% had Triple negative breast cancer. Breast Cancer Care Performances The overall Breast Cancer care results was 98%. A 98% composite score means that the centre provided an evidence based Breast Cancer Treatment 98 times for ever 100 opportunities. Performances varied from as low as 50%(Trastuzumab treatment ) to a perfect score of 100% (Pathology report confirming malignancy, surgical treatment and radiotherapy) Survival Data The 5 years overall survival 99% Stage I, 83% Stage II,36% Stage III and 28% Stage IV. The relative survival at 5years was 99% Stage I and 97% Stage II indicating these patients were practically cured of their disease. This was far better then the results reported in Malaysian Study on Cancer survival of 87% in Stage I and 80% in Stage II. In the other stages NMC survival was 81.9% in Stage III and 50.4% in stage IV compared with 59% in Stage III and 23.3% in Stage IV in the Malaysia Study. NMC results were comparable with the SEER results( 2008 till 2014) as Early stage 99%,Localized Stage 85% and Distant stage 27%.
Conclusions
The results will set as a base line for future measurements.
Legal entity responsible for the study
Kananathan R.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
LIVE Q&A (ID 114)
- Pilar Garrido Lopez (Madrid, Spain)