- Email: [email protected]
P3.15-010 Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH): Natural History of the Disease Progression and Management
November 2017 differences in drug doses corresponded with improved outcomes for PDXs treated with 0.3 mg/kg in combination with radiotherapy (RT; median 84 days, p¼0.04) but not 0.1 mg/kg + IR (66 days) compared to RT alone (52 days). Conclusion: [F18]PARPi PET can differentiate between multiple doses and timing of orally administered TAL and correlates with drug efficacy. This likely reflects differences in intratumoral drug level and demonstrates the potential of this PET radiotracer to assess differences in drug delivery and efficacy for patients treated with PARP inhibitors. Keywords: small cell lung cancer, Patient derived Xenograft, PARP INHIBITOR
P3.15-009 Impact of Interstitial Lung Disease on Clinical Outcomes in Small Cell Lung Cancer Patients
Abstracts
S2341
cough were the commonest presenting symptoms. Three patients were under surveillance without treatment, two patients were treated with short acting somatostatin analog, another three were treated with long acting monthly somatostatin analogs and azithromycin combination, one patient got long acting somatostatin analog and everolimus combination. Two patients had concomitant well-differentiated neuroendocrine tumor of lung. Conclusion: DIPNECH is a rare pathology which can have profound effects on patient’s quality of life. Paroxysmal coughing spells can be difficult to treat. Our limited single center experience shows encouraging response to use of somatostatin analog, azithromycin and everolimus in the management of debilitating DIPNECH associated symptoms. Keywords: DIPNECH, azithromycin, everolimus
K. Akaike,1 K. Saruwatari,2 Y. Sakamoto,1 T. Jodai,1 S. Sakata,1 S. Iyama,1 R. Sato,1 T. Iriki,1 Y. Tomita,1 S. Saeki,1 H. Ichiyasu,1 K. Fujii1 1Respiratory Medicine, Kumamoto University Hospital, Kumamoto-Shi/JP, 2Kumamoto University Hospital, Kumamoto-Shi/JP
P3.15-011 Contemporary Treatment and Prognosis of NonMetastatic Atypical Bronchopulmonary Carcinoid Tumors
Background: The impact of interstitial lung disease (ILD) on the clinical outcome in small cell lung cancer (SCLC) patients has not been fully understood. The purpose of this study is to investigate the impact of ILD on treatment and survival in SCLC. Method: From April 2006 to March 2016, 67 SCLC patients treated with chemotherapy at Kumamoto University hospital were evaluated. Therapeutic response, progression-free survival (PFS) and overall survival (OS) were compared between SCLC with ILD (n¼16) and SCLC without ILD (n¼51). Result: Patients’ characteristics including age, sex, smoking, serum LDH, stage (limited/ extensive disease) between two groups were similar, except for lower proportion of chemoradiotherapy in SCLC with ILD (7% vs. 57%, P0.001). SCLC with ILD had a significantly lower objective response rate than SCLC patients without ILD (50% vs. 84%, P¼ 0.005). SCLC patients with ILD had a significantly shorter PFS (median, 184 days vs. 290 days, P¼ 0.008) and OS (median, 241 days vs. 704 days, P0.001) than patients without ILD. In addition, multivariate analysis for PFS and OS revealed that the coexisting ILD was independent predictive factor for poor survival in SCLC patients treated with chemotherapy (PFS, hazard ratio [HR] 2.06, 95% confidence interval [CI], 1.01-4.18, P¼ 0.046, OS, HR 3.29, 95% CI 1.53-7.08, P¼ <0.002). Acute exacerbation of ILD was observed in 31% of SCLC patients with ILD. Conclusion: This study suggests that coexisting ILD is a predictive factor for poor PFS and OS in SCLC treated with chemotherapy. Keywords: small cell lung cancer, interstitial lung disease, chemotherapy
B. Imber,1 A. Rimner,2 J. Isbell,3 A. Wu2 1Dept of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY/US, 2Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY/US, 3 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY/US
P3.15-010 Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH): Natural History of the Disease Progression and Management Z. Myint, A. Chauhan, S. Arnold, L. Anthony Hematology/Medical Oncology, University of Kentucky, Lexington, KY/US Background: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare, often benign pulmonary condition which is characterized by diffuse proliferation of neuroendocrine cells in respiratory epithelium. DIPNECH lesions are less than 5 mm in size and are limited to the basement membrane without any invasion. There is limited evidence regarding epidemiology, natural history of disease progression and management of this rare entity. We would like to present our single center experience. Method: Retrospective record based descriptive study of all DIPNECH patients managed at University of Kentucky Markey Cancer Center over past 5 years. Result: Our patient cohort had 8 females and one male with mean age of 64.5 years at the time of diagnosis. Dyspnea on exertion and dry
Background: Despite rising incidence, there remains limited data guiding the prognostication and treatment of patients with bronchopulmonary carcinoid tumors, particularly atypical carcinoids. We report outcomes of a large, modern, single-institutional series of patients treated for localized or locally advanced atypical carcinoid of the lung. Method: We retrospectively analyzed the demographic, histologic and treatment histories of 69 patients (74% female) with median age of 65 at diagnosis (range 31-83) who were treated between 2004-2016. The Kaplan-Meier method was used for overall survival (OS) estimates and compared by log-rank. Cox proportional hazards models were used for univariate (UVA) and multivariate analyzes (MVA). Result: Median follow-up time was 33.6 months. The majority (96%) of patients underwent surgical resection (86% R0, 9% R1, 3% R2) with common approaches being lobectomy (59%), wedge resection (13%) and pneumonectomy (9%). Three patients (4%) received definitive radiotherapy as their local treatment. Nearly half (49%) of patients had nodal involvement with a stage distribution of 39% stage I, 25% stage II and 36% stage III. Twenty-one patients received chemotherapy as part of their initial treatment, 81% of whom had stage III disease. Sixteen patients received radiotherapy (median 50.4 Gy, range 18-66 Gy) as part of their initial treatment, most of whom received postoperative radiation for N2 disease (63%). Five patients (31%) received postoperative radiotherapy due to concern of incompletely resected disease. Higher stage was significantly associated with poorer OS (p¼0.04). 3-year OS for Stage I, II and III disease was 96%, 88% and 72%, respectively. Stage I disease also had a significantly lower risk of distant metastasis compared to Stage II/III disease (17% vs. 31% at 3 years p¼0.04). On UVA, Stage III disease was significantly associated with poorer OS (HR 4.7, p¼0.021) and risk of distant failure (HR 2.8, p¼0.039). Multivariate modeling showed that older age (HR 1.05, p¼0.03) and stage III status (HR 6.6, p¼0.009) were predictive of poorer OS. For stage III patients treated surgically, receipt of adjuvant therapy (chemotherapy and/or radiotherapy) was not significantly associated with OS (p¼0.36) or distant failure (p¼0.69). Conclusion: This is one of the largest reported series of atypical pulmonary carcinoid patients treated with curative intent. We observed generally favorable prognosis in this cohort that was primarily treated with surgery. We did not observe a significant impact of adjuvant therapy on outcomes, but small patient numbers limit our ability to quantify their potential effect. Keywords: Atypical Carcinoid, carcinoid, neuroendocrine
P3.15-009 Impact of Interstitial Lung Disease on Clinical Outcomes in Small Cell Lung Cancer Patients
Abstracts
S2341
cough were the commonest presenting symptoms. Three patients were under surveillance without treatment, two patients were treated with short acting somatostatin analog, another three were treated with long acting monthly somatostatin analogs and azithromycin combination, one patient got long acting somatostatin analog and everolimus combination. Two patients had concomitant well-differentiated neuroendocrine tumor of lung. Conclusion: DIPNECH is a rare pathology which can have profound effects on patient’s quality of life. Paroxysmal coughing spells can be difficult to treat. Our limited single center experience shows encouraging response to use of somatostatin analog, azithromycin and everolimus in the management of debilitating DIPNECH associated symptoms. Keywords: DIPNECH, azithromycin, everolimus
K. Akaike,1 K. Saruwatari,2 Y. Sakamoto,1 T. Jodai,1 S. Sakata,1 S. Iyama,1 R. Sato,1 T. Iriki,1 Y. Tomita,1 S. Saeki,1 H. Ichiyasu,1 K. Fujii1 1Respiratory Medicine, Kumamoto University Hospital, Kumamoto-Shi/JP, 2Kumamoto University Hospital, Kumamoto-Shi/JP
P3.15-011 Contemporary Treatment and Prognosis of NonMetastatic Atypical Bronchopulmonary Carcinoid Tumors
Background: The impact of interstitial lung disease (ILD) on the clinical outcome in small cell lung cancer (SCLC) patients has not been fully understood. The purpose of this study is to investigate the impact of ILD on treatment and survival in SCLC. Method: From April 2006 to March 2016, 67 SCLC patients treated with chemotherapy at Kumamoto University hospital were evaluated. Therapeutic response, progression-free survival (PFS) and overall survival (OS) were compared between SCLC with ILD (n¼16) and SCLC without ILD (n¼51). Result: Patients’ characteristics including age, sex, smoking, serum LDH, stage (limited/ extensive disease) between two groups were similar, except for lower proportion of chemoradiotherapy in SCLC with ILD (7% vs. 57%, P0.001). SCLC with ILD had a significantly lower objective response rate than SCLC patients without ILD (50% vs. 84%, P¼ 0.005). SCLC patients with ILD had a significantly shorter PFS (median, 184 days vs. 290 days, P¼ 0.008) and OS (median, 241 days vs. 704 days, P0.001) than patients without ILD. In addition, multivariate analysis for PFS and OS revealed that the coexisting ILD was independent predictive factor for poor survival in SCLC patients treated with chemotherapy (PFS, hazard ratio [HR] 2.06, 95% confidence interval [CI], 1.01-4.18, P¼ 0.046, OS, HR 3.29, 95% CI 1.53-7.08, P¼ <0.002). Acute exacerbation of ILD was observed in 31% of SCLC patients with ILD. Conclusion: This study suggests that coexisting ILD is a predictive factor for poor PFS and OS in SCLC treated with chemotherapy. Keywords: small cell lung cancer, interstitial lung disease, chemotherapy
B. Imber,1 A. Rimner,2 J. Isbell,3 A. Wu2 1Dept of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY/US, 2Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY/US, 3 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY/US
P3.15-010 Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH): Natural History of the Disease Progression and Management Z. Myint, A. Chauhan, S. Arnold, L. Anthony Hematology/Medical Oncology, University of Kentucky, Lexington, KY/US Background: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare, often benign pulmonary condition which is characterized by diffuse proliferation of neuroendocrine cells in respiratory epithelium. DIPNECH lesions are less than 5 mm in size and are limited to the basement membrane without any invasion. There is limited evidence regarding epidemiology, natural history of disease progression and management of this rare entity. We would like to present our single center experience. Method: Retrospective record based descriptive study of all DIPNECH patients managed at University of Kentucky Markey Cancer Center over past 5 years. Result: Our patient cohort had 8 females and one male with mean age of 64.5 years at the time of diagnosis. Dyspnea on exertion and dry
Background: Despite rising incidence, there remains limited data guiding the prognostication and treatment of patients with bronchopulmonary carcinoid tumors, particularly atypical carcinoids. We report outcomes of a large, modern, single-institutional series of patients treated for localized or locally advanced atypical carcinoid of the lung. Method: We retrospectively analyzed the demographic, histologic and treatment histories of 69 patients (74% female) with median age of 65 at diagnosis (range 31-83) who were treated between 2004-2016. The Kaplan-Meier method was used for overall survival (OS) estimates and compared by log-rank. Cox proportional hazards models were used for univariate (UVA) and multivariate analyzes (MVA). Result: Median follow-up time was 33.6 months. The majority (96%) of patients underwent surgical resection (86% R0, 9% R1, 3% R2) with common approaches being lobectomy (59%), wedge resection (13%) and pneumonectomy (9%). Three patients (4%) received definitive radiotherapy as their local treatment. Nearly half (49%) of patients had nodal involvement with a stage distribution of 39% stage I, 25% stage II and 36% stage III. Twenty-one patients received chemotherapy as part of their initial treatment, 81% of whom had stage III disease. Sixteen patients received radiotherapy (median 50.4 Gy, range 18-66 Gy) as part of their initial treatment, most of whom received postoperative radiation for N2 disease (63%). Five patients (31%) received postoperative radiotherapy due to concern of incompletely resected disease. Higher stage was significantly associated with poorer OS (p¼0.04). 3-year OS for Stage I, II and III disease was 96%, 88% and 72%, respectively. Stage I disease also had a significantly lower risk of distant metastasis compared to Stage II/III disease (17% vs. 31% at 3 years p¼0.04). On UVA, Stage III disease was significantly associated with poorer OS (HR 4.7, p¼0.021) and risk of distant failure (HR 2.8, p¼0.039). Multivariate modeling showed that older age (HR 1.05, p¼0.03) and stage III status (HR 6.6, p¼0.009) were predictive of poorer OS. For stage III patients treated surgically, receipt of adjuvant therapy (chemotherapy and/or radiotherapy) was not significantly associated with OS (p¼0.36) or distant failure (p¼0.69). Conclusion: This is one of the largest reported series of atypical pulmonary carcinoid patients treated with curative intent. We observed generally favorable prognosis in this cohort that was primarily treated with surgery. We did not observe a significant impact of adjuvant therapy on outcomes, but small patient numbers limit our ability to quantify their potential effect. Keywords: Atypical Carcinoid, carcinoid, neuroendocrine