bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of chemotherapy (CT) in performance status 3 and 4 small cell lung cancer (SCLC) patients
Authors: Cronenberger E. , Rodrigues A. , Small I. , De Biase P. , Zamboni M. , Zukin M. , Ferreira C. 
Published: March 2020

17026 Background: SCLC is an aggressive malignancy, but has shown high response rate to CT. Performance status (PS) has been recognized as one of the main prognostic factors in SCLC. Sudden and toxic deaths after CT were found to correlate with poor PS. There are few data about risk-benefit ratio of CT in PS 3 and 4 patients, although it has been often used. This study was performed to assess the clinical and laboratorial factors and the outcome of poor PS SCLC patients that received CT in our institution. Methods: A retrospective review was performed at INCA’s tumor registry for SCLC cases diagnosed between January 2001 and December 2004. Patients with pre-treatment ECOG PS 3 and 4 that received CT were selected for analysis. Results: Thirty of 107 SCLC patients (28%) were eligible (73.3% PS 3/ 26.7% PS 4). The median patient age was 64 years and 73.3% were male. Extensive- disease was observed in 83% of these patients. At the first cycle, 21 patients (70%) had to be hospitalized to receive CT and 5 of them (24%) required respiratory support. There were 10 deaths (33.3%) after the first cycle of CT. The median response rate was 77.8% and median overall survival was 2.8 months (138 days for PS 3 and 5 days for PS 4). In this series, there was a statistically significant correlation of PS 4, high serum LDH, hospitalization to start treatment and respiratory support with worse survival. Conclusions: Despite good response rate, poor PS patients, especially PS 4, had high risk of early CT related mortality and had dismal survival. Further studies are required to determine how to best treat these high-risk patients, in particular PS 4 patients, to minimize the early treatment related mortality and to give them the best form of palliation and prolongation of life. No significant financial relationships to disclose.
The significance of SUV of 18-FDG PET for the diagnosis and treatment of lung cancer
Authors: Guo H. , Hu X. , Li Z. 
Published: March 2020

17032 Background: To explore the possibility that the standardized uptake value(SUV) of positron emission tomography(PET) could be a prognostic factor for lung cancer and whether it holds more significance than clinical stage,the current predominant prognostic factor for NSCLC patients. To assess the possible connection between the SUV and clinical and histopathologic characteristics of lung cancer patients(especially the histology), in order to build a comprehensive picture for the potential application of SUV. Methods: Eighty-two patients taking PET examination before receiving any treatment were analysed, the majority of which(fifty) consisted of patients treated with multiple modality treatment where surgery played a central role. 1-year and 3-year survival(OS) Rate, Progress Free Survival(PFS) Rate were calculated by Kaplan-Meier method and evaluated with the log-rank test.The prognostic significance was assessed by univariate and multivariate analyses.Nonparametric tests were performed to determine whether there was valuable difference amid each SUV group classified by certain clinical or histopathologic characteristic. Results: A SUV cutoff of 5.0 for the primary tumor showed the greatest discriminative value for overall survival.As for the PFS,the cufoff is 4.0. The SUV for the primary tumor was a significant predictor for both overall survival and PFS, based on the result that the relative risk was 7.075 and 2.719 respectively. As a result of multivariate analyse,the prognostic value of SUV and Clinical Staging was independent of each other, and the value of the SUV was considerably higher than the latter. The SUV for the small-cell lung cancer group was statistically higher than the non-small-cell lung cancer group. And there was significant overall discrepancy across the groups sorted by the degree of differentiation. Conclusions: The SUV of the primary tumor has the potential to be the leading prognostic factor for patients treated by multiple modality treatment, leading to substantially improved management for lung cancer patients. And there could be close connection between SUV and histopathologic or differentiation feature of lung cancer tissue, although it is still open to discussion. Analysis for larger number of cases could settle the issue. No significant financial relationships to disclose.
Infusional topotecan with concurrent radiation followed by consolidation etoposide platinum and docetaxel for patients with high risk unresectable stage III non-small cell lung cancer (NSCLC)
Authors: Seung S. , Fisher B. K. , Ross H. J. 
Published: March 2020

17042 Background: Good PS patients (pts) with locally advanced NSCLC treated with concurrent chemoradiotherapy have a 20–40% 3 year survival. Treatment is arduous and poor PS or high risk pts often cannot complete a full course of treatment. The optimal combination of chemotherapy and radiation and the role of consolidation chemotherapy are unknown. Despite response rates exceeding 50%, most pts eventually progress with brain as the first site of relapse in up to 30%. Continuous infusion chemotherapy is better tolerated than intermittent chemotherapy combined with radiation and may improve outcome in other locally advanced aerodigestive malignancies, however it has not been studied extensively in NSCLC. Topotecan is active in NSCLC, can safely be combined with radiation, can be given by continuous infusion and penetrates the CNS making it an attractive study agent in locally advanced NSCLC. Methods: In this pilot study, 20 pts were treated with infusional topotecan 0.4 mg/m2/d with 3D conformal radiation to 63 Gy both delivered M-F for 7 weeks. Pts without progressive disease underwent consolidation chemotherapy with etoposide and platinum for one cycle to take advantage of upregulation of topoisomerase II by topotecan. Two cycles of docetaxel consolidation followed. Study endpoints include response, time to progression, survival, toxicity and development of CNS metastases. Results: All pts have completed induction chemoradiotherapy. 12/20 have completed consolidation. 17/20 pts had a PR and 1/20 SD after induction chemoradiation. 1 pt developed CNS metastases 228 days after study entry and is alive with disease at 541 days. 3 pts had pulmonary emboli. Therapy has been well tolerated with 1/20 grade 4 lymphopenia. Grade 3 hematologic toxicity was seen in 17/20 pts. Other grade 3 toxicities include esophagitis (3/20), esophageal stricture (2/20), pneumonitis (6/20), fatigue (6/20), weight loss (1/20). Conclusion: Continuous infusion topotecan with radiation is well tolerated and shows evidence of activity in the management of poor risk patients with unresectable stage III NSCLC. Survival data will be presented at the meeting. No significant financial relationships to disclose.
Elderly advanced non-small-cell lung cancer (NSCLC) patients (p) treated with vinorelbine (vrb) plus gemcitabine (gem): Molecular correlates
Authors: Maestu I. , Isla D. , Diz P. , Muñoz J. , Oramas S. , García R. , Provencio M. , Jaen A. , Taron M. , Rosell R. 
Published: March 2020

17043 Background: The clinical benefit of non-cisplatin doublets (vrb/gem) vs a single agent (vrb or gem) in elderly p is still controversial. The present study focuses on clinical outcome with vrb/gem in the elderly and the role of functional status. Genetic predictive markers of response to vrb/gem will also be examined in genomic and cDNA from tumor and circulating tumor DNA. Methods: NSCLC p with stage IIIB (pleural effusion or supraclavicular lymph nodes)-IV or recurrent disease and age ≥ 70 years were treated with vrb (25 mg/m2 iv or 60–80 mg/m2 oral) plus gem 1200 mg/m2, days 1,8 every 21 days. Activities of daily living (ADL), instrumental activities of dalily living (IADL) and comorbidities were evaluated. Primary tumor and baseline serum DNA were collected for assessment of microtubule associated protein 4 (MAP4) in tumor and checkpoint with forkhead-associated and ring finger (CHFR) methylation in serum. A preliminary analysis of response and toxicity was performed on 51 p. Results: From April 2004 to December 2005, 145 p were included. Data on 68 p is available: median age 74.5 years (70–83); stage IIIB: 21.2%, IV: 78.7%; PS 0: 23.4%, 1: 54.6%, 2: 21.8%. Self-sufficiency in ADL and IADL was 56.2% and 25% of the p analyzed. All p but 8 had comorbidities. Response rate for 51 p: partial response, 12% (95% CI, 8.9–20%); stable disease, 32% (95% CI, 19.2–44.8%). Main hematological toxicities: grade 3/4 neutropenia, 8.3/4.1%; grade 3 thrombocytopenia, 4.1%; grade 3 anemia, 4.1% of the p respectively. Conclusions: Preliminary findings indicate that vrb/gem is feasible in elderly p with acceptable toxicity. Complete data on response, survival and genetic markers will be presented. No significant financial relationships to disclose.
Objective improvement in lung cancer patient care by the development of a multidisciplinary clinic (MDC) in the community
Authors: Mayfield W. , Bordoni R. , Holder R. , Waldman M. , Muster A. , McLaughlin M. , Hermann R. 
Published: March 2020

17086 Background: Medical resources allocated to lung cancer management are limited, scattered and uncoordinated, resulting in sub-optimal care. The MDC offers patients access to multi-disciplinary care (Pulmonary Medicine, Thoracic Surgery, Medical and Radiation Oncology) to operate in an efficient, cost effective way. Methods: 2004 Cancer Registry data on time to treatment (TTT) for lung cancer was 53 days. A project with the primary endpoint of reducing the TTT from 53 to 30 days was designed. Secondary endpoints were improvement in treatment planning; enhancement in clinical trials referral, and patient satisfaction. On 9/15/05 the MDC open its doors. The project was assigned to this clinic including patients with solitary lung nodules, lung, esophageal, and mediastinal cancers, mesothelioma, and other thoracic malignancies. Results: 54 pts were seen in the first 90 days; median age 60 (range 41–82), 29 males; 32 (59%) lung cancer (94% NSCLC), 8 (15%) esophageal cancer, 6 other diagnosis, and 6 abnormal radiological findings without diagnosis. The TTT of 30 evaluable patients is 26.36 days. Of the 30 NSCLC the TNM stage was: 4 IA, 5 IB, 2 each IIA/IIB, 8 (27%) IIIA, 3 (10%) IIIB, and 6 (20%) IV. Fifteen of the cases had pathologic staging. Out of 9 pts with cstage I, 7 (78%) had definitive surgery; 4 pts confirmed to have pstage IB, were evaluated for adjuvant chemo. Four pts with cstage II had surgery, 2 of them adjuvant chemo. Of the 11 pts with cstage III, 5 (46%) received concurrent CHRT, 1 (stage IIIA) underwent surgery f/b chemo, 2 received chemo alone and 2 refused therapy. Out of 6 pts with stage IV, 5 (83%) received systemic therapy. Conclusions: The TTT of 26.36 days represents a 50.26% improvement from our institutional benchmark of 53 days. Updated and expanded data on our project primary and secondary endpoints will be presented at the meeting. No significant financial relationships to disclose.
Phase II trial of imatinib maintenance therapy after irinotecan and cisplatin in patients with c-kit positive extensive-stage small cell lung cancer (ES SCLC)
Authors: Schneider B. J. , Gadgeel S. , Ramnath N. , Worden F. P. , Wozniak A. , Ruckdeschel J. , Kalemkerian G. P. 
Published: March 2020

17089 Background: The prognosis for patients (pts) with ES SCLC is poor, with a median survival of 9 mo. This trial was designed to evaluate the efficacy and toxicity of cisplatin plus irinotecan followed by maintenance imatinib (Gleevec) in pts with c-kit positive ES SCLC. Methods: Immunohistochemistry for c-kit was performed on paraffin-embedded tissue prior to enrollment. Treatment consisted of irinotecan 65 mg/m2 IV on days 1 and 8 plus cisplatin 60 mg/m2 IV on day 1 repeated every 21 days for 4 cycles. If no evidence of disease progression was identified, Gleevec was given at 400 mg orally BID until disease progression or unacceptable toxicity. Results: 14 pts have been enrolled: median age 61 yrs (range 47–73); 9 men: 5 women; PS 0/1/2 = 3/10/1. 6 pts did not begin Gleevec due to disease progression (4), persistent grade 3 emesis (1), and referral for radiation therapy (1). 8 pts had a PR with cisplatin/irinotecan and received Gleevec. Median number of wks on Gleevec was 6.1 (range 4.6–25.1). Reasons for discontinuation of Gleevec were disease progression (7) and persistent neutropenia (1). Median progression-free survival was 4.7 mo. (range 0.7–16.3) for all pts and 5.5 mo. (range 4.7–16.3) for pts receiving Gleevec. There were no objective responses to Gleevec, but 3 pts (21%) had stable disease for 12, 15 and 25 wks. Median survival was 8.1 mo. (range 3.7–19.6) for all pts and 10.0 mo. (range 7.1–19.6) for those receiving Gleevec. Myelosuppression was mild (grade 1–2 ANC 13%, anemia 76%, platelets 13%) with one pt with grade 3 neutropenia. Non-heme toxicity included grade 1–2 nausea 76%, diarrhea 51% and peripheral edema 75%. Conclusions: Gleevec did not appear to maintain disease stability after response to chemotherapy in the majority of pts despite c-kit tumor positivity. Although disease stability with Gleevec was noted in 3 pts (12–25 wks) and therapy was well tolerated, this approach does not appear to warrant further clinical study. Supported by Novartis Pharmaceuticals. No significant financial relationships to disclose.
A phase II trial of paclitaxel plus carboplatin in patients with non-small cell lung cancer previously treated with chemotherapy
Authors: Yoh K. , Kubota K. , Kakinuma R. , Ohmatsu H. , Goto K. , Niho S. , Nishiwaki Y. , Saijo N. 
Published: March 2020

17103 Background: The purpose of this phase II trial was to evaluate the efficacy and toxicity of paclitaxel plus carboplatin in the treatment of advanced non-small cell lung cancer (NSCLC) previously treated with chemotherapy. Methods: Eligible patients were aged 20 to 75 years with a performance status (PS) 0 to 1, previous treatment with one or two prior chemotherapy regimen for advanced NSCLC, and adequate organ function. Paclitaxel 200 mg/m2 was infused over 3 hours, before carboplatin (area under the curve 6; Calvert formula) infused over 1 hour, once every 3 weeks for six cycles maximum. The primary endpoint of this study was response rate. Simon’s two-stage design was used to determine the sample size and the planned accrual was 30 patients. Results: Thirty patients were enrolled. Complete response was observed in one patient and partial response in eleven patients for an overall response rate of 40% (95% confidence interval: 23–59%). The median time to progression was 5 months. The median survival was 9.9 months (range, 2.5–33.8 months), and the 1-year survival rate was 46%. The hematologic toxicities were 7% for grade 4 neutropenia, 3% for grade 3 febrile neutropenia, 17% for grade 3 and 4 anemia, and 7% for grade 3 thrombocytopenia. Grade 3 non-hematologic toxicities included rash (7%), myalgia/arthralgia (3%), arrhythmia (3%), and infection (3%). There were no toxic deaths. Conclusions: The combination of paclitaxel plus carboplatin is an active and well-tolerated regimen in the treatment of patients with NSCLC previously treated with chemotherapy who have a good PS. No significant financial relationships to disclose.
Artificial intelligence, complex system analysis and simulation modeling in recognition of N1–2 lymph node metastases of non-small cell lung cancer
Authors: Kshivets O. 
Published: March 2020

17123 Background: Precise recognition of N1–2 lymph node metastases (RLN) of non-small cell lung cancer (LC) means great importance in prediction LC patients (LCP) survival after surgery. We examined the immunologic factors associated with LCP with N0 and N1–2. Methods: In trial (1987–2005) the data of consecutive 289 LCP after complete pneumonectomies/lobectomies and mediastinal lymph node dissection (age = 58.1 ± 0.5 years; tumor size = 4.4 ± 0.1 cm; m = 260, f = 29) with pathologic stage I-III (T1–4N0–2M0) (squamous = 169, adenocarcinoma = 102, large cell = 18; G1 = 67, G2 = 110, G3 = 112; T1 = 100, T2 = 114, T3 = 54, T4 = 21; N0 = 147, N1 = 70, N2 = 72; pneumonectomies = 135, bi/lobectomies = 154) was reviewed. Variables selected for ED study were input levels of 64 immunity blood parameters, sex, age. Representativeness of samplings was reached by means of randomisation based on unrepeated random selection. Logistic regression, clustering, discriminant analysis, neural networks computing, structural equation modeling, Monte Carlo and bootstrap simulation were used to determine any significant regularity. Results: Logistic regression modeling displayed that RLN of LC significantly depended on: CDw26, CD16, phagocytic number, ratio of lymphocytes, T-lymphocytes, CD4+2H to LC cells (P = 0.003–0.043). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between N1–2 and blood IgM (rank = 1), eosinophils (2), T-lymphocytes (3), CD8 (4), phagocytic number (5), CD8+VV (6), CDw26 (7), B-lymphocytes (8), IS2 (9), CD4 (10), CD4+2H (11), NST-A2 (12), monocytes (13), index of thymus function (14), IgA (15). Conclusions: Correct RLN of LC was 79.2% by logistic regression (odds ratio = 15.65), 82.0% by discriminant analysis and 99.6% by neural networks computing (area under ROC curve = 0.99; error = 0.059). No significant financial relationships to disclose.
Efficacy of erlotinib in the treatment of patients with brain metastasis from non small cell lung cancer
Authors: Abigerges D. , Khater R. , Mokadem W. , Chammas S. 
Published: March 2020

17149 Background: Erlotinib has shown good activity in lung cancer.Brain metastases remain a major problem in lung cancer treatment because of the blood brain barrier.We report three cases of adenocarcinoma of the lung metastatic to the brain treated with erlotinib100 mg daily. Methods: Two males (age 54 and 57 years) and one female (age 50 years). The two male patients received combination chemotherapy for stage IV disease (carboplatine, gemcitabine, docetaxel) and recurred after initial response. Both have been irradiated to brain with relapse. The female patient received adjuvant chemotherapy (carboplatine and gemcitabine) and adjuvant radiation to the mediastinum and presented one month after the end of radiation with right upper limb paralysis and clonic crisis. Results: The three patients presented very rapid response to erlotinib, with almost disappearance of neurological signs within the first two weeks. MRI of the brain showed partial response after 15 days in two patients and after one month in the third. The female patient is still responding and well doing after four months on erlotinib without radiation nor corticosteroids or antiepileptics, the later treatments being refused by the patient. One male patient died from pulmonary embolism 40 days after the initiation of erlotinib while he was still presenting tumor response. The other two patients are still alive with partial response and no neurological symptoms, four months after the initiation of erlotinib. Conclusions: We believe that erlotinib deserves further evaluation in non small cell lung cancer metastatic to the brain. The very quick response to treatment can select responders very early because of the cost of the drug. No significant financial relationships to disclose.
Primary pulmonary adenocarcinoma in a 13-year-old girl with absence of EGFR gene mutation
Authors: Lim Y. , Ghim T. T. , Park B. , Park H. , Lee J. , Hah J. , Jung E. 
Published: March 2020

17150 Non-small cell carcinoma of lung frequently associated with cigarette smoking is extremely rare in children. We, here, describe a 13-year-old female diagnosed with stage IV pulmonary adenocarcinoma. She had never started smoking. Yet, she had environmental tobacco smoking exposure in the household as her father had been a long-time heavy smoker. The patient presented with 6-month history of chronic recurring cough. A CT of chest showed a mass obstructing the left upper lung bronchus with a collapse of the lung in the left upper segment. A bronchoscopic biopsy revealed a poorly differentiated adenocarcinoma. There were bilateral pleural and pericardial effusions along with multiple nodular lesions in the brain, liver and bones suggesting of wide dissemination of the lung cancer. In her past, there was no history of radiation exposure or immune deficiency. She had never had any other childhood cancer treated previously. Interestingly, there was no evidence of EGFR gene mutation in the genomic DNA analysis of the tumor specimen. In the hospital, she was treated with palliative chemotherapy initially starting with gefitinib and later with regimen of navelbine, gemcitabine and cisplatin combination with no response. A palliative radiation therapy to mediastinum was added mainly to relieve her airway obstruction. Currently, after 6 months from initial diagnosis, she remains clinically stable and ambulatory without tumor progression on docetaxel monthly chemotherapy cycle. Our report here suggests that a primary pulmonary adnenocarcinoma without previous radiation exposure to chest in a child who never had smoking may occur. It might be that environmental tobacco smoking exposure may have had a deleterious impact. No significant financial relationships to disclose.
Phase I trial of chir-258 in multiple myeloma
Authors: Lonial S. , Alsina M. , Anderson K. C. , Richardson P. , Stewart K. , Fonseca R. , Heise C. , Fox J. , Allen A. , Michelson G. 
Published: March 2020

17502 Background: CHIR-258 is an orally active small molecule receptor tyrosine kinase (RTK) inhibitor which has potent activity against multiple RTKs involved in tumor growth and angiogenesis (IC50 ≤13 nM for FGFR, VEGFR, PDGFR, C-KIT, and FLT3). Approximately 15% of newly diagnosed MM patients harbor a t(4;14) translocation, which results in ectopic expression of FGFR3 and MMSET and is associated with poor treatment outcome [0]and reduced survival. CHIR-258 inhibits proliferation and induces apoptosis in FGFR3-expressing MM tumor xenografts as well as FGFR3-expressing primary MM cells (Trudel et al, Blood 2005). CHIR-258 was synergistic with dexamethasone (dex) in vitro. Methods: CHIR-258 was administered once daily in a dose-escalating phase 1 study to patients with relapsed/refractory MM. Drug tolerability and safety, pharmacokinetics (PK) and pharmacodynamics (PD) were assessed. Results: as of December 2005, 9 total pts have been treated (50, 100, and 200mg qd cohorts) [6M, 3F; median age: 58 (range: 44–68), median of 3 prior therapies(range:1–7)]. Prior tx: 9/9 pts-thalidomide; 8/9 -Velcade; 8/9-transplant; 8/9- had progressed through dex. 4 of 9 pts treated were FGFR3+ and 4 pts remain on study (3 are FGFR3+). No CR or PR have been observed; stable disease has been noted. CHIR-258 has been generally well tolerated, and most drug related AEs were CTC grade 1 or 2, including: headache, dysgeusia, fatigue and anorexia. No neuropathy. One DLT has been observed to date: neutropenia (200mg cohort). Five pts had dex added to CHIR-258 of which 3 are ongoing (all FGFR3+). FGFR3+ pts receiving dex and CHIR-258 have a greater decline in urine and serum paraproteins (pp) vs CHIR-258 alone. Plasma exposure and Cmax increased proportionally across the doses. Conclusions: CHIR-258 is a novel inhibitor of RTKs involved in MM growth and proliferation. FGFR3+ pts have a more marked reduction in pp than FGFR3- pts. CHIR-258 has generally been well tolerated and further accrual continues. [Table: see text]