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C. Tang



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    P1.06 - Poster Session 1 - Prognostic and Predictive Biomarkers (ID 161)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P1.06-005 - The Clinical Significance of Serum BAP, TRACP 5b and ICTP as Bone Metabolic Markers for Bone Metastasis Screening in Lung Cancer Patients (ID 826)

      09:30 - 16:30  |  Author(s): C. Tang

      • Abstract

      Background
      The early diagnosis of bone metastasis (BM) may bring improvements of life quality and treatment to cancer patients. Although single-photon emission computed tomography (SPECT) is the most frequently used method for BM screening, it still has some shortages. This study was initiated to investigate the clinical significance of serum BAP, TRACP 5b and ICTP as bone metabolic markers for BM screening in lung cancer patients.

      Methods
      Newly diagnosed advance lung cancer patients with (N=130) and without (N=135) BM were enrolled in present study. In addition, newly diagnosed primary lung cancer patients (N=38) were enrolled as control. Serum BAP, TRACP 5b and ICTP were measured using enzyme-linked immunosorbent assay (ELISA) before the initiation of treatment. The differences in concentration of BAP, TRACP 5b and ICTP were analyzed by one-way analysis of variance (ANOVA) (or Kruskal-Wallis tests when appropriate). The screening effectiveness of BAP, TRACP 5b, ICTP and the combination of TRACP 5b and ICTP was assessed by receiver operating characteristic (ROC) curves analysis in patients with and without BM.

      Results
      For concentrations of BAP, TRACP 5b and ICTP, significant differences was found between patients with and without BM (all P<0.0001), as well as patients with solitary and multiple BM (BAP: P<0.0001, TRACP 5b: P=0.0008, ICTP: P=0.0474). ROC curves analysis reveals the area under curve (AUC) of BAP, TRACP 5b and ICTP was 0.760, 0.753 and 0.835 (all P=0.0001), respectively. The optimal cut-off value for BAP, TRACP 5b and ICTP was 21.8 μg/L (sensitivity=63.1%, specificity=77.0%), 7.8 U/L (sensitivity=58.5%, specificity=80.7%) and 8.8μg/L (sensitivity=63.1%, specificity=90.4%), respectively. When TRACP 5b and ICTP was combined for BM screening , AUC was elevated to 0.895 (P=0.0001), and the optimal cut-off value was TRACP 5b > 7.6 U/L and ICTP >8.4μg/L (sensitivity=71.5%, specificity=93.3%).

      Conclusion
      Our research has demonstrated that serum BAP, TRACP 5b and ICTP may serve as a useful supplement for SPECT in lung cancer BM screening. If the 3 markers can be properly used together with SPECT, BM screening would turn to be more timely and accurate.

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    P2.11 - Poster Session 2 - NSCLC Novel Therapies (ID 209)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.11-003 - How to make the choice in the reuse of EGFR-TKI for advanced NSCLC patients who benefited from prior Gefitinib therapy: the original drug or switching to a second EGFR-TKI? (ID 831)

      09:30 - 16:30  |  Author(s): C. Tang

      • Abstract

      Background
      For advanced NSCLC patients who benefited from prior EGFR-TKI therapy, the choice of a second TKI therapy has gradually become a new strategy for the treatment. Some investigators recommend that the second therapy should be continued with the original TKI; however, other investigators recommend the administration of another TKI. This study aims to discuss which choice is more reasonable.

      Methods
      In retrospect, patients with advanced NSCLC or with postoperative relapse of advanced NSCLC achieved CR, PR or SD in prior Gefitinib therapy, PFS≥3 months. They received repeated Gefitinib or Erlotinib at an interval of at least one month. The analysis was carried out with respect to efficacy and optimal population of the two groups.

      Results
      A total of 61 patients were enrolled into the study, 30 in Gefitinib group and 31 in Erlotinib group. Baseline characteristics of the two groups were comparable. Among these patients, overall response rate was 16.4% (10/61), disease control rate was 67.2% (41/61), median PFS was 3.5 months (95%CI 3.0-4.0 months), median OS was 8.5 months (95%CI 7.0-11 months). In the comparison between patients treated with Gefitinib and with Erlotinib, no statistical differences were seen for response rate (10% vs 22.6%, P=0.3006), disease control rate (60% vs 74.2%, P=0.2378), median PFS (3.0 vs 3.5 months, P=0.4945), or median OS (8.3 vs 8.5 months, P=0.1408). Multivariate analysis showed that in the initial dose of Gefitinib, PFS≥6 months (HR 0.317, 95%CI 0.102-0.984, P=0.0469). With an interval ≥3 months (HR 0.224，95%CI 0.071-0.713,P=0.0113) between two doses of TKI, the risk of disease progression was reduced; but if with an interval ≥3 months (HR 0.262, 95%CI 0.097-0.705,P=0.0080), the risk of death was reduced.

      Conclusion
      Advanced NSCLC patients who benefited from prior Gefitinib therapy can benefit again either with the original drug Gefitinib or the alternative drug Erlotinib when a second TKI therapy is resumed. Such benefit is related to PFS of initial TKI therapy and time interval between two doses of TKI.