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G. Jiang



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    P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P2.02-013 - Strategy of Management for Synchronous Pure GGOs Detected in Patients Undergoing Resection for Primary NSCLC (ID 2599)

      09:30 - 17:00  |  Author(s): G. Jiang

      • Abstract

      Background:
      It is quite common to discover some synchronous pure ground-glass opacity (GGO) nodules in other lobes beside the operable primary tumor on initial CT scans, while the appropriate surgical strategy for these pure GGOs remains controversial.

      Methods:
      We included patients with primary tumor lesion and pure GGOs in different lobes between June 2010 and December 2013. The radiographic manifestations of all GGOs, pathologic features of resected GGOs and follow-up outcomes of unresected GGOs were analyzed to make clear which GGOs should be resected concomitantly with the primary tumor.

      Results:
      A total of 59 patients with 72 pure GGOs were included, of which, 29 were resected at the primary surgery and 43 were left behind and followed up. In the resection group, 8 (27.6%) were invasive or minimally invasive lesions, 12 (41.4%) were preinvasive lesions and 9 (31%) were benign lesions. In the follow-up group, 7 nodules grew, and the growth rate was 16.3% (7 of 43) on a per-nodule basis, and 19.4% (7 of 36) on per-person basis. In all, concomitant resection at the primary surgery was considered for 15 of 72 GGOs (8 malignant lesions and 7 growth lesions). Multivariate analysis showed that the initial size was an independent risk factor for these GGOs (P=0.011), and a cut-off value was calculated as 9.9 mm by receiver operating curve (ROC) curve analysis. Tabel Predictors for synchronous GGO nodules which need concomitant resection

      Univariate analysis Multivariate analysis
      P value OR P value OR
      Age at operation 0.056 1.075 0.872 1.01
      Sex 0.279 0.527
      Smoking 0.136 2.667
      Size <0.001 18.733 0.011 10.922
      Location
      LUL Reference
      LLL 0.345 0.333
      RUL 0.217 0.381
      RML 0.577 1.778
      RLL 0.886 0.889
      Location of primary lesion
      Ipsilateral Reference
      Contralateral 0.334 1.8
      Shape
      Round Reference
      Oral 0.584 1.625
      Irregular 0.349 2.275
      Margin
      Smooth Reference
      Lobulated 0.629 1.4
      Spiculated 0.125 3.111
      Air bronchogram 0.001 8 0.355 2.199
      Bubble lucency 0.024 6.545 0.274 3.356
      Pleural tag 0.006 6.933 0.175 3.724
      Figure 1



      Conclusion:
      About 20% of synchronous pure GGO nodules should need surgical treatment at the time of primary operation, and a lesion size of more than 9.9 mm is an effective discriminator of these GGOs. As to the unresected GGOs, a close follow-up is always indispensible.

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    P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P3.03-017 - Interim Overall Survival of Neoadjuvant Erlotinib Intercalated with Gemcitabine/Cisplatin for IIIA N2 NSCLC Patients: A Phase II Study (ID 1743)

      09:30 - 17:00  |  Author(s): G. Jiang

      • Abstract

      Background:
      The optimal treatment for locally advanced stage IIIA non-small cell lung cancer (NSCLC) disease is not well established although neoadjuvant chemotherapy showed active results in stage IIIA N2 pts. A few case reports also indicate the advantages of neoadjuvant erlotinib. FASTACT II study showed that the regimen of erlotinib intercalated with chemotherapy improved PFS and OS in an unselected advanced NSCLC population of east Asian patients. Here we report the interim overall survival (OS) results of a phase II study which was to assess the efficacy and safety profile of erlotinib intercalated with gemcitabine/cisplatin as neoadjuvant treatment in stage IIIA N2 NSCLC pts.

      Methods:
      Patients with untreated stage IIIA bulky N2 NSCLC and ECOG PS 0/1 were enrolled to received up to 2 cycles of gemcitabine 1,000 mg/m[2] on days 1 and 8 and cisplatin 75 mg/m[2] on day 1 or carboplatin AUC=5 d1, followed by oral erlotinib (150 mg, once a day) on days 15 to 28 as neoadjuvant therapy. A repeat computed tomography (CT) scan evaluated the response after induction therapy and eligible patients would undergo surgical resection. The primary endpoint was ORR which was reported in 2013 WCLC. The secondary endpoints included pCR, resection rate, DFS (disease free survival) and OS (overall survival), safety, QoL and biomarker analyses.

      Results:
      Between March 2011 and December 2012, a total of 39 patients (29 male, median age 59.0 years; range 34.0 to 74.0 years) were enrolled in the study, in which 36 patients ( 92.3%) had completed 2-cycle erlotinib neoadjuvant treatment. For pathologic type, 13 pts were adenocarcinoma, 18 pts were squamous carcinoma, and 8 pts were other types. One patient withdrew from the study and one patient was lost in the follow-up. Twenty-two (56.4%, 22/39) patients underwent surgical resection after erlotinib neoadjuvant treatment. Till Jan 15, 2015, the median follow up duration was 24.4 mo (range 5.5 to 43.7 mo). To the cut-off date, 22 patients (56.4%) died. The median OS for total 39 patients was 29.0 mo (Figure 1A, range 3.4 to 43.7 mo). The median OS for those no surgery pts was 17.0 mo (range 6.1 to 39.8 mo) while the median OS is not matured ye for those pts who received surgery (Figure 1B).Figure 1



      Conclusion:
      Neoadjuvant erlotinib intercalated with gemcitabine/cisplatin brought clinical benefits by extending overall survival for stage IIIA N2 NSCLC pts.