Teresa Parent

Physical activity promotion among oncology nurses.

Background: Oncology nurses may be influential for providing physical activity guidance to cancer patients. Objective: The purposes of this study were to examine physical activity promotion practices of oncology nurses and to explore nurses’ perceived benefits of physical activity for cancer patients and barriers to physical activity promotion. Methods: Two thousand e-mails were sent by a data service company to a random selection of oncology nurses throughout the United States with a link to a Web-based survey. To be eligible, nurses had to be currently seeing patients. Results: Completed surveys were received from 274 oncology nurses. Most participants inquired about physical activity on at least some office visits (74.9%) and gave physical activity recommendations to 65.7% and 66.9% of on-treatment and posttreatment patients. “Lack of time” and that “patients are not interested” were the most prominent barriers identified by nurses, whereas perceived benefits for patients were rated favorably, with the exception of “reducing risk of recurrence.” Almost all perceived benefits and barriers were correlated with physical activity promotion, with the strongest correlates being “unsure what to recommend” and “unsure that physical activity is safe.” Conclusions: Although most oncology nurses frequently inquire about patient physical activity, they may be less apt to provide recommendations. A number of barriers and perceived benefits may influence physical activity promotion, especially concerning what to recommend and patient safety. Implications for Practice: Oncology nurses would benefit from education opportunities about the benefits of physical activity for survival outcomes and types of physical activity to recommend.

Results of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) in treatment of obstructive endobronchial non-small cell lung cancer (NSCLC)

INTRODUCTION We reviewed the outcome of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) for patients with symptomatic obstruction from endobronchial non-small cell lung cancer. METHODS Nine patients who received combined PDT and HDR for endobronchial cancers were identified and their charts reviewed. The patients were eight males and one female aged 52-73 at diagnosis, initially presenting with various stages of disease: stage IA (N=1), stage IIA (N=1), stage III (N=6), and stage IV (N=1). Intervention was with HDR (500 cGy to 5 mm once weekly for 3 weeks) and PDT (2 mg/kg Photofrin, followed by 200 J/cm(2) illumination 48 h post-infusion). Treatment group 1 (TG-1, N=7) received HDR first; Treatment group 2 (TG-2, N=2) received PDT first. Patients were followed by regular bronchoscopies. RESULTS Treatments were well tolerated, all patients completed therapy, and none were lost to follow-up. In TG-1, local tumor control was achieved in six of seven patients for: 3 months (until death), 15 months, 2+ years (until death), 2+ years (ongoing), and 5+ years (ongoing, N=2). In TG-2, local control was achieved in only one patient, for 84 days. Morbidities included: soft-tissue contraction and/or other reversible benign local tissue reactions (N=8) and photosensitivity reactions (N=2). CONCLUSIONS Combined HDR/PDT treatment for endobronchial tumors is well tolerated and can achieve prolonged local control with acceptable morbidity when PDT follows HDR and when the spacing between treatments is 1 month or less. This treatment regimen should be studied in a larger patient population.

Tocilizumab for the management of immune mediated adverse events secondary to PD-1 blockade

Background Immune checkpoint inhibitors are poised to revolutionize the management of a growing number of malignancies. Unfortunately, the management of steroid-refractory immune mediated adverse events is based on a paucity of randomized data and limited to single center experiences. Our initial experience with the IL-6 receptor antagonist tocilizumab showed clinical improvement in a wide variety of irAEs. As a result, we adopted the use of tocilizumab for the management of steroid refractory irAEs. Methods The character and clinical course of irAEs were abstracted from the medical record and analyzed. The dose of tocilizumab was 4 mg/kg given IV over one hour. C-reactive protein was drawn at first nivolumab infusion and at q two weeks (and with irAEs) thereafter. Clinical improvement was defined as either: documentation of resolution of symptoms or hospital discharge within seven days. Results Of the initial 87 patients that were treated with nivolumab, 34 required tocilizumab (39.1%). All patients were on corticosteroids. The majority (88.2%) were lung cancer patients. The index grade 3/4 irAE was pneumonitis in 35.3%, serum sickness/SIRS in 35.3%, cerebritis in 14.7% and one case each of hypophysitis, colitis, pancreatitis, hepatitis and immune mediated coagulopathy. Median time between first nivolumab and initiation of tocilizumab was 76 days (range 1–429). There was a statistically significant increase in C-reactive protein from a median of 23 mg/L (range 0.1–238.5) at baseline to 109.3 mg/L (21.5–350.4) at the time of index irAE, followed by a decrease to 19.2 mg/L (0.25–149) after tocilizumab (p < 0.00001). Clinical improvement was noted in 27/34 patients (79.4%). Some patients (52.9%) required a single dose, while 38.2% required two, 8.8% required three and 1 patient required four doses. Twenty-seven doses were given in the inpatient setting (49.1%). Median time to discharge was four days (range 1–27). Seventy-four percent of patients were discharged home. For the 53 doses of tocilizumab that were delivered when infliximab was an option, there was a cost savings of

PS01.36: Blood-Based Mutation Testing in Non–Small Cell Lung Carcinoma Patients Supports Individualized and Optimal Treatment: Topic: Medical Oncology

141,048.72 (WAC) during the 18 month study period. Conclusions Tocilizumab may be a therapeutic option for the management of steroid refractory irAEs secondary to immune checkpoint blockade. However, randomized trials are needed to better elucidate the relative efficacy and safety of these agents.

Phase II study of low-dose paclitaxel with timed thoracic radiotherapy followed by adjuvant gemcitabine and carboplatin in unresectable stage III non-small cell lung cancer

Background: As the molecular genotypes of NSCLC expands, the strategy of treatment changes. EGFR exon 19 deletions and 21 mutations have different optimal treatment approaches. EGFR T790M mutations can now be targeted and may be immunogenic epitopes. KRAS mutations have different platinum, taxane and pemetrexed sensitivities. ALK is the most prevalent driver mutation in young people under the age of 40 and is often pharmacogenomically platinum resistant. ALK has a very high predilection for central nervous system metastases which can now be targeted with tyrosine kinase inhibitors (TKI) with high CNS penetrance and effectiveness. BRAF V600E mutations benefit from dual BRAF and MEK TKIs as in melanoma. Tissue quantity and lengthy turnaround time for tissue-based mutation results greatly impact and delay the optimal individualization of treatment in NSCLC with ultimate outcomes greatly impacted if treatment with an actionable targeted TKI is not received. We sought mutation testing that would allow our institution to identify actionable mutations quickly and to insure an actionable mutation status was known on all patients. Methods: Our institution has been prospectively collecting blood samples from NSCLC patients from March 2016 and submitting them for testing on the commercially available GeneStrat platform. Patients were tested for EGFR, ALK, KRAS and BRAF mutations using previously-described ddPCR methods. Blood samples were drawn at either their diagnostic bronchosocpy or at their first consultation interaction. Results: Blood samples from 62 patients were collected and submitted for GeneStrat testing. Results were available within 72 hours of blood draw for all of patients. 12 out of 62 patients had actionable mutations; 1 patient (pt.) EGFR exon 19, 1 pt. with exon 19 and exon 20 T790M, 2 pts. EGFR exon 20 T790M, 1 pt. exon 21 L858R, 1 pt. BRAF V600E, 2 pts. KRAS G12C, 2 pts. KRAS G12D, 1 pt. KRAS G12V and 1 pt. EMLA4-ALK mutations were identified. If platinum doublet chemotherapy was arbitrarily given, the initial treatment for these patients would have been suboptimal, not individualized and delayed awaiting tissue actionable mutation results and possible repeated biopsy attempts. Conclusion: Blood-based mutation testing with GeneStrat optimized and individualized treatment in one out of five of our institution’s NSCLC patients without the need for repeat tissue biopsies.

Synchronized low-dose paclitaxel with timed thoracic radiotherapy (RT) followed by adjuvant chemotherapy (CT) with gemcitabine and carboplatin in stage III non-small cell lung cancer (NSCLC): Results of LJCC 07-01 phase II trial.

OBJECTIVES The purpose of the proposed study is to evaluate the effectiveness and safety of low-dose paclitaxel with timed thoracic radiotherapy (TTR) for local control by inducing maximum radiosensitization through G2-M phase cell cycle arrest, followed by full dose adjuvant chemotherapy with gemcitabine and carboplatin for eradication of possible micrometastasis in unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This is a single-center, non-randomized prospective phase II study. Patients with unresectable stage III NSCLC were treated with paclitaxel 15 mg/m(2) IV, followed by TTR 6 h later on Monday/Wednesday/Friday, and TTR only on Tuesday/Thursday mornings (total 55 Gy). Full dose adjuvant chemotherapy consisted of intravenous carboplatin (AUC 5) on day 1, gemcitabine 1000 mg/m(2) on days 1 and 8, every 21 days for 4 cycles. The primary endpoint was overall survival (OS). Secondary endpoints were overall response rate (ORR), and toxicities. RESULTS Twenty-seven patients were eligible for the study. Patient characteristics were: 19 males (70%); median age 67 years (range 39-82); 15 (56%) stage IIIB; 89% with ECOG performance status ≥1. Three-year OS was 16.7% in all patients, and 27.3% in patients received three or more cycles of adjuvant chemotherapy, respectively. ORR was 63%. Grade 3 toxicities during paclitaxel plus concurrent TTR phase were radiation esophagitis (11%) and radiation pneumonitis (4%), no grade 4 toxicities occurred. One grade 5 hemoptysis. Grade 3/4 toxicities during adjuvant gemcitabine/carboplatin were pneumonitis (22%), anemia (30%), neutropenia (22%), and thrombocytopenia (33%), one grade 5 neutropenic fever. CONCLUSION Low-dose paclitaxel with concurrent TTR is an effective chemoradiotherapy regimen in unresectable stage III NSCLC. Improved survival benefit was observed in patients who have received three or more cycles of full dose adjuvant chemotherapy, yet, gemcitabine related radiation pneumonitis and hematological toxicities limited adjuvant chemotherapy delivery.

Results of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) in treatment of obstructive endobronchial non-small cell lung cancer

e17507 Background: Synchronizing low-dose paclitaxel with timed daily RT achieves remarkable local tumor response by inducing maximum radio sensitization through G2-M cell cycle arrest and apoptosis of cancer cells (Chen et al Clin Can Res 9:963-975, 2003). LJCC 0701 is a single institutional phase II trial based upon timed chemoradiation (CRT) approach for definitive local treatment followed by full-dosing adjuvant CT in non-surgical stage III NSCLC. Methods: Patients with non-surgical stage III NSCLC and PS 0-2 were eligible. Paclitaxel 15mg/m2 IV over 1 hour at 8am on M-W-F with 5500cGy thoracic RT delivered at 4pm M-W-F and 8am T-Th over 5 weeks. Adjuvant carboplatin (AUC 5) day 1 and gemcitabine 1,000mg/m2 IV days 1 and 8, q21d for 4 cycles. Primary end point overall response rate (ORR); secondary end points progression-free survival (PFS) and toxicities. Results: 24 eligible patients were accrued between 05/09/07 to 11/16/09. Patient characteristics: male 71%; median age 65 (39-82) with 42% > 70; 29...

OA03.05 Tocilizumab for the Management of Immune Mediated Adverse Events Secondary to PD-1 Blockade: Overall Survival Analysis: Topic: Medical Oncology

We reviewed the outcome of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) for patients with symptomatic obstruction from endobronchial non-small cell lung cancer. Methods: Nine patients who received combined PDT and HDR for endobronchial cancers were identified and their charts reviewed. The patients were eight males and one female aged 52-73 at diagnosis, initially presenting with various stages of disease: stage IA (N=1), stage IIA (N=1), stage III (N=6), and stage IV (N=1). Intervention was with HDR (500 cGy to 5 mm once weekly for 3 weeks) and PDT (2 mg/kg Photofrin, followed by 200 J/cm2 illumination 48 hours post infusion). Treatment group 1 (TG-1, N=7) received HDR first; Treatment group 2 (TG-2, N=2) received PDT first. Patients were followed by regular bronchoscopies. Results: Treatments were well tolerated, all patients completed therapy, and none were lost to follow-up. In TG-1, local tumor control was achieved in six of seven patients for: 3 months (until death), 15 months, 2+ years (until death), 2+ years (ongoing), and 5+ years (ongoing, N=2). In TG-2, local control was achieved in only one patient, for 84 days. Morbidities included: stenosis and/or other reversible benign local tissue reactions (N=8); photosensitivity reaction (N=2), and self-limited pleural effusion (N=2). Conclusions: Combined HDR/PDT treatment for endobronchial tumors is well tolerated and can achieve prolonged local control with acceptable morbidity when PDT follows HDR and when the spacing between treatments is one month or less. This treatment regimen should be studied in a larger patient population.