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B. Zhang



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    ESMO-IASLC Best Abstracts (ID 61)

    • Event: ELCC 2018
    • Type: Best Abstract session
    • Track:
    • Presentations: 1
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      91O - Adjuvant chemotherapy candidates in stage I lung adenocarcinomas following complete lobectomy: What does an analysis based on recurrence risk stratification tell us? (ID 435)

      16:45 - 18:30  |  Author(s): B. Zhang

      • Abstract
      • Presentation
      • Slides

      Background:
      The study aimed to (i) develop a recurrence risk-scoring model in stage I lung adenocarcinoma (LAD) after complete lobectormy; (ii) explore the high-risk population that would benefit from adjuvant chemotherapy (ACT).

      Methods:
      A retrospective study was performed on 4606 patients with pathologically confirmed stage I LAD who underwent complete lobectomy at Shanghai Chest Hospital from 2008 to 2014. Patients were categorized into the non-ACT group (n = 3514) and ACT group (n = 1092). The nomogram was developed in the non-ACT group using Cox proportional hazards regression to predict 5-year recurrence-free survival (RFS). The predictive value was compared between the nomogram and the 8[th] edition of TNM system. The population that benefited from ACT was determined by comparing RFS between the non-ACT and the ACT group as stratified by the TNM stage, risk score quartiles and 5-year recurrence probability, respectively. The optimal cut-off scores were determined using X-tile software.

      Results:
      Six independent predictors including age, gender, tumor size, pathological subtype, visceral pleural invasion (VPI), and lymphovascular invasion (LVI) were associated with recurrence. The nomogram showed a better accuracy in predicting RFS than the TNM staging [C-index: 0.784 (95% CI: 0.756–0.812) vs 0.719 (95% CI: 0.689–0.749), P = 0.0017]. A trend in ACT benefit was observed along with the increasing risk scores. An improved RFS was exhibited after ACT for patients having a 50% recurrence probability (P = 0.0286). The optimal cut-off of the risk score was set at 203 and 244. ACT was detrimental in patients with risk scores below 203 (P < 0.0001) and beneficial in those with risk scores above 245 (P = 0.0416). Patients with score ≥ 245 accounted for 0.4% of stage IA patients and 7.5% of stage IB patients, respectively. In stage IB, patients with predominant solid/micropapillary subtype (62.8%) was the subgroup with the most percentage of score ≥ 245.

      Conclusions:
      The nomogram provided a more accurate RFS prediction for lobectomized stage I LAD. High-risk population, determined as recurrence risk score ≥ 245, may benefit from postoperative ACT.

      Clinical trial identification:


      Legal entity responsible for the study:
      Shanghai Chest Hospital, Shanghai Jiao Tong University, China

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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    Immunotherapy and next-generation TKIs: From second to frontline treatment (ID 55)

    • Event: ELCC 2018
    • Type: Poster Discussion session
    • Track:
    • Presentations: 1
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      140PD - Complex epidermal growth factor receptor (EGFR) mutations and responses to tyrosine kinase inhibitors (TKIs) in advanced lung adenocarcinomas (ID 411)

      07:45 - 09:00  |  Presenting Author(s): B. Zhang

      • Abstract
      • Slides

      Background:
      Two or more different epidermal growth factor receptor (EGFR) mutations can be detected within a single tumor sample, which represents complex mutations. However, the frequency and efficacy of tyrosine kinase inhibitor (TKI) treatments for patients harboring these mutations are unknown.

      Methods:
      From January 2011 to January 2017, patients diagnosed with EGFR mutation were screened. The effectiveness of TKIs in patients with complex mutations was retrospectively analyzed.

      Results:
      A total of 16,840 subjects were screened, with 5898 positive patients. 187 patients (3.2% of all EGFR mutant patients) had complex EGFR mutations with 95 of advanced lung adenocarcinoma patients were treated with TKIs. The objective response rate (ORR) for patients who had Del-19 + 21L858R (Group A, n = 27), Del-19/21L858R + atypical mutations (Group B, n = 28), double atypical mutations (Group C, n = 20) and complex mutations with primary drug-resistant pattern (Group D, n = 20) were 72.7%, 54.2%, 66.7% and 15.0%, respectively. Median progression free survival (PFS) in the four groups were 18.2 months (95% CI, 12.0 months to 24.4 months), 10.1 months (95% CI, 6.5 months to 13.7 months), 11.1 months (95% CI, 6.8 months to 15.4 months) and 1.4 months (95% CI, 0.2 months to 2.5 months), respectively.

      Conclusions:
      These results suggest on the largest sample size that EGFR–TKI therapy is effective in patients with Del-19 + 21L858R, Del-19/21L858R + atypical mutations and double atypical mutations, but less effective in patients with primary drug–resistant pattern. Patients with the Del-19 + 21L858R mutations may therefore benefit more from treatment with first–generation TKIs.

      Clinical trial identification:


      Legal entity responsible for the study:
      Bo Zhang

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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    Poster Display session (Friday) (ID 65)

    • Event: ELCC 2018
    • Type: Poster Display session
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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      104P - Adjuvant chemotherapy may improve prognosis in surgically resected stage I NSCLC with lymphovascular invasion (ID 481)

      12:30 - 13:00  |  Author(s): B. Zhang

      • Abstract
      • Slides

      Background:
      The 8[th] edition of the TNM classification for non-small cell lung cancer (NSCLC) has recently been approved. Lymphovascular invasion (LVI) has been reported to be a strong risk factor for stage I patients. Meanwhile, the efficacy of adjuvant chemotherapy for surgically resected pathologic stage I NSCLC is controversial. This study aimed at exploring the association between adjuvant chemotherapy and survival in stage I NSCLC patients with LVI.

      Methods:
      A total of 2600 patients with stage I NSCLC treated in the Shanghai Chest Hospital (2008–2012) were included in the analysis, of which 221 were pathologically diagnosed with LVI. We divided these patients into an ACT (adjuvant-chemotherapy) group and a surgery alone group. By using the Kaplan–Meier method and Cox proportional hazard regression model, we explored whether lymphovascular invasion was a poor prognostic factor and the application of adjuvant chemotherapy could improve the prognosis.

      Results:
      For all stage I NSCLC patients, it was observed that patients with LVI had an unfavorable Lung-cancer specific survival (LCSS) (hazard ratio [HR]: 1.604; 95% confidence interval [CI]: 1.124–2.289; P = 0.009) and recurrence-free survival (RFS) (HR: 1.943; 95% CI: 1.491–2.532; P < 0.001). The presence of LVI was suspected to be correlated with larger tumor size, and adenocarcinoma. Analysis of 221 patients with LVI indicated an increased LCSS (HR: 0.31; 95% CI: 0.161–0.595; P < 0.001) and RFS (HR: 0.53; 95% CI: 0.530–0.286; P = 0.044) with adjuvant chemotherapy treatment. We saw significant differences in LCSS and RFS in patients treated with adjuvant chemotherapy with both stage IA and stage IB disease.

      Conclusions:
      For all stage I NSCLC patients, LVI was correlated with poorer prognosis, which was improved by adjuvant chemotherapy. Our preliminary study suggests that adjuvant chemotherapy might be an appropriate option for stage I NSCLC patients with LVI.

      Clinical trial identification:


      Legal entity responsible for the study:
      Wang Shuyuan

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      167P - Efficacy of pemetrexed-based chemotherapy in advanced lung adenocarcinoma patients with ROS-1 rearrangement (ID 413)

      12:30 - 13:00  |  Presenting Author(s): B. Zhang

      • Abstract
      • Slides

      Background:
      When chemotherapy is commenced as first-line treatment in advanced lung adenocarcinoma patients with ROS-1 rearrangement, it is unclear that which agent should be preferentially administered. The aim of this study is to compare the therapeutic efficacy of pemetrexed-containing (Pem-C) and non-pemetrexed-containing (Non-Pem-C) chemotherapy in these patients.

      Methods:
      We retrospectively identified patients who were demonstrated to be ROS-1 positive by multiplex reverse-transcriptase polymerase chain reaction (RT-PCR) between October 2014 and December 2016. Those who received platinum-based dual agent chemotherapy as palliative treatment were included for further analysis.

      Results:
      A total of 4596 consecutive individuals were screened and 55 eligible individuals were enrolled into this study. In first-line treatment, patients who received Pem-C treatment (n = 39) derived a higher objective response rate (ORR, 40.0% vs. 7.1%, P = 0.02) and progression-free survival (PFS1, 7.0 months vs. 3.9 months, P < 0.01) compared with those who received Non-Pem-C treatment (n = 16). However, in later-line treatment, progression-free survival (PFS2) was not statistically superior in the Pem-C group (3.1 months, 95% CI: 0.6–5.6 months) compared with the Non-Pem-C group (1.9 months, 95% CI: 0.1–3.1 months, P = 0.12).

      Conclusions:
      Pem-C treatment resulted in better clinical outcomes compared with other agents in patients with ROS-1 rearrangement when initiated as first-line treatment.

      Clinical trial identification:


      Legal entity responsible for the study:
      Bo Zhang

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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