Francisco Aparisi

Predictive and prognostic clinical and pathological factors of nivolumab efficacy in non-small-cell lung cancer patients

AbstractBackgroundImmunotherapy increases overall response rate (ORR) and overall survival (OS) in patients with non-small-cell lung cancer (NSCLC). Prognostic and predictive factors are a high need.Patients and methodsRetrospective review of NSCLC patients treated with nivolumab was performed. Analyzed variables included age, sex, stage, performance status (PS), location of metastases, presence of tumour-related symptoms and comorbidities, number of metastasis locations, previous chemotherapy, anti-angiogenic and radiotherapy treatments, and analytical data from the standard blood count and biochemistry.ResultsA total of 175 patients were included. Median age was 61.5xa0years, 73.1% were men, 77.7% were ECOG-PS 0–1, and 86.7% were included with stage IV disease. Histology was non-squamous in 77.1%. Sixty-five received nivolumab in second line (37.1%). Thirty-eight patients had brain metastasis (22%), and 39 (22.3%) liver metastasis and 126 (72%) had more than one metastatic location. The ORR was 15.7% with median Progression free survival (PFS) 2.8xa0months and median OS 5.81xa0months. Stage III vs IV and time since the beginning of the previous line of treatmentxa0≥xa06 vsxa0<xa06xa0months were associated with better response. PS 2, time since the previous line of treatmentxa0<xa06 vsxa0≥xa06xa0months, and more than one metastatic location were independently associated with shorter OS in multivariable analysis (7.8 vs 2.7xa0months, 11.2 vs 4.6xa0months, and 9.4 vs 5.1xa0month). Finally, time since the previous treatmentxa0<xa06 vsxa0≥xa06xa0months and more than one metastatic location were independently associated with shorter PFS in multivariable analysis (4.3 vs 2.3xa0months and 4.7 vs 2.3xa0months).nConclusionPoor PS, short period of time since the previous treatment, and more than one metastatic location were associated with poorer prognostic.

Incidence, predictors and prognostic significance of thromboembolic disease in patients with advanced ALK-rearranged non-small cell lung cancer

Thromboembolic disease is fairly common in patients with lung cancer [1–3]. This incidence seems to be higher in patients with lung adenocarcinomas [4], with approximately 15% of those with advanced stage disease developing venous thromboembolisms (VTE) during the whole course of their disease [5–7]. Pulmonary adenocarcinomas are a heterogeneous group of diseases that can be stratified according to the presence of major oncogenic driver alterations. Anaplastic lymphoma kinase (ALK) rearrangements are detected in approximately 4% of these cases [8]. Isolated reports have suggested that patients bearing ALK-rearranged tumours might have a higher than expected incidence of thromboembolisms [9, 10]. In the present study, we have analysed the incidence, predictors and prognostic significance of thromboembolic events in a large, multi-institutional and homogeneous cohort of advanced stage patients with ALK-rearranged lung cancers from Spain and Portugal. Our primary objective was to estimate the incidence of thromboembolic events and their association with overall survival in these patients. High incidence and prognostic relevance of thromboembolic disease in patients with ALK-rearranged NSCLCs http://ow.ly/DEZr30j6kC8

Geriatric assessment in clinical practice for patients with stage IV non-small-cell lung cancer: The Grup de Investigació I Divulgació Oncològica experience

Therapeutic decision-making for older patients with stage IV non-small-cell lung cancer (NSCLC) with no identifiable activating mutation is complex. In this prospective study, we evaluated the usefulness of geriatric assessment (GA) in identifying frail patients. Stage IV NSCLC patients ≥70xa0years of age were evaluated with GA and classified according to this evaluation into three different groups: fit, vulnerable and frail. Classifications based on GA, treatment decision, toxicity and overall survival were analysed. In total, 93 patients were included. Median age was 76 (70-92) years and 90% were men. Most patients had performance status (PS) 0 or 1 (82%), unrelated to their GA (pxa0=xa00.006). GA groups were associated with overall survival (pxa0=xa00.000), treatment decision (pxa0=xa00.0001), and toxicity (pxa0=xa00.0001). Chemotherapy was delivered to 100% of fit patients, to 48% of vulnerable patients, and to only 8% of frail patients (pxa0=xa00.000). Toxicity was higher in vulnerable patients than in fit individuals (pxa0=xa00.000). Multivariable analysis showed PS (pxa0=xa00.001), active treatment (pxa0<xa00.001) and GA group (pxa0=xa00.001) to be prognostic factors related to survival. Our results suggest that GA identified patients with poor natural prognosis.

Correction to: Predictive and prognostic clinical and pathological factors of nivolumab efficacy in non-small-cell lung cancer patients

Clinical and Translational Oncology.

Clinical management and outcome of patients with advanced NSCLC carrying EGFR mutations in Spain

BackgroundAlthough the benefit of first-line epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) over chemotherapy has been demonstrated in several clinical trials, data from clinical practice is lacking and the optimal EGFR TKI to be used remains unclear. This study aims to assess the real-life diagnostic and clinical management and outcome of patients with advanced non-small-cell lung cancer (NSCLC) carrying EGFR mutations in Spain.MethodsAll consecutive patients recently diagnosed with advanced or metastatic NSCLC from April 2010 to December 2011 in 18 Spanish hospitals and carrying EGFR mutations were retrospectively evaluated.ResultsBetween March and November 2013, a total of 187 patients were enrolled (98.3% Caucasian, 61.9% female, 54.9% never-smokers, 89.0% adenocarcinoma). Mutation testing was mainly performed on biopsy tumour tissue specimens (69.0%) using a qPCR-based test (90%) (47.0% Therascreen EGFR PCR Kit). Common sensitising mutations were detected in 79.8% of patients: 57.1% had exon 19 deletions and 22.6% exon 21 L858R point mutations. The vast majority of patients received first-line therapy (nxa0=u2009168; 92.8%). EGFR TKIs were the most commonly used first-line treatment (81.5%), while chemotherapy was more frequently administered as a second- and third-line option (51.9% and 56.0%, respectively). Of 141 patients who experienced disease progression, 79 (56.0%) received second-line treatment. After disease progression on first-line TKIs (nxa0=u2009112), 33.9% received chemotherapy, 8.9% chemotherapy and a TKI, and 9.8% continued TKI therapy. Most patients received first-line gefitinib (83.0%), while erlotinib was more frequently used in the second-line setting (83.0%). Progression-free survival (PFS) and overall survival (OS) in patients harbouring common mutations were 11.1xa0months and 20.1xa0months respectively (exon 19 deletions: 12.4 and 21.4xa0months; L858R: 8.3 and 14.5xa0months), and 3.9xa0months and 11.1xa0months respectively for those with rare mutations.ConclusionEGFR TKIs (gefitinib and erlotinib) are used as the preferred first-line treatment while chemotherapy is more frequently administered as a second- and third-line option in routine clinical practice in Spain. In addition, efficacy data obtained in the real-life setting seem to concur with data from EGFR TKI phase III pivotal studies in NSCLC.