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P. Akın Kabalak
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-038 - Survival and Prognostic Factors of Oligometastatic Non-Small Cell Lung Carcinoma: A Single Center Experience (ID 5283)
14:30 - 15:45 | Author(s): P. Akın Kabalak
- Abstract
Background:
In patients without targeted mutations platinum-based chemotherapy is still current treatment method with a median survival rates of 8-11 months. Patients with single side oligo-metastatic disease should be consider for curative aggressive therapies for both primary and metastatic sides for better survival (NCCN 2016).
Methods:
Totally 19 oligo-metastatic NSCLC patients was evaluated retrospectively by using hospital database. All patients had single metastatic side.
Results:
Among 19 eligible patents there was male predominance (n= 16, 84.2%). Eight patients had co-morbidities requiring regular medication. Histopathological, there were 13 (68.4%) adenocarcinoma and 6 (31.6%) non-adenocarcinoma. While brain was the most common site for metastasis 10 (52.6%), it was followed by bone (n=6, 31.6%). Treatments for primary tumour side were surgery (n=6, 31.7%), concurrent CRT (n=5, 26.3%) and sequential CRT (n=1, 5.3%). Median follow-up for whole cases were 59.1 weeks. Median overall survival (OS) and progression free survival (PFS) were 140 (±33.7) and 76 (±24.2) weeks respectively. Progressions were observed mostly in 45.4. week. Univariate cox regression analyses for OS and PFS is indicated in Table 1. Clinical T and N staging had significant relation with OS (p=0.02 and 0.03 respectively). There was no relation between bone or brain metastasis and histopathology, gender, clinical T and N staging. Median survival after first progression (SAFP) was 63 weeks (±SS 29.05). Among study parameters only clinical T staging had significant relation with SAFP (p=0.026). Median SFAP was better in patients with progression of primary tumour however median OS was better in patients with progression of distant metastasis (p>0.05).Factor OS PFS Hazard Ratio p Hazard Ratio p Age (cut-off=65) 1.034 (0.18-5.1) 0.96 0.4 (0.1-2.2) 0.3 Co-morbidity 2.3 (0.54-9.8) 0.24 3.4 (0.8-14) 0.07 Brain Metastasis 0.88 (0.21-3.6) 0.86 1.5 (0.42-5.45) 0.52 Histopathology (adeno vs non-adeno) 0.22 (0.03-1.4) 0.10 0.67 (0.16-2.8) 0.6 Bone Metastasis 1.78 (0.43-7.31) 0.42 1.7 (0.47-6.6) 0.4 pN Staging (n0 and N1-2) 0.12 (0-173) 0.21 0.94 (0.22-4.02) 0.94 cT Staging 2.17 (1-4.7) 0.02 1.11 (0.73-1.81) 0.54 cN Staging (n0 and N1-2) 2.3 (0.86-6.6) 0.03 1.77 (0.79-3.97) 0.1 Non-surgical curative treatment 1.88 (0.41-8.52) 0.42 1.9 (0.50-7.38) 0.34 Surgery 0.31 (0.06-1.65) 0.14 0.21 (0.02-1.78) 0.09
Conclusion:
Even oligo-metastatic NSCLC means stage 4 of disease, curative treatment approaches for both primary and metastasis sides can increase patients’ prognosis than other stage 4 cases. Similar to the existed retrospective studies we had OS more than 2 years and PFS more than 1 year.
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-005 - A Rare Clinical Presentation Of EGFR-Mutant Non-Small Cell Lung Cancer With Oligo-Acrometastasis (ID 5278)
14:30 - 15:45 | Author(s): P. Akın Kabalak
- Abstract
Background:
44% of acrometastasis are originated from primary lung tumors and metastasis to digits is seen in 0.2% of patients with lung cancer. After clinical staging, amputation or radiotherapy are most often therapeutic options for pain palliation. We want to present an oligo-acrometastasis of fourth proximal phalanx of left hand from EGFR-mutant non-small cell lung cancer.
Methods:
A 58-year-old man was admitted with pain and swelling in fourth finger of his left hand (Figure 1A). Magnetic resonance imaging (MRI) of left upper extremity showed a destruction by a soft tissue measuring about 30x17 mm on the distal part of fourth proximal phalanx of left hand (Figure 1B-C). Three phase bone scan with technetium-99m methylene diphosphonate (MDP) revealed increased radiotracer uptake in the fourth finger. Diffuse increased uptake is seen at the left wrist secondary to the old fracture and trauma in both blood pool and metabolic phases and hypertrophic osteoartropathy in both tibia (Figure1E-F). Computed thorax tomography (CTT) revealed a 25x21 mm lobulated contour lesion in the posterior segment of right lower lobe (Figure 1H). CT-guided biopsy was performed and pathological examination showed non-small cell lung carcinoma-not otherwise specified (NSCLC-NOS). A 24x27x24 mm mass with SUV-max value 9.85 in the right lower lobe, right tracheobronchial and right hilar lymphadenopathies 13 mm in diameter was detected (SUV-max: 7.51) on PET-CT. Patient was staged as T1bN2M1b with oligoacrometastasis. Figure 1
Results:
His finger was amputated from metacarpophalangeal level and surgery margin was negative for tumour. Pathological diagnosis was metastatic NSCLC-NOS harbouring EGFR-21L858R mutation. After curative treatment of acrometastasis, concurrent chemo-radiotherapy was planned for primary lung cancer as a therapeutic approach. He is still under treatment.
Conclusion:
Oligometastatic disease by acral involvement in NSCLC is extremely rare. Curative treatment approach should be consider for both primary tumour and metastasis side.
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P2.06 - Poster Session with Presenters Present (ID 467)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Scientific Co-Operation/Research Groups (Clinical Trials in Progress should be submitted in this category)
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.06-044 - Frequency of Mutations and Related Factors in Lung Adenocarcinoma Cases in Turkey (ID 5291)
14:30 - 15:45 | Author(s): P. Akın Kabalak
- Abstract
Background:
Epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 receptor tyrosine kinase (ROS1) gene mutations in lung adenocarcinoma (LA) cases give an opportunity to use some of targeted therapy agents. The aim of this study is to obtain EGFR, ALK and ROS1 gene mutation frequencies in Turkey and to examine the factors affecting these frequencies.
Methods:
EGFR, ALK, ROS1 mutation analyses were examined in a total of 971 LA cases; 745 men (76.7%), and 226 women (23.3%) diagnosed in 12 hospitals from different districts of Turkey were enrolled in the study. The demographic characteristics, smoking status, asbestos exposure history, radiological findings associated with asbestos exposure (AE) were investigated with relation to the frequencies of EGFR, ALK and ROS1 gene mutations. In the univariate analysis of the study data chi-square and t-tests were used. To determine the independent factors associated with gene mutations, multivariate logistic regression model was created with the variables that give p <0.10 level of significance in univariate analysis.
Results:
The mean age of 971 patients was 60.8±9.8 years (range:23-91). Smoking rate was 92.6% in men, 42.5% in women (p<0.001). The number of patients with AE history was 279 (28.7%) and the number of patients with radiologic findings associated with AE was 114 (11.7%). The frequencies of EGFR, ALK and ROS1 mutations were 15.9% (152/956), 3.3% (26/768) and 1.6% (6/379), respectively. Female patients were more likely to have EGFR mutations compared with male patients (37.8% versus 9.3%; p<0,001). Never-smokers had higher incidence of EGFR mutations than smokers (39.6% versus 10.3%; p<0.001). The patients with radiological findings of AE had a 24.6% rate of EGFR mutations compared with a 14.7% rate of patients with no radiological findings (p=0.007). ALK rearrengement was detected in patients with younger age, having history of AE or radiological findings associated with AE (11.1%; p<0.001, 5.9%; p=0.014, 6.7%; p=0.044, respectively). No associated factor was found with ROS1 fusion frequency.
Conclusion:
To have a relationship between radiographic findings associated with AE or AE history and EGFR and ALK mutation frequencies is an original finding. The obtained results will be useful in the discussion of standards of treatment with the new agents and pathogenesis. *This study was carried out through the project named as “Network cooperation for the management of environmental and occupational exposure to mineral fibers induced pulmonary pathologies” which was supported by General Directorate of Health Researches, Republic of Turkey, Ministry of Health.
