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X. Wang



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    MINI 06 - Quality/Prognosis/Survival (ID 111)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      MINI06.07 - High Incidence of PD-L1 Expression in Surgically Resected Pulmonary Lymphoepithelioma-Like Carcinoma Is Linked to Prognosis (ID 1495)

      16:45 - 18:15  |  Author(s): X. Wang

      • Abstract
      • Presentation
      • Slides

      Background:
      Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare and distinct type of primary lung cancer which is characterized by Epstein-Barr virus (EBV) infection. The prognostic significance of programmed cell death ligand 1 (PD-L1) in pulmonary LELC remains poorly understood.

      Methods:
      A total of 113 surgically resected pulmonary LELC in Sun Yat-sen University Cancer Center between January 2008 and December 2012 were included. Paraffin-embedded tumor sections were stained with PD-L1 antibody. H score were calculated by multiplying the percentage of positively stained cells by an intensity score. Tumors with >5% PD-L1 expression were deemed PD-L1 positive. The mRNA level of latent membrane protein 1 (LMP1) were determined by RT-PCR. Univariate and multivariate analyses were performed to identify prognostic factors for disease-free survival (DFS) and overall survival (OS).

      Results:
      The positive rate of PD-L1 was 74.3%. Patients with PD-L1 (+) tumor were significantly younger than those with PD-L1 (-) (median age, 50 vs 58 years; p = 0.008). High PD-L1 expression (H-score > 30) was associated with impaired DFS (median: 33.8 months vs not reached; p = 0.008) compared with low PD-L1 expression (Figure 1). Multivariate analysis shows that PD-L1 expression level (p = 0.014), N stage (p = 0.039) and M stage (p= 0.024) were independent prognostic factors for DFS. N stage and M stage but not PD-L1 expression level were significantly associated with OS (Figure 2). Also, LMP1 mRNA level was significantly associated with PD-L1 expression level (p < 0.001).Figure 1Figure 2





      Conclusion:
      Our results reveal higher incidence of PD-L1 expression in pulmonary LELC than common lung cancer, which may be linked to EBV burden. PD-L1 was a negative prognostic factor for DFS but was not associated with OS in surgically resected pulmonary LELC. These findings may provide a rationale for immunotarget therapy in this virus-associated lung cancer.

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    P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P3.03-017 - Interim Overall Survival of Neoadjuvant Erlotinib Intercalated with Gemcitabine/Cisplatin for IIIA N2 NSCLC Patients: A Phase II Study (ID 1743)

      09:30 - 17:00  |  Author(s): X. Wang

      • Abstract

      Background:
      The optimal treatment for locally advanced stage IIIA non-small cell lung cancer (NSCLC) disease is not well established although neoadjuvant chemotherapy showed active results in stage IIIA N2 pts. A few case reports also indicate the advantages of neoadjuvant erlotinib. FASTACT II study showed that the regimen of erlotinib intercalated with chemotherapy improved PFS and OS in an unselected advanced NSCLC population of east Asian patients. Here we report the interim overall survival (OS) results of a phase II study which was to assess the efficacy and safety profile of erlotinib intercalated with gemcitabine/cisplatin as neoadjuvant treatment in stage IIIA N2 NSCLC pts.

      Methods:
      Patients with untreated stage IIIA bulky N2 NSCLC and ECOG PS 0/1 were enrolled to received up to 2 cycles of gemcitabine 1,000 mg/m[2] on days 1 and 8 and cisplatin 75 mg/m[2] on day 1 or carboplatin AUC=5 d1, followed by oral erlotinib (150 mg, once a day) on days 15 to 28 as neoadjuvant therapy. A repeat computed tomography (CT) scan evaluated the response after induction therapy and eligible patients would undergo surgical resection. The primary endpoint was ORR which was reported in 2013 WCLC. The secondary endpoints included pCR, resection rate, DFS (disease free survival) and OS (overall survival), safety, QoL and biomarker analyses.

      Results:
      Between March 2011 and December 2012, a total of 39 patients (29 male, median age 59.0 years; range 34.0 to 74.0 years) were enrolled in the study, in which 36 patients ( 92.3%) had completed 2-cycle erlotinib neoadjuvant treatment. For pathologic type, 13 pts were adenocarcinoma, 18 pts were squamous carcinoma, and 8 pts were other types. One patient withdrew from the study and one patient was lost in the follow-up. Twenty-two (56.4%, 22/39) patients underwent surgical resection after erlotinib neoadjuvant treatment. Till Jan 15, 2015, the median follow up duration was 24.4 mo (range 5.5 to 43.7 mo). To the cut-off date, 22 patients (56.4%) died. The median OS for total 39 patients was 29.0 mo (Figure 1A, range 3.4 to 43.7 mo). The median OS for those no surgery pts was 17.0 mo (range 6.1 to 39.8 mo) while the median OS is not matured ye for those pts who received surgery (Figure 1B).Figure 1



      Conclusion:
      Neoadjuvant erlotinib intercalated with gemcitabine/cisplatin brought clinical benefits by extending overall survival for stage IIIA N2 NSCLC pts.