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T. John
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MINI 16 - EGFR Mutant Lung Cancer 2 (ID 130)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:G.J. Riely, M.C. Garassino
- Coordinates: 9/08/2015, 16:45 - 18:15, Four Seasons Ballroom F3+F4
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MINI16.07 - AZD9291 in Treatment-Naïve EGFRm Advanced NSCLC: AURA First-Line Cohort (ID 1232)
16:45 - 18:15 | Author(s): T. John
- Abstract
- Presentation
Background:
AZD9291 is an oral, potent, irreversible epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) selective for both EGFR-sensitizing (EGFRm) and T790M resistance mutations. It has shown anticancer activity and manageable tolerability in patients with EGFRm advanced NSCLC that had progressed after EGFR‑TKI treatment.
Methods:
In this first-line expansion cohort (AURA, NCT01802632), patients received AZD9291 at 80 or 160 mg/day, in sequential dose groups. EGFRm status was determined locally and/or by central testing using the cobas EGFR Mutation Test. Other inclusion criteria included measurable disease, World Health Organization performance status (WHO PS) 0 or 1, and acceptable organ function; stable brain metastases were allowed. Safety, tolerability, and anticancer activity were assessed in these cohorts, to evaluate AZD9291 in the first-line treatment setting. The data cut-off was December 2, 2014.
Results:
Sixty treatment-naïve patients were enrolled; 30 patients in each dose group (80 or 160 mg/day). By central testing, EGFR mutation subtypes were: L858R 40%; exon 19 deletion, 37%; other EGFR-sensitizing mutations, 3%; and T790M, 8%. Baseline median age was 63.5 years; 25% of patients were male; 57%/43% had WHO PS 0/1, respectively; 72% were Asian and 23% Caucasian. Median treatment exposure at the 80 and 160 mg dose levels was 260 and 171 days, respectively. Fifty-two out of 60 patients remained on treatment at the data cut-off. Anticancer activity of AZD9291 is shown in Table 1. One-third (33%) of patients experienced Grade ≥3 adverse events; two patients had Grade 3 diarrhea and one patient had Grade 3 skin rash. New data from a 2015 data cut of the AURA first-line expansion will be available for presentation.Table 1. Anticancer activity findings in AURA first-line expansion
Endpoint Finding Objective response rate: Overall 70% (95% CI 57, 81) AZD9291 80 mg/160 mg 60%/80% Disease control rate: Overall 97% (95% CI 89, 100) AZD9291 80 mg/160 mg 93%/100% Progression-free survival: Median Not yet reached 3-month/6-month 93%/87% Events to date 7/60 (12% mature)
Conclusion:
AZD9291 has a manageable tolerability profile and is associated with promising anticancer activity in treatment-naïve patients with EGFRm advanced NSCLC. A Phase III study (FLAURA, NCT02296125) has been initiated to assess the efficacy and safety of AZD9291 in comparison with a standard-of-care EGFR-TKI (gefitinib or erlotinib) in the first-line setting.
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MINI 17 - WT EGFR, Angiogenesis and OMD (ID 131)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:R. Feld, R. Dziadziuszko
- Coordinates: 9/08/2015, 16:45 - 18:15, Mile High Ballroom 4a-4f
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MINI17.09 - Discussant for MINI17.06, MINI17.07, MINI17.08 (ID 3351)
16:45 - 18:15 | Author(s): T. John
- Abstract
- Presentation
Abstract not provided
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ORAL 13 - Immunotherapy Biomarkers (ID 104)
- Event: WCLC 2015
- Type: Oral Session
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:D. Kim, D. Grunenwald
- Coordinates: 9/07/2015, 16:45 - 18:15, Four Seasons Ballroom F3+F4
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ORAL13.06 - Programmed Death Ligand-1 (PDL-1) Expression in Non-Small Cell Lung Cancer (NSCLC): Analysis of a Large Early Stage Cohort; and Concordance of Expression in Paired Primary-Nodal and Primary-Metastasis Tumour Samples (ID 3226)
16:45 - 18:15 | Author(s): T. John
- Abstract
- Presentation
Background:
PDL-1 expression in NSCLC is frequently associated with response to PD-1 pathway inhibitor therapy. However, it is unclear whether PDL-1 expression status is maintained in nodes and distant metastases and further information is needed on the relationship between expression and patient and tumour characteristics and prognosis
Methods:
TMAs were constructed using 1mm cores (triplicate) of FFPE primary tumour from patients undergoing surgery with curative intent, from N2 nodal tumour (triplicate) and from metastatic NSCLC tumour (duplicate cores or single small sections). PDL-1 protein expression was measured using a validated, automated immuno-histochemical assay using the 28-8 monoclonal antibody (Dako, Carpinteria, CA), with samples categorised as positive when tumour cell membranes were stained to any intensity in 5% of assessable tumour in any core.
Results:
57 paired primary–metastasis cases were analysed: median age 64 years (33-56); 30 male (53%); adenocarcinoma 27 (47%) and squamous cell 15 (26%). Metastatic sites were: brain 27; trachea/bronchus/lung/pleura 17; chest wall/skin 5; lymph nodes 6. Seven cases were synchronous (6 brain) while the median interval between primary and metastasis for other cases was 1.3 years (range 0.2-8.5). Primary and metastatic tumour samples were PDL1 positive for 13 (23%) and 14 (25%) cases respectively and for 44 cases (77%) expression was concordant. Discordance with negative primary and positive metastasis was seen in 7 cases (12%), while 6 cases (11%) were positive in primary and negative in metastasis. Using assay cut offs of 1% and 50%, concordance was 63% and 89% respectively. Eight cases had more than one metastasis analysed and the primary and all metastases were concordant for 6 cases while 2 cases were positive in primary but negative in one of the metastases. TMAs from 518 primary cases were also analysed and data on 123 cases are currently available. Histology was adenocarcinoma 58 (47%) and squamous 38 (31%). Thirty seven cases (30%) were PDL1+. Of the 13 never or light (≤10 PY) smokers, only 2 (9%) were positive. Further data on all cases and matched primary-nodes will be presented.
Conclusion:
PDL1 expression in ≥5% tumour cell was seen in 30% of cases. Concordance of expression in matched primary and metastasis was seen in 77% of cases. These data suggest that if PDL-1 expression status is critical in the decision to treat metastatic NSCLC with a PD-1 pathway inhibitor, then re-biopsy of a metastasis may be warranted.
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-061 - Comparison of MET Expression in Primary and Corresponding Nodal and Distant Metastases in Non-Small Cell Lung Cancer (NSCLC) (ID 2430)
09:30 - 17:00 | Author(s): T. John
- Abstract
Background:
Hepatocyte Growth Factor and its corresponding receptor MET are potential therapeutic targets for NSCLC. In NSCLC MET is over expressed, activated and mutated and is involved in resistance to tyrosine kinase inhibitors. A high proportion of primary NSCLC cases show elevated MET expression on immunohistochemistry (IHC), however, it is not clear whether expression changes during the metastatic process. We investigated paired NSCLC tumour samples to determine whether MET receptor expression differs in the primary and its corresponding lymph node and distant metastases.
Methods:
Tissue Microarrays (TMAs) were constructed using 1mm cores of primary and metastatic matched NSCLC archival paraffin tissues in triplicate. For IHC, TMAs were stained with the SP44 clone (Ventana) and an H-score calculated based on the percentage of cells stained and their intensity with a minimum of 0 and maximum of 300. The mean of values from multiple cores was calculated. Two independent scorers assessed the tissues. Discordance was defined as an H-score difference of greater than 100 between the primary tumour and its metastasis.
Results:
61 patients with primary and matched distant metastasis were included in the main analysis with 38 (62%) male and brain the most common site of metastasis (27/61, 44%). The histology was adenocarcinoma in 26 patients, squamous cell in 21 and large cell, undifferentiated or mixed in 14. The median H-score was 100 in primary tissue and 120 in metastatic tissue. Brain secondaries showed the highest median H-score (140) compared with other metastatic sites (105). MET concordance was present in 50/61 cases (82%). MET discordance was found in 11/61 tumours including 6/26 (23%) of adenocarcinomas, 2/21 (10%) of squamous carcinomas and 3/14 (21%) of mixed or large cell tumours. Discordant elevation in metastases was present in 6/61 (10 %) and reduction in 5/61 (8%). MET FISH data was available for 54/61 of primary tissues and 60/61 of metastasis. MET was amplified only in 2/61(3%) cases, seen in both primary and secondary tissues, associated with strong positivity on IHC. An additional 75 patients had matched primary and lymph node metastasis MET IHC and FISH data available. High rate of concordance, 66/75 (88%) also was present in this nodal cohort. The median H-score was 100 in primary tissue and 117 in nodal metastatic, similar to the main primary and distant metastatic group. MET discordance between primary and nodal secondary was found only in 9/75 (12%) with discordant elevation in 4/75 (5%) and discordant reduction in 5/75 (7%). MET FISH true amplification was seen in 2 paired specimens and one primary with clonal amplification which was non-amplified in the lymph node metastasis.
Conclusion:
In this cohort of paired biopsies, increased MET expression in the primary was retained in a high proportion of distant and lymph node metastases. These data indicate that MET expression in metastases can be predicted by expression in the primary and further suggests that treatment decisions in the metastatic setting can be based on MET IHC results of archival primary or lymph node tumour.
