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K. Hotta
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P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.01-010 - Development of Skin Rash within the First Week Is a Potential Surrogate Marker of Effect in Afatinib for EGFR Mutant NSCLC (ID 1184)
09:30 - 17:00 | Author(s): K. Hotta
- Abstract
Background:
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are now key agents in EGFR-mutant non-small-cell lung cancer (NSCLC). In gefitinib or erlotinib monotherapy, its efficacy could be predicted by development of skin rash, however, it has not been fully evaluated if this is similarly the case with afatinib monotherapy.
Methods:
We retrospectively studied consecutive 49 patients with EGFR-mutant NSCLC who received afatinib therapy between 2009 and 2015. Relationship with several toxicities and tumor response was examined.
Results:
Figure 1Figure 2The Grade 2 or worse common adverse events (AEs) included skin rash in 17 patients (35%), diarrhea in 19 (39%) and mucositis in 15 (31%). Of these, number of patients who developed ≥ Grade 2 AEs within the first week was 5 (10%; skin rash), 12 (25%; diarrhea) and 4 (8%; mucositis). As for objective response, 21 (43%) of the 49 had partial response. In association with AEs and antitumor effect, those who had Grade 2 or worse skin rash within the first week tended to have better tumor response as compared with those who did not have (80% vs. 39%; p = 0.077).
Conclusion:
Our small study demonstrated that early development of skin rash might predict the response to afatinib monotherapy.
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-013 - A Phase II Study of S-1 and Thoracic Irradiation for Elderly Pts with Locally Advanced Non-Small Cell Lung Cancer: Okayama Lung Cancer Study Group (ID 224)
09:30 - 17:00 | Author(s): K. Hotta
- Abstract
Background:
Although thoracic irradiation (TRT) is one of the standarad therapies in elderly pts with locally advanced non-small cell lung cancer (LA-NSCLC), its treatment outcome is still poor. We previously reported safety profiles of S-1, an oral fluoropyrimidine possesing a radio-sensitizing effect, and concurrent TRT in such population [Lung Cancer 2011]. Here, we investigated the efficacy and safety of S-1 with concurrent TRT for elderly pts with LA-NSCLC.
Methods:
Pts with stage III, aged >75 years and PS 0-1, and without any prior chemotherapy were eligible for this study. Pts were treated with S-1 (40 mg/m2/dose b.i.d on days 1-14 and 29-42) and TRT (60 Gy/30 fr over 6 weeks starting on day 1). Primary endpoint was response rate (RR), and required sample siza was 30 pts.
Results:
Between 2007 and 2012, 30 pts were enrolled (24 men; median age, 79 years; PS 1, 15; IIIa, 20; Sq, 12). Median Charlson score was 1 (range; 0-3). The proportion of actual dose schedule relative to the planned one of S-1 and TRT was 95 and 98%, respectively. Partial response was observed in 19 pts (63%; 95% confidence interval: 45-82%), which did not meet the endpoint. At the time of the analysis, 24 (80%) of the 30 had experienced recurrences; 13 (43%) were locoregional, 6(20%) distant, and 5 (17%) both locoregional and distant. At a median follow-up of 23.7 months, median progression-free survival and MST were 13.0 months and 27.9 months, respectively. Toxicities were generally mild, including G3/4 neutropenia (17%), G3 febrile neutropenia (7%) and G3 pneumonitis (10%). No toxic deaths occurred.
Conclusion:
This study did not meet the primary endpoint. However, concurrent S-1 and TRT yielded favorable survival data. Also, it was well-tolerated in elderly pts with LA-NSCLC
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-014 - Interleukin-6 Is a Valuable Predictive Marker for Therapeutic Effect of Gefitinib in Patients with Advanced NSCLC Harboring EGFR Mutations (ID 1187)
09:30 - 17:00 | Author(s): K. Hotta
- Abstract
Background:
Although epidermal growth factor receptor (EGFR) -tyrosine kinase inhibitors (TKIs) are the key drug in patients with EGFR-mutant Non-small-cell Lung Cancer (NSCLC), some of them can not respond well to its therapy. An overexpression of Interleukin (IL)-6 in tumor cells is postulated as a potential mechanism for such resistance or low sensitivity to EGFR-TKI in the preclinical models (PNAS 2010). Here, we evaluated clinically if tumor IL-6 level can be predictive for the effect of EGFR-TKI therapy.
Methods:
A total of 52 patients with advanced EGFR-mutation NSCLC who had received gefitinib were retrospectively assessed. The protein expression of IL-6 in the tumor cells was immunostained. Each specimen was assessed independently by 2 physicians (YK and TT) and 2 pathologists (KI and TT), and judged as positive if ≥ 50% of 100 tumor cells were stained positively (BJC 1999). Serum IL-6 level was measured by CLEIA in 11 (21%) of 52 patients.
Results:
Patients demographics were as follows: 24 men; median age, 66 yrs; PS 0-1, 48; stage IV, 22; Ad, 49; exon19, 29). Of these, 24 (46%) and 28 (54%) were defined as IL-6-postitive (group P) and IL-6-negative (group N), respectively. Group P had worse PFS (75% v 92% at 6m; p < 0.05), which was retained in the multivariate analysis (HR: 2.38; 95%CI: 1.00-5.68; p=0.05) (Fig1). In contrast, PFS in the platinum-based chemotherapy did not differ in groups P and N (p=0.47). The serum IL-6 level ranged from 0.75 to 23.80 pg/ml (median: 2.90 pg/ml), which correlated neither to that in the tumor cells (regression coefficient: 1.69, p = 0.29) nor PFS in gefitinib therapy (p = 0.44). Figure 1 Figure 2
Conclusion:
Patients in group P benefited less from gefitinib therapy. This might suggest the inhibition of IL-6 expression can improve the low sensitivity to EGFR-TKI especially in EGFR-mutation tumors with high IL-6 expression.
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P3.01-020 - Updated Data from JP28927 Study of Alectinib in ALK+ NSCLC Patients with or without History of ALK Inhibitor Treatment (ID 346)
09:30 - 17:00 | Author(s): K. Hotta
- Abstract
Background:
Alectinib, a next generation ALK inhibitor, was granted approval in Japan 2014, since it showed good efficacy and tolerability in ALK+ NSCLC patients without previous ALK inhibitor treatment in Phase I/II study (AF-001JP). We also reported its promising response and good tolerability for crizotinib pre-treated patients in JP28927 study (ESMO 2014). This report describes the update of efficacy and safety result in JP28927 study.
Methods:
Patients (with/without prior ALK inhibitor treatment) who had ALK+ NSCLC were enrolled in JP28927. Patients received alectinib (300mg) twice daily; treatment was continued until the investigator determined lack of clinical benefit.
Results:
Thirty-five patients were enrolled into JP28927 study. Median follow-up duration was 400 days (35-457 days). The median progression free survival (PFS) of 35 patients was 13.9 months (95%CI: 11.1- NR). Among 30 patients with the target lesions at base line, the overall response rate (ORR) was 70% (95%CI: 50.6-85.3) with rapid response (the median time to response was 1.2 months [95%CI: 1.1-2.1]). Twenty-three out of 35 patients had been confirmed the progressive disease with crizotinib treatment. Their median PFS was 12.9 months (95%CI: 3.9-NR). Twenty out of 23 patients had the target lesions at base line. ORR was 65% (95%CI: 40.8-84.6) and the median time to response was 1.2 months (95%CI: 1.1-1.3). The treatment-related adverse events (AEs) observed in more than 10% of the patients were constipation (31.4%), dysgeusia (25.7%), WBC count decreased (22.9%), neutrophil count decreased (22.9%), vomiting (14.3%), rash (14.3%), blood bilirubin increased (14.3%) and AST increase (14.3%). Treatment-related Grade 3 AEs, i.e. pulmonary thrombosis, lymphocyte count decrease, hypophosphatemia, were observed in 3 patients. No treatment-related Grade 4 or 5 AEs were observed.
Conclusion:
The updated results in JP28927 study once again endorsed our previous reports which had indicated alectinib’s promising response even for ALK+NSCLC patients who failed to crizotinib treatment.
