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T. Oguma

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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
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      P1.01-046 - Characteristics of Complete Remission Cases in Advanced Non-Small Cell Lung Cancer (ID 419)

      09:30 - 17:00  |  Author(s): T. Oguma

      • Abstract
      • Slides

      Various types of chemotherapies have been extensively investigated in advanced non-small cell lung cancer (NSCLC). Although median survival times have been getting long, the outcomes remain poor. This study aimed to analyze the characteristics of those with complete remission among advanced NSCLC patients.

      Based on our hospital database, 1,699 patients who were registered as lung cancer between August 2004 and April 2011 were examined, and Stage III or IV NSCLC patients, whose treatment began between September 2004 and April 2011, were retrospectively evaluated at September 2014. We defined complete remission as a continuous complete response observed in spite of the treatment initiation over three years ago, regardless of treatment continuation.

      Seven patients were observed. Two patients were at stage IIIA, one at stage IIIB, and four at stage IV. The treatment modalities included cytotoxic chemotherapy only (one patient), chemotherapy and EGFR-TKI followed by surgery (one patient), radiosurgery for brain metastasis followed by surgery and chemotherapy (one patient), and chemoradiation (four patients). Three patients had adenocarcinoma, three squamous cell carcinoma, and one large-cell carcinoma. The numbers according to survival time since the date of treatment initiation were two (between three and four years), three (between four and five years), and two (over five years). All cases had complications of inflammatory diseases. In case 1, an acquired immunological response against lung cancer was suggested. The patient had rheumatoid arthritis and stage IV adenocarcinoma with massive pleural effusion, treatment was only 1 course of vinorelbine, and sepsis occurred after chemotherapy. After that, complete remission has been achieved. Acquired cancer immunity was also suggested in case 2, who had stage IV adenocarcinoma with cardiac tamponade. Pericardial drainage was done and three courses of cisplatin and gemcitabine were administered, followed by EGFR-TKI. Gefitinib have continuously been used for four years, however the tumor in the right upper lobe had gradually getting large. The tumor was resected, while EGFR mutation was negative and many inflammatory cell infiltrations were observed. In case 3, oligo-metastatic states have been controlled by surgery and radiation. The patient had stage IV large cell carcinoma with a brain metastasis, the primary pulmonary lesion was surgically removed after cyber-knife therapy. Chemotherapies were started. Oligo-metastatic new brain lesions were firstly cyber-knife therapies, and the relapsed or new lesions were removed by brain surgeries. After the brain surgery, encephalitis and meningitis developed. Many inflammatory cells were observed around and inside the brain tumor. Finally, the brain tumors and the pleural dissemination disappeared. In case 4, who had stage IIIA adenocarcinoma with bulky N2, PET-assisted three-dimensional conformal radiation therapy was used to control oligo-metastases. The tissue types of chemoradiation-induced complete remission were squamous cell carcinoma in three patients and adenocarcinoma in one patient.

      These results suggest that complete remission can be achieved for several types of advanced NSCLC by employing combinations of treatment modalities. Oligo-metastatic states could be controlled by surgery and radiation therapies with or without chemotherapies. The acquired immune response against lung cancer might be important to induce complete remission.

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