Background: Cancer cachexia is a syndrome characterized
by wasting of lean body mass and fat, resulting in decreased
treatment tolerance and quality of life. Approximately 50%
to 60% of patients with lung cancer develop cancer cachexia.
Knowledge of cancer cachexia trends and outcomes in different types of lung cancers can help target patients most at risk
of decreased survival. In this study, we examined weight loss
trends in patients with lung cancer and survival according to
Methods: We conducted a chart review of patients diagnosed
with lung cancer from 2007 to 2013 at a medical center in a
large metropolitan area. Data collected included demographics, date of diagnosis, treatment received, type of cancer by
histology, presence of metastasis, preexisting conditions, and
other medications used. Body mass index and weight before,
during, and after treatments were recorded, and percentage
weight loss and survival days were calculated. Patients were
also categorized according to the extent of weight loss (< 5%,
5%-10%, > 10%) through their disease course. Descriptive
statistics, ANOVA, t tests, and regression analysis were used
for data analysis to assess differences and relationships between percentage of weight loss and survival for all groups.
Results: Data from 197 patients were available for the study.
All patients were males with an average age of 68 years; 55%
of the patients were white and 35% were African American.
Of the total patients, 47.7% had adenocarcinoma, 8.1% had
small cell lung cancer (SCLC), and 44.2% had squamous cell
cancer (SCC). Percentage weight loss trends for patients with
adenocarcinoma showed a 9% loss from baseline till time of
diagnosis and a total of 15% loss posttreatments. Patients with
SCLC similarly showed a decline from 13% to 22%, and patients with SCC showed a 14% to 17% weight loss. Of the
total patients with > 10% weight loss over time, 48% were patients with adenocarcinoma, compared with 10% of patients
with SCLC, and 42% of patients with SCC. Average survival
for patients with adenocarcinoma was 420 days, for patients
with SCLC 321 days, and 492 days for patients with SCC.
Weight loss percentage was significantly related to survival in
all patients (r = -0.19, P < .01) and patient groups with adenocarcinoma (r = -0.25, P < .01) but not in patients with SCC or
Conclusions: Cancer cachexia trends in patients with lung
cancer are similar for patients with adenocarcinoma, SCLC,
and SCC; however, the percentage of weight loss may adversely impact survival in patients with SCLC.
22. Frequency of EGFR Mutations and
ALK Rearrangements in Pulmonary
Carcinomas at the Minneapolis VA
Manivel JC, Aslan D
Purpose: To evaluate the frequency of molecular testing in
Background: Pulmonary carcinoma represents the second
most common type of new malignancies in males and females. Although its incidence is plateauing, it represents the
20. Brentuximab Vedotin in a Patient
With Aggressive Systemic Mastocytosis
and Pure Red Cell Aplasia
Cooper K, Richter J, Reder N, Henry E, Phelan K,
Czerlanis C, Bhoopalam N
Backround: Mastocytosis is a rare disease with a variable clinical course. Pure red cell aplasia has not been frequently reported in association with aggressive systemic mastocytosis.
CD30 is often expressed on mast cells in systemic mastocytosis. The CD30-directed antibody-drug conjugate brentuximab
vedotin has shown in vitro activity against CD30-positive neo-plastic mast cells. We describe a case of systemic mastocytosis with the development of severe hemolytic anemia, pure red
cell aplasia, and evidence of weak bone marrow CD30 posi-tivity. Brentuximab vedotin was administered with some evidence of clinical benefit.
Patient: A 64-year-old man presented with fatigue and a
20 pound weight loss. He was found to have transfusion-de-pendent anemia, a low reticulocyte count, and splenomegaly.
Evaluation for gastrointestinal blood loss was unremarkable.
Bone marrow biopsy showed mast cell aggregates, spin-dle-shaped mast cells, CD-2 and CD25-positivity, increased
myelopoiesis and dysmegakaryopoiesis, red cell aplasia, eosinophilia, and increased reticulin fibrosis. The D816V c-kit
mutation was present, and serum tryptase level was elevated
at 114 ng/mL. He later developed Coombs-positive hemolysis
and direct hyperbilirubinemia, concerning for mast cell liver
Intervention: The patient received high-dose steroids and red
blood cell transfusions. Interferon alpha and cladribine were
contraindicated, given severe liver dysfunction. He was started
on hydroxyurea. He received a dose of brentuximab vedotin
1.8 mg/kg IV. Thirteen days after starting steroids and 10 days
after brentuximab, haptoglobin became detectable, and total bilirubin decreased to 18.4 mg/dL from 40.5 mg/dL. Red blood cell
transfusion requirements decreased. He then developed severe
neutropenia, pneumonia with sepsis, and respiratory failure, requiring intubation, maximal pressor support, and broad-spectrum antibiotics. Despite these measures, he expired.
Discussion/Conclusion: This is a rare case of pure red cell
aplasia in the setting of aggressive systemic mastocytosis.
Therapeutic options were limited in the setting of liver dysfunction, and therapy with brentuximab vedotin resulted in
initial clinical benefit. Brentuximab vedotin is being investigated in patients with advanced systemic mastocytosis or mast
21. Cancer Cachexia and Survival
in Patients With Lung Cancer by
Histology: Who Is Most at Risk?
Simeunovic K, Gavrancic T, Malhotra S,
Huang K, Vinnakota R, Villanueva N, Dietz D,
Fenn K, Biswas A, Beck K, Coker C, Halmos B,
Park Y-HA, Acharyya S