Tumori Journal Abstract Book - October 2020 - 62

62	
1
Department of Medical Oncology, Centro di Riferimento Oncologico (CRO),
IRCCS, Aviano, PN, Italy, Aviano

Background: Serum LDH levels are recognized as indirect marker of tumor hypoxia and angiogenesis for several
solid tumors. Ramucirumab is the first target agent
approved for second-line therapy in advanced gastric cancer (GC), alone or in association with chemotherapy. To
date, no reliable biomarkers can predict the potential benefit from anti-VEGFR2 treatment. This retrospective study
aimed to assess the prognostic impact of baseline LDH
levels in advanced GC in second-line setting.
Materials and methods: We analyzed a cohort of consecutive patients with advanced GC treated at IRCCS, CRO of
Aviano, Italy, from 2010 to 2019. LDH levels prior to secondline treatment were classified as low-normal or high and normalized according to the upper limit of the reference range. To
determine the optimal LDH cut-off value, ROC analysis was
performed. A multivariate Cox regression analysis assessed
the prognostic impact of LDH levels for PFS and OS.
Subgroup analyses according to LDH levels were carried out.
Results: Overall, 94 patients were enrolled. Of these, 65
patients (69.15%) received ramucirumab alone or plus
paclitaxel as second-line treatment, while 29 (30.85%) had
taxanes or fluoropyrimidines combined with irinotecan.
Median age was 68 years, 93% had an ECOG PS ⩽ 1,
62.7% was first diagnosed with metastatic disease and
40.4% underwent primary tumor resection. Median secondline PFS and OS were 3.7 and 7.9 months, respectively.
Serum LDH values were reported for 66 patients, exceeding
the upper limit in 19.7% of cases. High baseline LDH level
was confirmed as a negative prognostic factor by multivariate Cox regression analysis for both PFS (HR 2.35, 95% CI
1.09-5.1, p=0.029) and OS (HR 2.26, 95% CI 1.01-5.07,
p=0.04). Notably, ROC analysis identified a normalized
LDH value of 0.84 as the optimized cut-off point. Subgroup
analyses showed a trend towards worse PFS (HR 2.76, 95%
CI 1.09-6.94) and OS (HR 4.29, 95% CI 1.59-11.51) (p of
interaction=0.096) in patients treated with ramucirumabbased schemes with high baseline LDH levels.
Conclusions: Elevated serum LDH levels at second-line
treatment start is an independent prognostic factor of poor
prognosis in advanced gastric cancer. Moreover, this biomarker could have a role in predicting the activity of
antiangiogenic agents. Case expansion and prospective
validation are needed to assess the efficacy of the optimized LDH cut-off in better defining a poor prognosis
subgroup among patients with normal LDH levels.

C32
Clear cell variant of
hepatocellular carcinoma (HCCCC): a single-center observational
study of an uncommon subtype

Tumori Journal 106(2S)
Salani F.1, Pecora I.1, Vivaldi C.2, Massa V.1, Catanese S.1, Bernardini
L.1, Caccese M.1, Cesario S.1, Vasile E.1, Lencioni M.1, Fornaro L.1,
Falcone A.2, Masi G.2
1

Azienda Ospedaliera Universitaria Pisana, Pisa; 2Università di Pisa, Pisa

Background: HCC-CC is the second most frequent rare
pathological variant of HCC subtypes. Despite its epidemiological, clinical, radiological and molecular peculiarities, no
dedicated guidelines nor clinical trials are available.
Methods: We retrospectively collected data from HCC-CC
patients (pts) followed at our centre from 2015. Our aim
was to describe pts' baseline characteristics and outcomes
in terms of progression-free survival (PFS) and overall
survival (OS), using Kaplan-Meier method.
Results: Among 73 HCC pts with a histologically confirmed
diagnosis, 18 (24.7%) had HCC-CC subtype and were therefore included. Of them, 16 (88.9%) were males and 2 females
(11.1%), with a mean age at diagnosis of 67 years (range:
53-79). Etiology was dysmetabolic in 9 pts (50.0%), HCV in 1
(5.5%) and 8 cases (44.5%) arose on healthy liver. At baseline,
Child-Pugh was A in all pts, while BCLC was A in 12 (66.7%),
B in 1 (5.5%) and C in 5 (27.8%). As first treatment, 16 pts
(88.9%) underwent surgery, 1 liver transplantation and 1 transarterial chemoembolization (TACE). At first progression, 4
pts received additional locoregional treatments. After a median
of 19.0 months (mos) from initial curative-intent treatment, 10
pts (55.5%) progressed, showing extrahepatic spread in 80%
of cases (40% peritoneal, 30% lung and 10% skeletal, 20%
other). Six metastatic pts received a systemic first-line therapy:
4 sorafenib, 1 durvalumab and 1 lenvatinib plus pembrolizumab/placebo. Best radiological response was disease progression in 66.7% of cases, with a median PFS of 2.76 mos
(95% CI 1.38-5.03). Notably, most pts received subsequent
systemic therapies (50% second-line, 20% third-line) and 20%
were considered for surgery (peritonectomy with hypertermic
intraperitoneal chemotherapy), reaching a median OS of 55.23
mos. Surgery was the only treatment in other 2 metastatic pts;
of note, 1 of them reached a 50 mos of OS undergoing multiple excisions of extrahepatic localizations.
Conclusion: Our HCC-CC pts showed predominantly nonviral etiology, early-stage at diagnosis, preserved liver function and a relatively favourable outcome, consistently with
previously published data. Interestingly, we observed a poor
efficacy of systemic treatment, whereas surgery seemed to
be effective even in the metastatic setting. Wider multicentric experiences are warranted to shed light on this not-sorare HCC-subtype.

C33
EFFICACY AND SAFETY OF
PERIOPERATIVE CHEMOTHERAPY (FLOT)
IN LOCALLY ADVANCED GASTRIC
CANCER: REAL-WORLD EXPERIENCE OF
A SINGLE CENTRE



Tumori Journal Abstract Book - October 2020

Table of Contents for the Digital Edition of Tumori Journal Abstract Book - October 2020

Contents
Tumori Journal Abstract Book - October 2020 - Cover1
Tumori Journal Abstract Book - October 2020 - Cover2
Tumori Journal Abstract Book - October 2020 - I
Tumori Journal Abstract Book - October 2020 - II
Tumori Journal Abstract Book - October 2020 - Contents
Tumori Journal Abstract Book - October 2020 - IV
Tumori Journal Abstract Book - October 2020 - V
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