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M. Falk



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    MA04 - HER2, P53, KRAS and Other Targets in Advanced NSCLC (ID 380)

    • Event: WCLC 2016
    • Type: Mini Oral Session
    • Track: Advanced NSCLC
    • Presentations: 1
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      MA04.05 - P53 Non-Disruptive Mutation is a Negative Predictive Factor for OS and PFS in EGFR M+ NSCLC Treated with TKI (ID 5879)

      16:00 - 17:30  |  Author(s): M. Falk

      • Abstract
      • Presentation
      • Slides

      Background:
      P53 mutations are common in lung cancer, and have also been described in EGFR mutated patients The impact of p53 mutations in EGFR M+ patients is controversial, especially if classified as “disruptive” and “non-disruptive” according to their functional effect on the p53 protein as proposed by Poeta and colleagues. The aim of the study was therefore to systematically analyze EGFR and p53 mutations within a cohort of patients with lung cancer stage IV (UICC 7), to correlate alterations with clinical characteristics and to investigate a potential impact of p53 mutations on treatment outcome.

      Methods:
      484 patients diagnosed with lung cancer stage IV were studied for the presence of EGFR as well as inactivating p53 mutations. Methods for the detection of EGFR mutations included Sanger Sequencing and hybridization based COBAS testing, hybrid cage next generation sequencing. P53 mutations were detected by Sanger Sequencing and either Miseq or hybrid cage NGS. Clinical characteristics including smoking status were available for more than 97%.

      Results:
      484 consecutive patients were studied. The overall EGFR M+ rate was 17.8% (86/484) in all patients, 84.9% (73/86) showing common mutations of exon 19 or 21. In 21/86 (24.4%) patients’ p53 analysis was not successful. P53 disruptive mutations were demonstrated in 24.6% (16/65) of successfully tested patients, and p53 non-disruptive mutation occurred in 27.7% (18/65) whereas p53 WT configuration was found in 47.7% (31/65). Median OS was 28 months in p53 disruptive mutation and 44 month in p53 WT compared to 23 months in p53 non-disruptive mutation (p<0.023). PFS on 1[st] line TKI therapy was 14 months in p53 disruptive mutation, 27 months in p53 WT and 10 months in p53 non-disruptive mutation (p<0.040). Similar results were shown in the EGFR common mutation subgroup. 11/16 (68.8%) patients with a disruptive p53 M+ and 25/29 (86.2%) patients with a p53 WT constellation achieved an objective response on the 1[st] line TKI therapy compared to 7/13 (53.8%) patients with a non-disruptive p53 status. The patients with an unknown p53 status achieved an objective response on the 1[st] line TKI therapy of 82.4.8% (14/17).

      Conclusion:
      Significant differences in PFS and OS in EGFR M+ patients were observed depending on p53 M+ status. P53 mutational status is predictive when disruptive and non-disruptive p53 M+ are differentiated. A p53 WT constellation has a positive effect on OS and PFS. P53 should be tested prospectively in EGFR M+ patients as management of patients on 1st line TKI may be different.

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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
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      P2.02-039 - Intercalated EGFR and Chemotherapy in Locally Advanced NSCLC with EGFR Mutations: Data on 5 Patients and Clinical Study (ID 5896)

      14:30 - 15:45  |  Author(s): M. Falk

      • Abstract
      • Slides

      Background:
      EGFR TKI’s are standard of care in patients with EGFR mt+ NSCLC IV. However, induction concepts including intercalated TKI / CTx, in locally advanced NSCLC with EGFR mutation including TKI have not been studied extensively. This concept was used as induction regimen in 5 patients with activating EGFR mutations in stages IIIA and IIIB and is now carried on in a phase II study (NeoIntercal).

      Methods:
      Patients with EGFR mt+ NSCLC locally advanced were treated on an individual basis, remission induction was measured by RECIST 1.1, regression grading by Junker criteria.

      Results:
      3 female never smokers (pt #1, #3, #5), 59, 62, 62 y.o. 2 male light smokers (pt#2 and #4) , 58 and 69 y.o. were diagnosed with with TTF1+ adenocarcinomas of the lung, 2 with exon 21 L858R (#1,2) and 3 with exon 19 deletions (#3,4,5). 4/5 patients (#1-4) carried p53 mutations. Tumor stages were IIIB in pts. #1, 2, 5, IIIA pt. #3, oligometastastic OMD with one organ involved pt. #4. Induction therapy was TKI (Erlotinib or Gefitinib) days -12 to -1, followed by 3 cycles of chemotherapy (Docetaxel 75 mg/m[2] d1/Csplatin 50 mg/m[2] d 1+2 qd22 or Paclitaxel 200 mg/m2 and Carboplatin AUC 6.0 d1, q22) in combination with TKI (Erlotinib d4-20 100 mg/ die p.o. or Gefitinib 250 mg d4-20 of each cycle). PR was achieved after 2 cycles in all patients. All 5 patients were resected, regression grade IIB or III was remarked in mediastinal lymph nodes (#1-4). Pt. #5 had regression grade III. All 5 patients received adjuvant radiotherapy of the mediastinum. One patient died of secondary cancer (rectal cancer) 52 months after diagnosis of NSCLC. 4 pts are alive for 20 to 24 months. Pts 1 and 2 developed isolated CNS mets 8 and 12 months after primary diagnosis which were treated by surgery and/or radiosurgery. Pts 2, 4 and 5 relapsed with distant mets. No resistance mutation was observed and pts are on 1[st] or 2[nd] gen. TKI therapy. A phase II trial (NeoIntercal) trial is currently under way in 9 German centers in stages II and III supported by AstraZeneca Pharmaceuticals. Preliminary results of these patients will be presented at the meeting.

      Conclusion:
      Intercalated TKI treatment is a promising treatment in patients with EGFR mt+ locally advanced NSCLC that is pursued in a prospective phase II Trial in Germany. CNS mets seems to be the primary site of relapse in most patients.

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    P2.03b - Poster Session with Presenters Present (ID 465)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P2.03b-022 - Outcome in Molecularly Defined NSCLC within the NOWEL Network: The Influence of Sequential 2nd and 3rd Generation TKI in EGFR mt+ and ALK+ pts (ID 5902)

      14:30 - 15:45  |  Author(s): M. Falk

      • Abstract
      • Slides

      Background:
      Available clinical research data shows that early mutation testing for patients with NSCLC stage IV could lead to an effective choice of therapy for patients with a proved mutation. Targeted therapies achieve a better quality of life, a higher PFS and ORR and in some cases increased OS. The aim of the study was therefore to systematically analyze retrospective data from three cancer centers in the north of Germany. The study compares these three cancer centers in reference to the test rate and the therapeutic success of targeted therapy.

      Methods:
      1383 patients from the three cancer centers diagnosed with non-small lung cancer stage IV (UICC 7) were examined. Methods for the detection of mutations included Sanger Sequencing, hybridization based COBAS testing as well as hybrid cage next generation sequencing. Clinical characteristics including smoking status were available for more than 92% of the patients.

      Results:
      880 consecutive patients from the three cancer centers were studied for the presence of tumor mutations, especially for EGFR and ALK mutations. The overall mutation testing rate was 63.6% (880/1383). EGFR mutations were found in 18.4% (86/467)/ 13.1% (38/289)/ 11.3% (14/124) in the Pius-Hospital, Bremen-Ost or Hamburg Harburg respectively, ALK in 3.9% (18/467)/ 1.7% (5/289)/1.6% (2/124) yielding an overall EGFR M+ rate of 15.7% (138/880) and overall ALK M+ rate of 2.9% (25/880). Median OS was 43 (n=86) vs. 25 (n=38) vs. 16 (n=14) months (Pius vs. Bremen vs. Hamburg) (p<0.035). PFS on the 1[st] line TKI therapy was 25 (n=77) vs. 22 (n=31) vs. 10 (n=13) months respectively. Pts receiving 3[rd] generation TKI (Osimertinib n=12) had a significantly longer OS than pts not receiving 3[rd] gen. TKI (n=134). PFS on 3[rd] gen TKI was significantly longer than for other therapies (p<0.020). Median OS in ALK mutated patients was 31 (n=18) vs. 17 (n=5) vs. 10 (n=2) months (Pius vs. Bremen vs. Hamburg). Median OS of pts treated with Crizo alone (n=14) was 18 months, pts treated sequentially with Crizo and Ceritinib (n=6) 31 months, median OS without Crizotinib (n=4) was 17 months.

      Conclusion:
      The results illustrate differences between the three Lung Cancer Centers in the north of Germany. Significant differences in OS were observed, depending on the center and a significant difference in PFS between the therapy with Osimertinib and other therapies could be established. The differences mentioned could depend on the selection of the patients and their clinical characteristics. The clinical characteristics should be observed in detail.

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