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Browsing Over 212 Presentations
23P - Clinical utility of cell free DNA in pleural lavage and plasma in resectable NSCLC- A pilot study
- J. Saikia (New Delhi, India)
- J. Saikia (New Delhi, India)
- P. Malik (New Delhi, India)
- D. Jain (New Delhi, India)
- S. Kumar (New Delhi, India)
- S. Bharati (New Delhi, India)
- K. Madan (New Delhi, India)
- P. Gamit (New Delhi, India)
- S. Deo (New Delhi, India)
- S. Kumar (New Delhi, India)
Abstract
Background
Cell free DNA has been found in pleural effusion in patients with pleural metastases. But the role of cfDNA in pleural lavage in resectable primary NSCLC is unknown. We aimed to find out the feasibility of identification of cfDNA in pleural lavage fluid and its correlation with plasma in resectable NSCLCs.
Methods
We evaluated the intraoperative cfDNA levels in pleural lavage (PLV) and plasma (PrePL) in all consecutive resectable NSCLCs patients pre-resection in the last 3 years. Another paired blood sample (PostPL) was collected at 1 month after surgery. Cell-free DNA was isolated from the stored pleural lavage and plasma using QIAamp DNA Blood Mini Kit (QIAGEN). The extracted plasma and pleural lavage DNA was measured quantitatively by qPCR in a TaqMan probe detection approach using human β-actin gene as the amplifying target. A part of the same PLV fluid was also examined for malignant cytology.
Results
Only 29 patients were found suitable. The median cfDNA levels in PrePL, PostPL and PLV were 158.5ngldl, 112.5 ng/dl and 197.5 ng/dl respectively. At a follow up of 2 years there is a trend towards significant decrease in disease free survival (p = 0.07) with pleural lavage cfDNA levels more than 185 ng/ml. A positive correlation was found between preoperative plasma levels and pleural lavage levels of cfDNA. There was no significant differences in cfDNA levels in pleural lavage or plasma with respect to age, sex, smoking or TNM stages. For T stage upto 5 cm median cfDNA levels were higher than those more than 5 cm. There is trend towards significantly higher values when the cutoff for plasma cfDNA before surgery was kept at 160 ng/dl (p = 0.06). A trend towards significant recurrences when the PrePL is more than 125 ng/dl (p = 0.087). PLV cytology for malignant cells was negative in all.
Conclusions
Pleural lavage fluid cfDNA identification is a feasible method in resectable NSCLC patients. Median cfDNA values decrease after one month of surgery. Although PLV cytology was negative, cfDNA in PLV correlates positively with PrePL cfDNA levels in resectable NSCLC. Also, higher cfDNA in PLV predicts more towards early recurrences than plasma cfDNA labels even when they were at distant sites.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
24P - Peripheral blood transcriptomics reveal novel resistance mechanisms in immune checkpoint inhibitor (ICI) treated non-small cell lung cancer (NSCLC) patients
- J. Mankor (Rotterdam, Netherlands)
- J. Mankor (Rotterdam, Netherlands)
- H. Vroman (Rotterdam, Netherlands)
- R. Stadhouders (Rotterdam, Netherlands)
- A. Dingemans (Rotterdam, Netherlands)
- J. Aerts (Rotterdam, No, Netherlands)
Abstract
Background
Previous studies have demonstrated that peripheral blood PD-1+ CD8 T cells are important determinants of NSCLC immune checkpoint inhibitor (ICI) efficacy. This subset likely comprises tumor-specific cytotoxic T cells. However, little is known about the phenotype of these cells. To address this question, we isolated RNA from peripheral blood mononuclear cells (PBMCs) PD-1+ CD8 T cells of patients with NSCLC who were treated with ICI, aiming to map the transcriptomic landscape in relation to ICI response.
Methods
We collected PBMCs of patients with stage IV NSCLC prior to the first (n = 12) and third cycle of nivolumab (n = 9). We sorted PD-1+ CD8 T cells, isolated RNA and sequenced cDNA libraries (Illumina HiSeq2500). After alignment, we performed differentially expressed gene analyses using DESeq2. Efficacy of treatment was assessed according to Response Evaluation Criteria in Solid Tumors v.1.1.
Results
In this cohort, 7 patients acquired durable clinical benefit, defined as progression-free survival (PFS) of 6 months or longer and are referred to as responders (R). The remaining 5 patients are referred to as non-responders (NR). Unsupervised hierarchical clustering revealed a cluster of interferon-related genes (OASL, IFIT2, IFIT3, GPAT3, CD200R) that was significantly upregulated in NR pre-treatment. Pre-treatment IFIT2 and IFIT3 gene expression was significantly correlated to PFS (IFIT 2 R2 = 0.50, p = 0.01, IFIT3 R2 = 0.40, p = 0.03).
Conclusions
Using in-depth transcriptomic analysis, we identified a subset of interferon-related genes upregulated in NR patients prior to aPD-1 treatment. Interestingly, interferon-induced proteins with tetratricopeptide repeats (IFIT proteins) are upregulated upon T cell receptor stimulation. Thus, upregulation of IFIT genes could indicate that PD-1+ CD8 T cells experienced prolonged tumor antigen stimulation, inducing an exhausted state and rendering them insensitive to aPD-1. This analysis not only reveals novel characteristics of circulating PD-1+ CD8 T cells but also provides a promising lead for developing accessible pre-treatment ICI resistance markers.
Legal entity responsible for the study
Erasmus Medical Center, Rotterdam.
Funding
Has not received any funding.
Disclosure
A-M.C. Dingemans: Honoraria (institution): Roche; Honoraria (institution): Pfizer; Honoraria (institution): Boehringer Ingelheim; Honoraria (institution): Eli Lilly; Honoraria (institution): Takeda; Honoraria (institution): Amgen; Honoraria (institution): BMS; Honoraria (institution): Novartis. J.G. Aerts: Honoraria (institution), Advisory/Consultancy: Eli Lilly; Honoraria (institution), Advisory/Consultancy: Roche; Honoraria (institution), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (institution), Advisory/Consultancy: BMS; Honoraria (institution), Advisory/Consultancy: MSD; Honoraria (institution), Advisory/Consultancy, Shareholder/Stockholder/Stock options: Amphera B.V.; Honoraria (institution), Advisory/Consultancy: AstraZeneca. All other authors have declared no conflicts of interest.
25P - Evaluation of PD-L1 and Ki67 markers in CTCs of NSCLC patients treated with Pembrolizumab
- M. Spiliotaki (Nicosia, Cyprus)
- M. Spiliotaki (Nicosia, Cyprus)
- H. Charalambous (Nicosia, Cyprus)
- C. Neophytou (NICOSIA, Cyprus)
- G. Gregoriou (Nicosia, Cyprus)
- P. Vogazianos (Nicosia, Cyprus)
- C. Deltas (Nicosia, Cyprus)
- A. Constantinou (Nicosia, Cyprus)
Abstract
Background
Tumor Programmed cell death protein ligand-1 (PD-L1) expression is used to guide treatment of Non-Small Cell Lung Cancer (NSCLC) patients with Pembrolizumab. PD-L1 expression on circulating tumor cells (CTCs) may provide further predictive information.
Methods
In a prospective maintenance study of Pembrolizumab in NSCLC patients (NCT02705820), we evaluated the predictive role of CTCs expressing PD-L1 and Ki67 (n = 48). A triple immunofluorescence assay against cytokeratin (CK), PD-L1 and Ki67 was performed in peripheral blood mononuclear cell cytospins prior and after first cycle. PD-L1 levels on CTCs were classified as PD-L1- PD-L1low, PD-L1med and PD-L1high. CK+CTCs were also classified as Ki67+ or Ki67−.
Results
Among 45 CTC+ patients, 14 had a durable clinical benefit (DCB) (PFS lasting>12 months) whereas 31 showed no durable benefit (NDB). Patients with at least one PD-L1high CTC 79% (19/24) and patients with PD-L1- CTCs 79% (11/14) were more often encountered in NDB, while patients harbouring only PD-L1med and/ or PD-L1low CTCs 86% (6/7) were more often found in DCB (79%, 79%, 14% in NDB vs 21%, 21%, 86% in DCB p = 0.003). A higher percentage of patients with Ki67+ CTCs showed NDB 81% (22/27) compared to those not presenting 50% (9/18) p = 0.02. Regarding the co-expression of both markers the PD-L1high/Ki67+ phenotype prevailed in NDB 89% (17/19) compared to patients not having this 54% (14/26) p = 0.01. In contrast, patients with PD-L1med/Ki67− CTCs >20% more often showed DCB 60% (6/10) compared to those not presenting 23% (8/33) p = 0.01. Interestingly, PD-L1high/Ki67+ CTCs (thresholds ≥1% and >20%) were related to shorter overall survival (OS) (p = 0.036 and p = 0.030) while PD-L1med/Ki67− CTCs (threshold >20%) were related to increased OS (p = 0.036). After first cycle, a significant reduction in the average % of the PD-L1med/Ki67− CTCs per patient from 26% to 10%, was observed in patients with DCB (p = 0.043).
Conclusions
A differential distribution of the PD-L1 and Ki67 phenotypes was observed in patients with different clinical benefit during Pembrolizumab treatment. CTC characterization according to PD-L1 and Ki67 may provide valuable biomarkers to monitor NSCLC patients treated with Pembrolizumab.
Legal entity responsible for the study
The authors.
Funding
The Cyprus Research and Innovation Foundation.
Disclosure
All authors have declared no conflicts of interest.
26P - Analysis of prognostic and predictive factors of response in squamous cell carcinoma using NGS techniques
- P. Cruz Castellanos (Madrid, Spain)
- P. Cruz Castellanos (Madrid, Spain)
- L. Gutiérrez Sainz (Madrid, Spain)
- O. Higuera Gomez (Madrid, Spain)
- C. Antolin (Madrid, Spain)
- R. Rosas Alonso (Madrid, Spain)
- I. Ibañez (Madrid, Spain)
- B. Castelo (Madrid, Spain)
- X. Mielgo (Alcorcon, Ma, Spain)
- J. De Castro Carpeno (Madrid, Spain)
Abstract
Background
In recent years, the diagnosis and treatment of different neoplasms has undergone a great change due to the development of immunotherapy and targeted therapies. Furthermore, the incorporation of massive sequencing techniques (NGS) has made it possible to better understand the molecular profile of tumors and thus, the identification of possible biomarkers related to prognosis and response.
Methods
In our study, we proposed the analysis of a cohort of 13 patients with squamous histology but different topographic locations (7 with lung cancer, 1 with bladder cancer, 1 with cervical cancer, and 1 with head and neck cancer and 2 of origin unknown). The samples were analyzed by NGS with the OncoDEEP (OncoDNA) panel covering 313 genes.
Results
Only one of the cases was not evaluable due to the low cellularity of the tumor block. Of the 12 evaluable cases, molecular alterations were identified in 6 of them, as detailed below: in case number 1 (lung cancer) variant of TP53 cDNA c.595G> T-AA p. G199, in case number 2 (lung cancer) mutation in TP53 cDNA c.488a> G-AAp.Y163C and mutation in FANCA cDNA: c.3263C> T-AA: p.S1088F, in case number 3 (lung cancer) variant de TP53 c.DNA: c.455del-Aap.P152Rfs * 18, alteration in MRE11A cDNA: c.1688C> G-AA: p.S563 * and alteration KEAP1 cDNAc.224dup-Aap.L76Afs * 3, in case number 4 (lung cancer) AKT amplification and alteration in BRCA2 cDNA c.2701del-Aap.A902Lfs * 2, in case number 5 (lung cancer) mutation in PI3KCA E545 K, amplification in MDM2 and mutation in TP53 cDNA c.871AA> T-AA p.K291 *, in case number 6 (bladder cancer) amplification of JAK1 and in case number 7 (head and neck cancer) mutation of PI3KCA E545, mutation of TPMT Y240C and mutation in TPMT A154 T.
Conclusions
This review presents as its objective the analysis of these molecular alterations and their impact on the prognosis, and therapeutic evolution of patients with the aim of integrating clinical and molecular information in a translational oncology study.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
27P - The association between gut microbiome and response to checkpoint inhibitor therapy in non-small cell lung cancer
- H. Moon (Seoul, Korea, Republic of)
- H. Moon (Seoul, Korea, Republic of)
- J. Moon (Sungju, Korea, Republic of)
Abstract
Background
The diversity and composition of gut microbiome plays a crucial role in the host immune response. As such, the gut microbiome has been implicated in the pathophysiology of many seemingly unrelated diseases. With regards to non-small cell lung cancer (NSCLC), it has been shown in multiple studies that antibiotic treatment attenuates the outcome of immune checkpoint inhibitor (ICI) therapy and also that ICI therapy leads to alterations in the gut microbiome profile. Therefore, the objective of this review was to analyze available data on the relationship between gut microbiome and response to ICI therapy in NSCLC patients.
Methods
Two independent investigators reviewed the PubMed, Google Scholar, and Embase databases. Studies that utilized a metabolomics profiling approach were excluded to maintain consistency in data collection and analysis.
Results
A total of four studies published in 2019 and 2020 met our inclusion criteria and were included in this review. Two studies were from China and the other two were from Japan. The patients included in these studies were all diagnosed with advanced NSCLC and underwent treatment with anti-PD-1 inhibitors. Assessment of gut microbiota profiles was carried out using 16S ribosome RNA gene sequencing. All studies had similar results, with higher microbiome diversity being associated with longer progression-free survival periods. Patients who were pre-treated with antibiotics were found to have lower diversity and an underrepresentation of bacterial species that were associated with a favorable outcome. The specific compositional differences observed in the studies varied greatly; patients with more favorable outcome had a greater representation of such bacterial species as Parabacteroides, Methanobrevibacter, Lactobacillus, Clostridium, Agathobacter, and Bifidobacterium longum.
Conclusions
NSCLC patients with more favorable outcome after ICI therapy were associated with a higher microbiome diversity and exhibited specific compositional differences. Futher studies are warranted to determine how to modulate the gut microbiome to maximize outcomes in NSCLC patients undergoing ICI therapy.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
28P - Adherence to treatment recommendations from multidisciplinary tumor boards
- J. Roeper (Oldenburg, Germany)
- J. Roeper (Oldenburg, Germany)
- L. Kathmann (Oldenburg, Germany)
- A. Blanksma (Oldenburg, Germany)
- L. Ansmann (Oldenburg, Germany)
- F. Griesinger (Oldenburg, Germany)
Abstract
Background
Due to the German National Cancer Plan, cancer centers have been established. Lung cancer centers are responsible for coordinating the care of lung cancer pts in a region and to diagnose and treat them according to the latest evidence-based knowledge. For this purpose, every patient should be discussed in a multidisciplinary tumor board. In the tumor board an individual treatment plan is discussed and treatment recommendations are given. Therefore, we investigate: 1.) how are the recommendations from tumor boards being adhered to; 2.) which factors determine the adherence of tumor board recommendations and 3.) what is the relationship between the adherence of tumor board recommendations and patient outcomes in terms of overall survival?.
Methods
Data from 1784 newly-diagnosed pts with lung cancer discussed in tumor boards in one certified lung cancer center in Northern Germany between 2014 and 2018 were documented and evaluated according to the adherence to tumor board recommendations. A preliminary analysis of the first 109 cases analyzed will be presented.
Results
Median age of the 109 pts was 67 years (36–88 yrs) and 59% (n = 64/109) of them were male. Most of the pts had an ECOG of 0 or 1 (71%; n = 77/109) and 79% of them were current or ex heavy smoker (n = 86/109). In 78% (n = 85/109) of patients, the treatment recommendations from the multidisciplinary tumor boards were completely adhered to. There were different reasons for non-adherence, e.g. patient's wish, patient characteristics and death before starting therapy. The median overall survival for the 109 patients was 109 months. Patients with a complete adherence to the multidisciplinary tumor board recommendation had an overall survival of 17 months (n = 84) compared to 7 months (n = 13) for patients with a partial adherence compared to 1 months (n = 11) for patients with a non-adherent treatment (p < 0.000).
Conclusions
Preliminary results give a hint to the fact that patients with an adherent treatment after first diagnosis had a longer overall survival than patients with another therapy. More cases will be presented at the meeting using a multivariate analysis which includes patient characteristics and healthcare organizations that took over further treatment as predictors.
Legal entity responsible for the study
University Hospital Internal Medicine-Oncology, Pius Hospital Oldenburg, University Oldenburg.
Funding
Has not received any funding.
Disclosure
J. Roeper: Honoraria (self): Boehringer Ingelheim; Honoraria (self): AstraZeneca; Honoraria (self): Roche. F. Griesinger: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: MSD; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Siemens; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Celgene; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Lilly; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Takeda; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Shareholder/Stockholder/Stock options: AbbVie. All other authors have declared no conflicts of interest.
Prevention, Early detection, Epidemiology, Tobacco control
30P - Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008-2018: a nationwide population-based study from the Netherlands
- J. Evers (Utrecht, Netherlands)
- J. Evers (Utrecht, Netherlands)
- K. De Jaeger (Eindhoven, Netherlands)
- L. Hendriks (Maastricht, Netherlands)
- M. Van der Sangen (Eindhoven, Netherlands)
- C. Terhaard (Utrecht, Netherlands)
- S. Siesling (Utrecht, Netherlands)
- D. De Ruysscher (Maastricht, Netherlands)
- H. Struikmans (Leiden, Netherlands)
- M. Aarts (Utrecht, Netherlands)
Abstract
Background
This Dutch population-based study describes not previously well-documented nationwide treatment patterns and its variations for stage I–III non-small cell lung cancer (NSCLC).
Methods
Patients diagnosed with clinical stage I–III NSCLC in the period 2008–2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I–II), and concurrent (cCRT) versus sequential chemoradiotherapy (sCRT) (stage III) were analyzed by logistic regression.
Results
In stage I, the rate of surgery decreased from 58% (2008) to 40% (2018), while radiotherapy use increased over time (from 31% to 52%). In stage II, 54% of patients received surgery, and use of radiotherapy alone increased from 18% to 25%. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥2 vs 0: 23.39 (95%CI: 18.93–28.90)), increasing age (OR ≥80 vs <60 yr: 14.52 (95%CI: 13.02–16.18)) and stage (OR stage II vs I: 0.61 (95%CI: 0.57–0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35% (2008) to 39% (2018). In all years, 23% received cCRT, 9% sCRT, 23% radiotherapy or chemotherapy alone, and 25% best supportive care. The strongest factors favoring cCRT over sCRT were age (OR ≥80 vs <60: 0.14 (95%CI: 0.10–0.19)), WHO Performance status (OR ≥2 vs 0: 0.33 (95%CI: 0.24–0.47)) and region (OR east vs north: 0.39 (95%CI: 0.30–0.50)).
Conclusions
The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
Legal entity responsible for the study
The authors.
Funding
This work was funded by the Dutch Association of Radiation Oncology (NVRO) which had the opportunity, thanks to external funding, to financially support this study.
Disclosure
J. Evers: Research grant/Funding (institution: Dutch Association of Radiation Oncology (NVRO). L. Hendriks: Advisory/Consultancy, Research grant/Funding (institution), Fees for institution - all not related to the work currently submitted: Boehringer Ingelheim; Advisory/Consultancy, Non-remunerated activity/ies, Fees for institution, non-remunerated support: local PI of pharma initiated research - all not related to the work currently submitted: BMS; Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses, Non-remunerated activity/ies, Fees for institution, travel support (self), non-remunerated support: local PI of pharma initiated research - all not related to the work currently submitted: Roche Genentech; Research grant/Funding (institution), Not related to the work currently submitted: AstraZeneca; Honoraria (self), Educational webinairs - not related to the work currently submitted: Quadia; Advisory/Consultancy, Fees for institution - not related to the work currently submitted: Eli Lilly; Advisory/Consultancy, Fees for institution - not related to the work currently submitted: Pfizer; Advisory/Consultancy, Speaker Bureau/Expert testimony, Non-remunerated activity/ies, Fees for institution, non-remunerated support: local PI of pharma initiated research - all not related to the work currently submitted: MSD/Merck; Advisory/Consultancy, Non-remunerated activity/ies, Fees for institution, non-remunerated support: local PI of pharma initiated research - all not related to the work currently submitted: Takeda; Non-remunerated activity/ies, Non-remunerated support: local PI of pharma initiated research - not related to the work currently submitted: Novartis; Non-remunerated activity/ies, Non-remunerated support: local PI of pharma initiated research - not related to the work currently submitted: GSK; Non-remunerated activity/ies, Non-remunerated support: local PI of pharma initiated research - not related to the work currently submitted: Blueprint Medicines; Advisory/Consultancy, Fees for institution - not related to the work currently submitted: Amgen; Non-remunerated activity/ies, Non-remunerated support: local PI of pharma initiated research - not related to the work currently submitted: Janssen Pharmaceuticals; Non-remunerated activity/ies, Non-remunerated support: local PI of pharma initiated research - not related to the work currently submitted: Mirati. M.J. Aarts: Research grant/Funding (institution) - not related to the work currently submitted: Amgen. All other authors have declared no conflicts of interest.
31P - Lung cancer survival in Sri Lanka
- L. Alagiyawanna (Maharagama, Sri Lanka)
- L. Alagiyawanna (Maharagama, Sri Lanka)
- S. Wijesekera (Maharagama, Sri Lanka)
- V. Peiris (Maharagama, Sri Lanka)
- D. Silva (Maharagama, Sri Lanka)
- T. Rupasinghe (Maharagama, Sri Lanka)
- T. Skandarajah (Maharagama, Sri Lanka)
- N. Jeyakumaran (Maharagama, Sri Lanka)
- D. Gunasekera (Maharagama, Sri Lanka)
- N. Joseph (Chilaw, Sri Lanka)
Abstract
Background
Lung cancer is the second commonest cancer among males in Sri Lanka. Real world survival data is scarce, and we conducted a retrospective survival analysis among patients treated at the National Cancer Institute of Sri Lanka, Maharagama. This is the first ever study on lung cancer survival in Sri Lanka.
Methods
All patients with primary lung cancer treated at three selected units during 2015–2016 were included in the study. Data on clinicopathological and treatment delivered were extracted from clinic records. Overall survival defined as time to death or loss to follow-up was considered the primary end-point. Univariate and Multivariate analysis of survival was performed using the log-rank and Cox proportional hazards model respectively.
Results
The study population comprised 349 patients. Median age was 61 years and majority of patients (74%) were males. Adenocarcinoma (56%) was the commonest histological subtype followed by squamous cell carcinoma (26%), while 6% of patients had small cell lung cancer. 230/349 (63%) had systemic metastases and only 33/349 (9%) were treated with curative intent. Median overall survival was 12 months (95% CI 2–26) in patients treated with curative intent and there was no significant difference between radical surgery and radiotherapy. Median overall survival was 3 months (95% CI 2–6 months) in those treated palliatively. On multivariate analysis, female gender (p = 0.007, HR 0.67) and first line treatment with tyrosine kinase inhibitors (p < 0.001, HR 0.11) was associated with superior survival.
Conclusions
More than 90% of Lung cancer patients in Sri Lanka are treated with palliative intent. Further work is needed to identify patient and care pathway barriers to ensure diagnosis at an earlier stage.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
32P - Patient experience and outcomes during lung cancer treatment : a systematic review
- S. Hussain (Birmingham, United Kingdom)
- S. Hussain (Birmingham, United Kingdom)
Abstract
Background
Lung cancer diagnosis can be challenging, resulting in delays that may adversely affect survival, which could improve, if patients follow a rapid diagnosis and treatment pathway (1). This review will evaluate methods used to measure patient experience during lung cancer treatment along with patient reported outcomes and assess outcomes such as progression free survival by exploring the existing evidence, in order to ensure that novel knowledge is contributed to the field.
Methods
This systematic review was registered on PROSPERO (CRD42019126574), to study the effectiveness, safety and patient reported outcomes/experiences among people undergoing investigation or treatment for lung cancer following different pathways. It further investigated the nature of existing evidence to assess the patient reported outcomes and experience during SABR vs Surgery among patients with lung cancer. Standard systematic review methodology to eliminate sources of bias were employed, for example dual review at abstract and full text stage.
Results
The results of the review are in line with the findings of the lung cancer PROMS report published in 2010 stating that, “EORTC QLQ-LC13 has a more robust body of evidence in the literature as compared to other scales such as LCSS and FACT L” (2). The data based on the results of this review suggests that the measure used most frequently is EORTC QLQ-30. A variation in the reporting as well as level of deterioration or improvement in the QOL and PFS was observed across different modalities, which illustrates the impact of pathway being followed.
Conclusions
A variation in the reporting as well as level of deterioration or improvement in the QOL and PFS was observed across different modalities, which illustrates the impact of pathway being followed. There is a need to collect PROM data from lung cancer patients and analyse NLCA as well as NCPES data to study patient experience, as it will help identify the factors that influence patient experience and the type of information, decision aids and support patients require during lung cancer treatment.
Editorial acknowledgement
I am grateful to Prof Alice Turner and Dr Ian Woolhouse for their comments and Eli Harris for developing the search strategy and running the searches at the Bodlean Librairies, University of Oxford. I would also like to thank all the second reviewers for their contribution.
Legal entity responsible for the study
Samia Hussain.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.
33P - Demographic differentials of lung cancer survival in Bangladeshi patient
- M. Islam (Dhaka, Bangladesh)
- M. Islam (Dhaka, Bangladesh)
- A. Hasan (Dhaka, Bangladesh)
- N. Khatun (Dhaka, Bangladesh)
- I. Ridi (Dhaka, Bangladesh)
- N. Ishrat (Dhaka, Bangladesh)
- S. Das (Dhaka, Bangladesh)
- F. Arjuman (Dhaka, Bangladesh)
- H. Ahmed (Dhaka, Bangladesh)
- F. Begum (Dhaka, Bangladesh)
- M. Islam (Dhaka, Bangladesh)
- M. Rahman (Dhaka, Bangladesh)
- M. Karim (Melbourne, Australia)
- A. Hossain (Dhaka, Bangladesh)
- M. Hossen (Dhaka, Bangladesh)
Abstract
Background
Lung cancer is the leading cause of cancer-related mortality and most common cancer in worldwide with more than a million deaths annually. Despite vigorous improvement in diagnostics facilities and treatment modalities, the prognosis remains poor. The evaluating demographic variables associated with survival in lung cancer patients are useful as these generate data on prognostic variables, which could be used to develop models to disease prevention, predict treatment response and survival in newly detected lung cancer patients.
Methods
It is a retrospective cross-sectional study at national institute of cancer research & Hospital (NICRH), a tertiary care center at Dhaka, Bangladesh between 2018 and 2019. The Ethical Review Board of NICRH approved the study protocol. Survival estimate was generated using Kaplan-Meier method and Univariate and multivariable cox proportional hazards regression was fit to assess the association of demographic factors.
Results
In the study 84.6% were males and 15.4% were females. About 64% patients are between 50–69 years. 40% of the patients were underweight at time of diagnosis whereas 8.1% & 51.9% patient were overweight & normal weight respectively. Most of the patient had found illiterate (66.2%). 55.4% patients found in low economic condition. Around one third of the patient (29.5%) had comorbid condition. Statistically significant difference in survival estimates is observed in 70 years and above age groups compare to less than 50 years age group (p < 0.001). Primary education completed group had better survival then the illiterate group (P < 0.01), underweight patient group had worse outcome compare to normal or over weight patient groups (P = 0.001). No comorbidity group had better survival than comorbid group (p = 0.005). But the socioeconomical status (SES) and gender did not show any statistically significant result (p = 0.291 & p = 0.545 respectively.
Conclusions
SES, education level, lack of resources and social stigma plays important role in survival outcome of lung cancer patients in Bangladesh. The demographic variables related survival in lung cancer needs to be fully elucidated because of its importance in the design of experimental protocols for targeted chemoprevention, early screening, and individualized treatment.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
34P - Sex and age differences in primary lung cancer in Morocco: an epidemiologic study
- O. Erefai (Kenitra, Morocco)
- O. Erefai (Kenitra, Morocco)
- A. Soulaymani (Kenitra, Morocco)
- A. Mokhtari (Kenitra, Morocco)
- H. Hami (Kenitra, Morocco)
Abstract
Background
Lung cancer is a leading cause of death worldwide. In Morocco, it is the most commonly occurring cancer in men. The aim of this study is to determine the epidemiological and histological profile of primary lung cancer in Rabat (capital of Morocco) over a 4-year period, from 2014 to 2017, by sex and age.
Methods
This is a descriptive retrospective study of all patients with primary lung cancer diagnosed and treated at Ibn Sina University Hospital Center in Rabat during the period from January 2014 to December 2017. The data were collected from medical records for each patient. Statistical analysis was performed using Epi InfoTM7.
Results
During the period of study, 574 new cases of primary lung cancer were diagnosed. Of these, 87.5% were men and 12.5% were women, giving a male-female ratio of 7. The average age of patients at diagnosis was 58.4 years (range 21–85 years). There was no significant gender difference in average age. The age distribution show that 19.9% of patients were aged less than 50 years, 29.7% were in the 50–59-year age group, 33.8% were aged between 60 and 69 years and 16.5% were aged 70 years and older. According to the results, 7.3% of lung cancers were small cell lung cancer (SCLC) and 90.9% were non-small cell lung cancer (NSCLC). Adenocarcinoma was the most frequent cell type of lung cancer, with 60.45%, followed by squamous cell carcinoma, with 23%. According to gender, adenocarcinoma was more common in women (70.8%) than in men (58.4%), while squamous cell carcinoma was relatively frequent in men (24.7%) than in women (11.1%). There was no significant difference in age of diagnosis, by histological type of lung cancer.
Conclusions
Lung cancer is a serious and potentially deadly disease in Morocco. It is important to develop strategies that take into account the current trends in lung cancer and target particularly groups at risk.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.