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e18102 Background: Sarcomatoid lung cancers (SC) are associated with poor prognosis. A few studies suggest that these tumors are resistant to platinum-based chemotherapy. Methods: Between January 1994 and October 2011, all consecutive patients with SC were screened from six French centers. Patients with advanced disease and treated with first-line chemotherapy were included in this study. Clinical data, staging (TNM 2009 classification), drugs and response to chemotherapy (RECIST 1.1) at first tumor assessment were reported. Factors associated with progressive disease (PD) in univariate (p95% [1.3, 2.7]. Median overall survival was 6 months [3.2, 8.8]. In univariate analysis, age, gender, smoking status, numbers of metastatic locations, histological subtypes, monotherapy vs platin-based combinations, relapse after radical treatment vs initial advanced disease were not associated with PD. In multivariate analysis, initial advanced disease was the only independent factor of PD (OR 4.59 [1.17, 18] p=0.03). Conclusions: Our series confirm that advanced SC are refractory to conventional chemotherapy. Molecular characterizations are needed to improve therapeutic strategy.

e18075 Background: The majority of cases of NSCLC are diagnosed at an advanced stage and treated with a platinum-doublet CT. However, some patients are resistant to this treatment and develop early progressive disease. We investigated the clinicopathologic and molecular characteristics of such patients. Methods: All consecutive patients with NSCLC IIIB−IV treated with a platinum-doublet CT between 2003 and 2006 were included. Platinum resistance was defined as early progressive disease at the first tumor assessment according to WHO criteria. The clinical, histologic and molecular characteristics (EGFR:exon 19, 20, 21 and KRAS:exon 2 by PCR sequencing; ALK by IHC, confirmed by FISH) and survival of patients with early progression (P) and controlled disease (C) were compared by univariate analysis. Factors differing between the two groups with a p-value

Introduction: The 2004 WHO Pathological classification distinguishes two cytological subtypes of bronchioloalveolar carcinoma (BAC): mucinous (M) and non-mucinous (NM). This distinction appears to be relevant in terms of clinical characteristics, prognostic and treatment effectiveness. We attempted to better characterize the molecular profile of M relative to NM. Experimental procedures: Bronchoalveolar lavage fluid (BALF) supernatants from M-BACs (n = 23) and NM-BACs (n = 11) were analyzed for 30 cytokines (IL-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, FGF, PDGF, HGF, VEGF, Eotaxin, G-CSF, GM-CSF, IFNγ, CXCL-1, CXCL-8, CXCL-10, MCP-1, MIP-1α, MIP-1β, TNF-α, RANTES, VCAM-1) by Bio-Plex multiplex bead-based assay (BIORAD, Marne la Coquette, France). Cytokines of interest expression was studied on paraffin embedded specimens from surgical specimens (n = 45) using immunochemistry. EGFR and K-ras mutation analysis using direct PCR and Alk overexpression detection using immunochemistry were also performed. Univariate and multivariate analysis by Cox model was undertaken to identify the variables associated with a risk for shortened survival. Summary of results: Among the 30 chemokines analyzed, CXCL10 was the only one for which concentration was significantly higher in BALF supernatants from M-BAC (n = 23) compared to NM-BAC (n = 11) and control (n = 4) (p = 0.041). The cellular source of CXCL10 was not yet identified while CXCR3, its receptor, was expressed by tumor cells. CXCR3 was more frequently and more intensively expressed in M-BAC (n = 21) than in NM-BAC (n = 24) (52% vs 17%, p=0.023 and 52±16 vs 12±6, p = 0.047, respectively). EGFR mutation was never found in M-BAC (0%, 0/21) while present in 21% (5/24) of NM-BAC (p = 0.026). K-ras mutation and Alk overexpression did not differ between the two subtypes (2/21 vs 1/24, p > 0,05 and 3/21 vs 2/24, p > 0,05, respectively). The expression of CXCR3 was not associated with EGFR or K-ras mutation or Alk overexpression. In univariate analysis, factors associated with shorter survival were CXCL10 BALF concentration (HR=2.615, 95% CI: 1.102–6.206), PS > 0 (HR=1.308, 95% CI: 1.131–1.726) and bilateral extension (HR=2.914, 95% CI: 1.208–7.031). Multivariate analysis did not show any independent prognostic factor. Conclusions: Our results show a CXCL10/CXCR3 overexpression in M-BAC compared to NM-BAC and suggest an association between CXCL10 overexpression and shorter survival.

relations entre les variables ont ete evaluees avec le coefficient correlation de Pearson. Resultats.— La prevalence de la l’osteoporose est plus elevee chez les patientes BPCO (42% vs 17 %, p < 0,05). Les Z scores des patientes BPCO sont inferieurs a ceux des asthmatiques (p < 0,01). Chez les BPCO, l’indice de masse corporelle est correle positivement avec la DMO de la colonne lombaire (r = 0,52, p < 0,03) et l’ensemble du corps (r = 0,52, p < 0,01). Les autres variables biologiques ne sont pas correlees avec la DMO. Conclusion.— L’osteoporose doit faire partie integrante de la prise en charge de la BPCO chez la femme.

7007 Background: No survival differences was observed between any arms in the 528 early stage NSCLC randomized patients of the IFCT-0002 phase III trial comparing two chemotherapy timing, all pre- ...

e18025 Background: Pemetrexed is approved to treat non-small-cell lung cancer (NSCLC) and malignant pleural mesothelioma (MPM), and has an overall favorable toxicity profile. A case of pemetrexed-i...

2 Background: Incidence of advanced NSCLC in the elderly is increasing. Specific trials for elderly are seldom and those patients are not optimally treated. Current recommendations are monotherapies with gemcitabine or vinorelbine. Methods: French multicentric randomized phase III study in pts aged 70 to 89, PS 0-2 with advanced NSCLC not irradiable, comparing a 3-weekly single agent therapy (gemcitabine 1,150 mg/m2 or vinorelbine 30 mg/m2, d1, d8: arm A) with carboplatin AUC 6 every 4 weeks + paclitaxel 90 mg/m2 (d1,8,15) doublet (arm B). Five cycles of single agent and 4 cycles of the doublet were to be given. Second-line in case of toxicity or progressive disease was fixed with erlotinib 150 mg/d. The main endpoint was overall survival. Results: 451 pts were included from 04/2005 to 12/2009 by 60 centers. Males were 73.8%, median age was 77.2 years (range 70-89). PS was 0-1 in 73.6%. The 2 arms were well-balanced for pts characteristics. At time of second planned intermediate analysis (after two-third of expected deaths, i.e. 224), 451 pts were randomized, out of the 522 initially planned. The steering committee advice was to stop the inclusions. Overall survival of the 313 pts analysed at this time was significantly longer in arm B (median: 10.4 months, 95%CI: [8.2; 15.0] vs. 6.2 months, 95%CI: [5.3; 7.5] for arm A, (HR = 0.60, 95%CI : [0.46; 0.78], p = 0.0001). Median PFS was 6.3 months, 95%CI: [5.5; 6.9] in arm B vs. 3.2 months, 95%CI: [0.44; 0.70] (HR = 0.55, 95%CI: [0.44; 0.70], p < 0.0001). Grade 3-4 haematological toxicities were significantly more frequent in arm B (17.9% vs. 54.1%). No significant difference was observed in early deaths (arm A: 23.7%, arm B: 16.6%). Survival, response and toxicity data for the whole series of 451 pts will be updated at time of the meeting. Conclusions: Paclitaxel and carboplatin doublet provides a significantly longer survival in elderly pts with advanced NSCLC than current standard single agent therapy, with acceptable toxicity, making it a new treatment paradigm for PS 0-2 pts ≥ 70 years. [Table: see text]