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M. Schipper



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    MO25 - NSCLC - Combined Modality Therapy II (ID 112)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Mesothelioma
    • Presentations: 1
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      MO25.10 - A Phase II trial of mid-treatment FDG-PET adaptive, individualized radiation therapy plus concurrent chemotherapy in patients with inoperable non-small cell lung cancer (NSCLC) (ID 3461)

      10:30 - 12:00  |  Author(s): M. Schipper

      • Abstract
      • Presentation
      • Slides

      Background
      We hypothesized that individualized radiation treatment targeting to the FDG-avid tumor identified mid-treatment would improve local tumor control.

      Methods
      This is a phase II trial for patients with inoperable/unresectable NSCLC. Conformal radiotherapy (RT) was given in 30 daily fractions. RT dose was individualized to a fixed rate of grade >2 lung toxicity and adaptively escalated to the residual tumor on mid-tx FDG-PET upto a total dose of 86 Gy. Patients were given concurrent weekly followed by consolidation carboplatin/paclitaxel. The primary endpoint was local-regional tumor control (LRTC) and local-regional progression free survival (LRPFS) at 2 years.

      Results
      42 patients were enrolled: median age 63 years (range 45-83); 28 (67%) male; 39 (93%) smokers; 38 (92%) stage III; and 45% squamous cell. Median physical dose reached was 83 Gy (range 63-86 Gy), equivalent to 90 Gy in 2 Gy fractions (biological effective dose 107 Gy). Minimum and median follow-up were 9 and 27 months, respectively. The 2-year rates of in-field LRTC, overall LRTC, and LR-PFS were 84% (62-94%), 61% (39-77%), and 37% (22-52%), respectively. 15 patients progressed: 2 (13%) at primary tumor alone; 4 (27%) first at distant sites alone; 2 (13%) at nodal regions alone; 5 (33%) at both distant sites and nodal regions; 1 (7%) at both distant site and primary tumor; 1 (7%) at both nodal region and primary tumor. Median overall survival was 22 months (10-33 months) and 2-year overall survival rate was 49% (32-63%). These results compared favorably to stage-matched patients treated with standard-dose RT in our center 2-year overall survival 23% (8-41%) during the same time period.

      Conclusion
      Adapting RT by targeting high dose radiation to the FDG avid region detected mid-treatment provides outstanding 2-year local-regional tumor control. RTOG 1106 is currently testing this regimen in a randomized fashion.

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    P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.06-041 - Serum miRNA signature predicts survival in patients with unresectable/inoperable non-small cell lung cancer treated with definitive radiation therapy (ID 2785)

      09:30 - 16:30  |  Author(s): M. Schipper

      • Abstract

      Background
      The expression profiles of serum micro RNAs (miRNAs) are known to predict overall survival (OS) of metastatic and operable non-small cell lung cancer (NSCLC). We hypothesized that circulating miRNAs is also correlated with survival in unresectable/inoperable NSCLC treated with radiation therapy (RT).

      Methods
      134 patients with inoperable/unresectable NSCLC treated with definitive RT (18-month minimum follow-up) were eligible. Serum samples were collected prospectively before RT commencement. 100 patients with enough serum and reliable miRNA profile quality were randomly divided into training and validation sets (50 patients each). MiRNA profiling was performed using real-time PCR-based array, containing a panel of 84 miRNAs detectable in human bodily fluids. Spiked-in cel-miR-39 was used for normalization. Stepwise regression Cox model building was used to build a miRNA signature on the training set, which was then assessed on the validation set both alone and with clinical factors.

      Results
      The median age was 67 years; 76% were stages III and 79% received chemoradiation; the median physical dose was 70 Gy. Stepwise regression modeling identified five miRNAs as jointly significant predictors. Using coefficients from Cox model fit, the miRNA signature was 0.53*log(hsa-miR-15b)+0.21*log(hsa-miR-34a)-0.27*log(hsa-miR-221)-0.27*log(hsa-miR-224) -0.07*log(hsa-miR-130b). This signature was a significant predictor of OS in the validation set (p=0.011). It retained statistical significance in a model also containing terms for GTV Volume and KPS, the only two significant clinical factors in univariate analysis in the validation set (p=0.012). Using computational methods (TargetScan6.2) for miRNA target prediction, the putative targets of these five miRNAs are known to modulate apoptosis, cell cycle control, DNA damage response and repair process (including nucleotide excision repair and DNA translesion synthesis), angiogenesis and epithelial-mesenchymal transition.

      Conclusion
      In this study, we developed a prognostic miRNA signature consisting of five miRNAs and validated in an independent dataset for unresectable/inoperable NSCLC treated with RT. This circulating miRNA signature may be used as a non-invasive biomarker, which may have prognostic or therapeutic implications for the future management of locally advance NSCLC patients. Larger sample size studies are needed to further validate our findings.