Expert consensus to optimize the management of older adult patients with advanced EGFR-mutated non-small cell lung cancer.

Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica-SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón-GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres-ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations.

Molecular Characterization, Via Next-Generation Sequencing, of Refractory or Resistant Invasive Breast Carcinoma.

The most frequently diagnosed neoplasia in the world in 2020 was breast cancer (BC). On top of its high incidence, unexpected behavior as recurrence in patients, in spite of appropriate therapies, reaches 20%-30%. We believe that some molecular characteristics of tumors may lead to this bad behavior, and we can identify them with next-generation sequencing (NGS). We made a retrospective multicentric study, conducted to molecularly characterize, by means of a custom NGS panel, cases diagnosed with treatment-refractory or treatment-resistant invasive breast carcinoma, studied in formalin-fixed paraffin-embedded (FFPE) samples. The panel included 50 genes related to tumorigenesis, cancer evolution and targeted therapies. Twelve cases were included from three centers. Alterations of driver genes were found in all of the cases, and 75% harbored mutations in TP53. Furthermore, we found alterations that could be therapeutic targets in half of the patients, such as mutations in PIK3CA (33% cases), mTOR (8.3%) or BRCA1 (8.3%). Other significant molecular alterations were: the loss of SWI-SNF complex´s components, modified genes of the MAP kinase pathway and alterations in epidermal growth factor receptor (EGFR). Not all of them are known targets but prognostic significance was found. We conclude that NGS characterization of breast cancer in FFPE samples is a reproducible technique that can provide prognostic and predictive information about our patients and therefore, constitutes, in the near future, a valuable clinical tool in the context of precision medicine.

Impact of Age on Inflammation-Based Scores among Patients Diagnosed with Stage III Non-Small Cell Lung Cancer.

BACKGROUND: Inflammatory and nutritional indexes are prognostic factors in non-small cell lung cancer (NSCLC). Furthermore, a low grade of chronic inflammation has been described in the older population (inflammaging). We aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR), the Prognostic Nutritional Index (PNI), the advanced lung cancer inflammation index (ALI), the platelet-to-lymphocyte ratio (PLR), and the Glasgow Prognostic Score (GPS) in young and older patients diagnosed with locally advanced NSCLC to determine if significant differences between these groups exist. METHODS: We conducted a retrospective study analyzing the impact of age on the NLR, PNI, ALI, PLR, and GPS among patients diagnosed with stage III NSCLC at Hospital Universitario Doctor Peset between 2010 and 2015. RESULTS: We included 124 patients (84 young, 40 older patients). The median hemoglobin level and leukocyte count were lower in the older patients (p = 0.0158 and p = 0.001, respectively). A higher median C-reactive protein level was also found in this group (p = 0.0095). Regarding specific inflammatory indexes, the PNI, comprising inflammatory and nutritional parameters, was lower among the older patients (p = 0.0463). The median NLR, ALI, and PLR were similar in both age groups. Moreover, no differences between the age groups were found in the percentage of patients showing high versus low NLR (cutoff point, 5) or ALI (cutoff point, 18) or in the different GPS groups. CONCLUSIONS: The baseline PNI, hemoglobin level, and lymphocyte count were lower among the older patients; furthermore, CRP was higher, possibly, because of a more prominent inflammatory status in older patients with lung cancer. No other immunological or nutritional analytical variables were different between the age groups.

Cognitive impairment is related to a reduced count of T-lymphocytes in older patients diagnosed with non-small cell lung cancer (NSCLC).

BACKGROUND: Aging is a risk factor for cancer and cognitive impairment, and both have been related to changes in the immune system (immunosenescence) and chronic inflammation (inflammaging) of elderly individuals. Therefore, it would be interesting to know if there is a connection between immunological variations and cognitive function in oncologic patients, especially in lung cancer, in which, inflammation plays a crucial role in tumor development and progression. Our objective is to assess, in older patients diagnosed with non-small cell lung cancer (NSCLC), differences in parameters of the immune system depending on their cognitive status. METHODS: We retrospectively analyzed patients ≥70 years diagnosed with NSCLC with evaluated cognitive function, from January 2017 to April 2019. Lymphocyte count was gathered at baseline and checked for differences in lymphocyte counts between patients with a Pfeiffer result of 0-2 vs. 3-10 mistakes. Multiple regression models were used to assess the impact of clinical parameters on lymphocyte count. RESULTS: Seventy patients were analyzed. Sixty had a normal cognitive function, while ten had an impaired cognitive status; these were significantly older. Multivariate analysis showed that patients with cognitive impairment had lower levels of total, T and CD8+ T-lymphocytes (P=0.011, 0.011 and 0.019, respectively). Older age was only correlated to higher level of CD8+ T-lymphocytes (P=0.0390). Odds ratio for the risk of cognitive impairment depending on the level of T-lymphocytes was 0.996 (95% CI: 0.995-0.998), P=0.037. CONCLUSIONS: T-lymphocyte count is lower in patients diagnosed with lung cancer and cognitive impairment. These findings suggest that clinical features are closely related to immunological status in older patients with NSCLC. Therefore, age cannot always explain immunosenescence, and geriatric assessment could help.

Primary carcinoid tumour of the pancreas.

UNLABELLED: Pancreatic carcinoid tumours are extremely infrequent. Usually, the biological behaviour is indolent and diagnosis is late and often casual. We present the case of a patient initially diagnosed as having liver metastasis of unknown origin. PET identified a primary pancreatic site and the initial histologic diagnosis was adenocarcinoma. Following an uncertain response to chemo- and radio-therapy the repeat histologic assessment indicated a carcinoid tumour of the pancreas. After complete surgical resection and liver transplantation, patient remains free of disease. CONCLUSIONS: The co-existence of several diseases with similar morpho-structural features makes diagnosis complicated. PET is of uncertain use in the evaluation of carcinoid tumours, and is considered inferior to 111Indium-octreotide scan. The only curative treatment is surgical resection, with liver transplantation as a valid option in the treatment of these tumours.