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Y. Xu



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    MINI 07 - ChemoRT and Translational Science (ID 110)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      MINI07.14 - Endostatin Combined with Paclitaxel, Carboplatin, and Radiotherapy in Patients with Unresectable Locally Advanced Non-Small Cell Lung Cancer (ID 2830)

      16:45 - 18:15  |  Author(s): Y. Xu

      • Abstract
      • Presentation
      • Slides

      Background:
      Endostatin inhibits the pro-angiogenic action of basic fibroblast growth factor and vascular endothelial growth factor in different human cancers. This study assessed the efficacy of endostatin combined with concurrent chemoradiotherapy of non-small cell lung cancer (NSCLC).

      Methods:
      Nineteen patients with unresectable stage III NSCLC, ECOG performance status 0-l, and adequate organ function were treated with 60–66 Gy thoracic radiation therapy over 30–33 fractions concurrent with weekly 7.5 mg/m[2] endostatin for 14 days, 50 mg/m[2] paclitaxel, and 2 mg/mL/min carboplatin over 30 min. Patients were then treated with 7.5 mg/m[2] endostatin for 14 days, 150 mg/m[2] paclitaxel, and 5 mg/mL/min carboplatin every 3 weeks for 2 cycles as the consolidation treatment (Fig.1). The objective response rate was recorded according to the RECIST criteria, and the toxicity was evaluated using the NCI Common Toxicity Criteria. Figure 1



      Results:
      Six patients were unable to complete the consolidation treatment (4 pulmonary toxicity, 1 tracheoesophageal fistulae, and 1 progressive disease). Seventeen patients were included for data analysis. Specifically, one (5.9%) patient had a complete response and 13 (70.6%) had a partial response, whereas two patients had stable disease and the other two had disease progression. The overall response rate was 76% [95% CI, 51%–97%]. The median progression-free survival was 10 months (95% CI, 7.6–12.3 months), and the median overall survival was 14 months (95% CI, 10.7–17.2 months) (Tab.1). The toxicity analysis of 10 patients who completed the treatment regimen showed that four patients experienced grade III pulmonary toxicity. Figure 1



      Conclusion:
      The results demonstrated no evidence of the efficacy of endostatin concurrent with chemoradiotherapy of locally advanced unresectable NSCLC. The real impact of endostatin as the first-line treatment combined with chemoradiotherapy on the survival of NSCLC patients remains to be determined.

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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
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      P2.03-015 - A Phase II Trial of Individual Trimodality Treatment in Patients with Stage IIIA (N2) Non-Small Cell Lung Cancer: The ZTOG 1202 Study (ID 2805)

      09:30 - 17:00  |  Author(s): Y. Xu

      • Abstract

      Background:
      Currently, optimal management of clinical stage IIIA (N2) non-small cell lung cancer (NSCLC) is still controversial. We investigated the efficacy and toxicity of individual trimodality treatment using concurrent chemoradiotherapy as a neoadjuvant treatment followed by surgery in patients with stage IIIA (N2) NSCLC. This study is registered with ClinicalTrials.gov, number NCT01926483).

      Methods:
      Patients with potentially resectable locally advanced stage IIIA (N2) NSCLC received surgery and individual concurrent induction chemotherapy Docetaxel/Cisplatin or Pemetrexed/Cisplatin (Patients received individual chemotherapy regimens depending on the different pathological types: squamous cell carcinoma: Docetaxel 60mg/m[2] d1, Cisplatines 75mg/m[2] d1, repeated every 3 weeks for 2 cycles; non-squamous cell carcinoma: Pemetrexed 500mg/m[2] d1, Cisplatin 75mg/m[2] d1, repeated every 3 weeks for 2 cycles.) plus radiotherapy (46 Gy/23 fractions, 5 days per week) (Fig.1). Primary endpoint was pathological complete remission rate in the mediastinal lymph nodes and we aimed at a rate >47%. Secondary endpoint was a near pathologic complete response (pnCR) (Near pCR: near pathological complete response means only original site exist a small amount of cancer cells, without lymph node metastasis) rate and we aimed for >33%. Figure 1



      Results:
      Twenty two patients were included in analyses (12 patients with squamous cell carcinoma treated with Docetaxel/Cisplatin, 10 patients with non-squamous cell carcinoma treated with Pemetrexed/Cisplatin ). Pathological complete remission rate in the mediastinal lymph nodes was achieved in 11 patients (50%) exceeded the goal per study design. The postinduction pathological findings by T and N category were recorded. The categories were 3 T~ 0~N~0~ (13.6% patients) and 6 T~near 0~N~0~ (27.3% patients). In our study, the prevalence of postoperative complications was low, which was probably due to the thoracoscopic approach that was employed. No treatment-related deaths were reported. Toxicities associated with induction chemoradiotherapy were similar in both regimens. Neutropenia and esophagitis were the main grade 3 or 4 toxicities (9 [40.9%] and 2 [9.1%], respectively). Other grade 2 or higher toxicities occurring in about 50% of patients included nausea, vomiting, and fatigue. Most side effects were grade 2 and well tolerated by supportive care.

      Conclusion:
      Individual concurrent chemoradiotherapy based on the pathological type as a neoadjuvant treatment (two cycles of Docetaxel/Cisplatin or Pemetrexed/Cisplatin with 46 Gy/23f of concurrent radiotherapy) followed by resection was safe and well tolerated in patients with stage IIIa (N2) NSCLC. It could improve the pathological complete remission rate in the mediastinal lymph nodes to the preset criterion of 50% and a pnCR rate of 40.9%.

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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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      P3.03-013 - Predictive Factors for Survival in Stage IIIA (N2) NSCLC Patients Treated with Neoadjuvant Chemotherapy Followed by Surgery (ID 2770)

      09:30 - 17:00  |  Author(s): Y. Xu

      • Abstract

      Background:
      For locally advanced non-small cell lung cancer (NSCLC) patients, although the evidence level for induction chemo (chemoradio) therapy is low, the incorporation of chemotherapy, radiotherapy, and surgery will greatly impact the strategy of future treatment. The objective of this study was to evaluate the risks of recurrence and overall survival (OS) in stage IIIA (N2) NSCLC patients undergoing definitive resection after neoadjuvant chemotherapy.

      Methods:
      A retrospective analysis of 106 consecutive patients with stage IIIA (N2) NSCLC who received neoadjuvant chemotherapy followed by surgery between January 2008 and October 2013. While reviewing the clinical and surgical data, we also assessed histopathologic and imaging (chest CT scan) factors. Disease-free survival (DFS) and OS were estimated with predictors for recurrence and survival. The Kaplan–Meier method was used to evaluate patient DFS and OS. Univariate analysis of patient clinical characteristics and treatment response were conducted using the Chi-square and Fisher’s exact test.

      Results:
      Median age was 60, 96 (90.5%) patients were male, 85 (80.2%) patients were squamous cell carcinoma and 21 (19.8%) patients were non-squamous cell carcinoma, 93 (87.7%) patients had a lobectomy. The 3-year OS for patients with and without recurrence was 33.1 and 56.7 %, respectively (p < 0.001). Size decrease of target lesion(s) ≥30 % on post-neoadjuvant chemotherapy chest CT scan (p = 0.040), primary tumor size on surgical specimen <10 mm (p = 0.047), and pathological complete remission in the mediastinal lymph nodes were related to longer OS. Larger tumor size on post-neoadjuvant chemotherapy chest CT scan (p = 0.038), male gender (p = 0.043), squamous cell carcinoma (p = 0.048), larger primary tumor size on surgical specimen (p = 0.041), pathological non-complete remission in the mediastinal lymph nodes (p = 0.031 ) were related to shorter DFS significantly.

      Conclusion:
      OS is prolonged with greater extent of size decrease of target lesion(s) on post-neoadjuvant chemotherapy chest CT scan, smaller tumor size on surgical specimen and pathological complete remission in the mediastinal lymph nodes. Larger tumor size on post-neoadjuvant chemotherapy chest CT scan, male gender, squamous cell carcinoma, larger primary tumor size on surgical specimen, pathological non-complete remission in the mediastinal lymph nodes may prone to the higher probability of recurrence.