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S. Wang



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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): S. Wang

      • 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  |  Author(s): S. Wang

      • 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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      100P - Prognostic factors in surgically resected N2 small cell lung cancer: Significance of the subcarinal node (ID 316)

      12:30 - 13:00  |  Author(s): S. Wang

      • Abstract

      Background:
      Surgical resection is being increasingly used for stage IIIA-N2 small cell lung cancer (SCLC). The aim of this study was to determine the prognostic factors in patients with pathologic N2 (pN2) stage IIIA SCLC.

      Methods:
      A retrospective analysis of 163 consecutive patients with pN2 stage IIIA SCLC who underwent pulmonary resections and systemic lymphadenectomies was conducted. Potential clinicopathological factors that could influence OS were statistically analyzed. The prognostic significance was examined by Cox regression analysis.

      Results:
      The median overall survival (OS) was 10.6 months. Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (p = 0.003). With respect to the station of lymph node metastasis, the OS was only related to the involvement of the subcarinal node, regardless of tumor location (p < 0.05). Multivariate analysis showed two statistically significant risk factors for survival, including multiple-station lymph node and subcarinal node metastasis (hazard ratio [HR] = 1.76, 95% confidence interval [CI]:1.11–2.78, p = 0.015; HR = 1.61, 95% CI: 1.03–2.50, p = 0.036, respectively).

      Conclusions:
      We found multiple-station N2 metastases and subcarinal node involvement were independent prognostic factors for worse survival in pN2 stage IIIA SCLC patients, which may be helpful to identify a valid subpopulation of N2 patients who can benefit from surgical intervention and guide postoperative adjuvant therapy.

      Clinical trial identification:


      Legal entity responsible for the study:
      Shanghai Chest Hospital

      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  |  Author(s): S. Wang

      • 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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