- Email: [email protected]
P1.07-013 Treatment Related Side Effects of Oral Topotecan in Small Cell Lung Cancer
January 2017
assess clinical efficacy of PD-1 inhibitors in these patients. Methods: We retrospectively reviewed all consecutive LCNEC stage IIIB- IV patients treated with nivolumab or pembrolizumab after platinum-based first line therapy between July 2014 and November 2015 in six French centers. Patients were followed until June 2016. The drugs were given in an early access program or a clinical trial. Results: The analysis included 10 patients with advanced stage disease. Eight patients (80%) had a stage IV disease with a median age of 59 [interquartile range (IQR) 55-62] years. The majority were males (n¼9; 90%), with good performance status (0-1; 9/90%) and 50% were treated in third line or further. Three patients presented brain metastases. In 5 cases a molecular test was done, finding in one case (20%) a KRAS mutation. Patients received a first line treatment with platinum and etoposide in 8 cases (80%) with a disease control rate of 50%. Nine patients received nivolumab and the PD-L1 status was never performed, while the patient treated with pembrolizumab expressed PD-L1. Patients received a median number of 16 [IQR, 13-18] cycles, 6 showed a partial response (60%), 1 a stable disease (10%). Median PFS was 57 [24-57] weeks. Most of the patients stopped treatment due to disease progression (n¼4; 80%), only one for a pulmonary interstitial pneumonia. Conclusion: Our findings suggest that the use of immune-checkpointeinhibitors in LCNEC could be explored in a larger cohort of patients. This treatment could be considered in the scenario of a disease with limited therapeutic strategy. Keywords: Immune checkpoint inhibitors, large cell neuroendocrine carcinoma
P1.07-013 Treatment Related Side Effects of Oral Topotecan in Small Cell Lung Cancer Topic: Drug Treatment Alone and in Combination with Radiotherapy Filip Popovic, Marko Jakopovic, Miroslav Samarzija, cevic, Suzana Kukulj, Mihovil Roglic, Branka Cu Sanja Plestina Department for Respiratory Diseases “Jordanovac”, University Hospital Center, Zagreb/Croatia Background: Lung cancer is the most common tumor in men and the second most common tumor in woman according to the latest data available from the Croatian National Cancer Registry. Approximately 20% of all lung cancers are categorized as small cell lung cancer (SCLC).
Abstracts
S703
Topotecan is recommended as second-line chemotherapy in treatment of SCLC. Topotecan can be administrated orally with the same effectiveness as parenteral. Methods: The aim of this study was to determine toxicity of oral topotecan in second line of chemotherapy and to establish the frequency of drug related admissions. Results: A total of 177 courses of therapy were administered to the 64 patients, 17 woman and 47 men, with SCLC patients ranging from 42 to 77 years with the mean age of 59.3. All the patients were treated in University Hospital Centre Zagreb from January 2012 to October 2015. Included patients had ECOG performance status of 0 or 1. Topotecan was administrated every 21 day, at the dose of 2.3 mg/m2/day, during 5 days. Average number of courses received was 2.8. Of all included patients 17 of them (26.5%) were admitted to hospital because of adverse events related to topotecan administration. The majority of patient hospitalizations (11 patients, 16.9%) was due to febrile neutropenia. Other reasons for hospitalization were severe diarrhea in 4 patients (6.2%), pneumonia in 1 patient (1.5%) and severe electrolyte imbalance in 1 patient (1.5%). Of 17 admissions to hospital 10 (58.9%) of them were after application of first chemotherapy cycle, 3 (17.6%) after second cycle and 4 (23.5%) after third cycle. Quantitative hematologic toxicities were assessed using the National Cancer Institute Common Toxicity Criteria. Anemia grade 3 or 4 occurred in 13 patients (20.3%). Grade 3 or 4 thrombocytpenia occurred in 7 patients (10.9%). Grade 3 or 4 neutropenia occurred in 16 patients (25%). Of other, non-hematologic adverse effects the most serious was grade 3 or 4 diarrhea that occurred in 5 patients (7.8%). Conclusion: although admission of oral topotecan is well tolerated it is related with high rate of hospitalizations due to myelotoxicity and gastrointestinal toxicity during therapy. Keywords: SCLC, topotecan, side effects
P1.07-014 Impact of Chemotherapy for Small Cell Lung Cancer in the Third Line and beyond, a SEER-MEDICARE Analysis Topic: Drug Treatment Alone and in Combination with Radiotherapy Sungjin Kim,1 Camille Ragin,2 Zhengjia Chen,1 Madhusmita Behera,1 Rathi Pillai,1 Conor Steuer,1 Chandra Belani,3 Fadlo Khuri,1 Suresh Ramalingam,4 Taofeek Owonikoko5 1Emory University, Atlanta/United
assess clinical efficacy of PD-1 inhibitors in these patients. Methods: We retrospectively reviewed all consecutive LCNEC stage IIIB- IV patients treated with nivolumab or pembrolizumab after platinum-based first line therapy between July 2014 and November 2015 in six French centers. Patients were followed until June 2016. The drugs were given in an early access program or a clinical trial. Results: The analysis included 10 patients with advanced stage disease. Eight patients (80%) had a stage IV disease with a median age of 59 [interquartile range (IQR) 55-62] years. The majority were males (n¼9; 90%), with good performance status (0-1; 9/90%) and 50% were treated in third line or further. Three patients presented brain metastases. In 5 cases a molecular test was done, finding in one case (20%) a KRAS mutation. Patients received a first line treatment with platinum and etoposide in 8 cases (80%) with a disease control rate of 50%. Nine patients received nivolumab and the PD-L1 status was never performed, while the patient treated with pembrolizumab expressed PD-L1. Patients received a median number of 16 [IQR, 13-18] cycles, 6 showed a partial response (60%), 1 a stable disease (10%). Median PFS was 57 [24-57] weeks. Most of the patients stopped treatment due to disease progression (n¼4; 80%), only one for a pulmonary interstitial pneumonia. Conclusion: Our findings suggest that the use of immune-checkpointeinhibitors in LCNEC could be explored in a larger cohort of patients. This treatment could be considered in the scenario of a disease with limited therapeutic strategy. Keywords: Immune checkpoint inhibitors, large cell neuroendocrine carcinoma
P1.07-013 Treatment Related Side Effects of Oral Topotecan in Small Cell Lung Cancer Topic: Drug Treatment Alone and in Combination with Radiotherapy Filip Popovic, Marko Jakopovic, Miroslav Samarzija, cevic, Suzana Kukulj, Mihovil Roglic, Branka Cu Sanja Plestina Department for Respiratory Diseases “Jordanovac”, University Hospital Center, Zagreb/Croatia Background: Lung cancer is the most common tumor in men and the second most common tumor in woman according to the latest data available from the Croatian National Cancer Registry. Approximately 20% of all lung cancers are categorized as small cell lung cancer (SCLC).
Abstracts
S703
Topotecan is recommended as second-line chemotherapy in treatment of SCLC. Topotecan can be administrated orally with the same effectiveness as parenteral. Methods: The aim of this study was to determine toxicity of oral topotecan in second line of chemotherapy and to establish the frequency of drug related admissions. Results: A total of 177 courses of therapy were administered to the 64 patients, 17 woman and 47 men, with SCLC patients ranging from 42 to 77 years with the mean age of 59.3. All the patients were treated in University Hospital Centre Zagreb from January 2012 to October 2015. Included patients had ECOG performance status of 0 or 1. Topotecan was administrated every 21 day, at the dose of 2.3 mg/m2/day, during 5 days. Average number of courses received was 2.8. Of all included patients 17 of them (26.5%) were admitted to hospital because of adverse events related to topotecan administration. The majority of patient hospitalizations (11 patients, 16.9%) was due to febrile neutropenia. Other reasons for hospitalization were severe diarrhea in 4 patients (6.2%), pneumonia in 1 patient (1.5%) and severe electrolyte imbalance in 1 patient (1.5%). Of 17 admissions to hospital 10 (58.9%) of them were after application of first chemotherapy cycle, 3 (17.6%) after second cycle and 4 (23.5%) after third cycle. Quantitative hematologic toxicities were assessed using the National Cancer Institute Common Toxicity Criteria. Anemia grade 3 or 4 occurred in 13 patients (20.3%). Grade 3 or 4 thrombocytpenia occurred in 7 patients (10.9%). Grade 3 or 4 neutropenia occurred in 16 patients (25%). Of other, non-hematologic adverse effects the most serious was grade 3 or 4 diarrhea that occurred in 5 patients (7.8%). Conclusion: although admission of oral topotecan is well tolerated it is related with high rate of hospitalizations due to myelotoxicity and gastrointestinal toxicity during therapy. Keywords: SCLC, topotecan, side effects
P1.07-014 Impact of Chemotherapy for Small Cell Lung Cancer in the Third Line and beyond, a SEER-MEDICARE Analysis Topic: Drug Treatment Alone and in Combination with Radiotherapy Sungjin Kim,1 Camille Ragin,2 Zhengjia Chen,1 Madhusmita Behera,1 Rathi Pillai,1 Conor Steuer,1 Chandra Belani,3 Fadlo Khuri,1 Suresh Ramalingam,4 Taofeek Owonikoko5 1Emory University, Atlanta/United