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D. Vicente Baz
P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
P1.01-007 - Treatment with EGFR-TKIs in Non Small Cell Lung Cancer Patients. The Impact of EGFR Mutations (ID 2573)
09:30 - 17:00 | Author(s): D. Vicente Baz
Patients with advanced stage of non small cell lung cancer (NSCLC) have been treated with few platinum-doublets in first-line. Most of them are observed for disease progression wich is followed by second-line therapy in proper patients. Maintenance therapy were introduced, with either biologic or chemotherapeutic agents, given after first line treatment, trying to prevent progression and increasing progression-free survival (PFS). Ten years ago, somatic mutations in epidermal growth factor receptor (EGFR) were identified in patients with NSCLC, those targeted agents, used previously as maintenance, were seen to inactivate specific mutated proteins, and treatment of them has changed. For patients with lung adenocarcinoma and activating EGFR mutations who received EGFR TKIs median overall survival (OS) ranges between 24 and 30 months contrasts with the plateau of 10 months reached with first line platinum-based chemotherapy in populations not selected by molecular profiling.
We analyze all patients attended in our hospital with NSCLC, who had received EGFR-TKI since 2010. Continuous variables were summarized as arithmetic means, medians and standard deviations. Categorical variables were reported as proportions with 95% confidence intervals (95% CI). OS were measured from the day of EGFR TKI treatment to the date of death and analyzed with the Kaplan-Meier technique,
The amount of patients were 53. EGFR mutation was detected in 46 (86,8%) patients. The median patient age was 62.8 ± 19 years, 58.5% were women, 41.5 % had a history of non-smoking and 73% had adenocarcinoma histology. Six types of EGFR gene mutations were found: delection in exon 19, exon 18 (G719), exon 20(T790 and S768I),exon 21 (L861Q and L858R). There were 17 (32%) patients with exon 19 delection, 7 (13.2%) patients with exon 18 G719 mutation, 4 (7.5%) and 13 (24.5%) patients with exon 21 L861Q and L858R respectively, 4 (7.5%) with double mutation (two combinations of G719 and L861Q, one combination of G719 plus S768I, and one combination of delection in 19 exon and T790 mutation). Delection in exon 19 and L858R exon 21 mutations were higher in non-smoking patients (31.8% and 40.9%) and in women (35.5% and 32.3%). Mutations in exon 18 (G719) and delection in exon 19 -also- were higher in patients with smoking history (19.4% and 29%) and in men (18.2% and 22.7%). 79.2% received ITK as first line treatment and 1.9% as maintenance therapy. 50.9% had erlotinib, 43.4% had gefitinib and 3.8% received dacomitinib. 13 patients (24.5%) have recieved further lines of therapy including: chemotherapy, immunotherapy and second generation EGFR TKIs. Prognosis was worse in unkwoun mutations and in wild type tumors. OS was 25.8 months [11.4-40.2; IC 95%]
Treatment of patients with advanced NSCLC should be individualized, based on the molecular and histological features of tumours. When harbouring an activating EGFR mutation, first-line treatment should be with an EGFR TKI. Any avalilable agent can be used, until data from comparative studies may better guide TKI selection.
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