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K. Lee
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MA16 - Novel Strategies in Targeted Therapy (ID 407)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Chemotherapy/Targeted Therapy/Immunotherapy
- Presentations: 1
- Moderators:G. Purkalne, J. Von Pawel
- Coordinates: 12/07/2016, 14:20 - 15:50, Strauss 2
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MA16.05 - For EGFR Mutant Non-Small Cell Lung Cancer, Treatment Sequence Matters? (ID 5678)
14:20 - 15:50 | Author(s): K. Lee
- Abstract
- Presentation
Background:
EGFR tyrosine kinase (TKI) showed better progression free survival (PFS) in EGFR-mutant non-small cell lung cancer (NSCLC), but the overall survival (OS) benefit were not clear so far. Treatment sequence may contribute to OS, but there are little data so far. We aimed to analyze the impact of treatment sequence of EGFR TKI and chemotherapy on outcomes in EGFR-mutant NSCLC.
Methods:
Among NSCLC patients who had EGFR exon 18–21 mutation test results between 2009 and 2014 at Seoul St. Mary’s Hospital, 114 patients who had recurrent or metastatic disease, EGFR mutation positive excluding T790M mutation, and received both EGFR tyrosine kinase inhibitor (TKI) and chemotherapy as the 1[st] or 2[nd] line of treatment were included. Patients were categorized into two groups according to the treatment sequence: 1[st] line EGFR TKI followed by chemotherapy (group A), 1[st] line chemotherapy followed by EGFR TKI (group B). The median follow-up duration was 64.6 (15.8–202.8) months.
Results:
Among total 114 patients, 69 patients received EGFR TKI first and then chemotherapy (group A), and the remaining 45 patients received vice versa (group B). Group A was younger (P = 0.029) and less frequently received platinum-doublet agents than Group B (P <0.001). Performance status and EGFR mutation status were not different. Overall response or disease control rate were significantly better for EGFR TKI comparing to chemotherapy regardless of treatment sequence. However, PFS on both treatment were longer in group B (P = 0.008), especially for patients with exon 19 deletion (P = 0.002). On multivariate analyses, performance status (P = 0.006 for PFS, P <0.001 for OS) and treatment sequence [hazard ratio (HR) = 0.027, P = 0.027 for PFS; HR = 0.64, P = 0.065 for OS] were related to prognosis.
Conclusion:
For exon 19 deletion subtype of EGFR-mutant NSCLC patients, the sequence of cytotoxic chemotherapy followed by EGFR TKI showed better PFS comparing with the reverse sequence, EGFR TKI followed by cytotoxic chemotherapy . We will present the data from larger cohorts the WCLC meeting.
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OA15 - Sublobar Resections for Early Stage NSCLC (ID 396)
- Event: WCLC 2016
- Type: Oral Session
- Track: Surgery
- Presentations: 1
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OA15.07 - Is Necessary Completion Lobectomy in NSCLC (≤ 2cm) with Visceral Pleural Invasion or Lymphovascular Invasion after Sublobar Resection? (ID 5536)
16:00 - 17:30 | Author(s): K. Lee
- Abstract
- Presentation
Background:
The standard surgical treatment of stage I non-small cell lung cancer is anatomical lobectomy. However, in some cases, small peripheral lung cancer (≤2cm) is treated by sublobar resection. The purpose of this study was to define the necessity of completion lobectomy when the tumor was revealed as non-small cell lung cancer with pleural invasion or lymphovascular invasion after sublobar resection.
Methods:
We retrospectively reviewed 271 consecutive patients who underwent curative resection for stage I non–small cell lung cancer of 2 cm or less. We analyzed clinicopathological findings and survival between two groups with either invasion-positive tumor (tumor with visceral pleural invasion or lymphovascular invasion) or invasion-negative tumor (tumor without visceral pleural invasion and lymphovascular invasion): sublobar resection group and lobectomy group.
Results:
Except for age and pulmonary function, there were no differences in clinocopathological characteristics between sublobar resection group and lobectomy group with invasion-positive tumor or invasion-negative tumor. There was no difference in the 5-year recurrence-free survival rate between two groups in the invasion-positive tumor and invasion-negative tumor (78.9% vs 79.8%; p=0.928, 80.2% vs 85.4%; p=0.505). In the multivariate analysis, only number of dissected lymph nodes was a significant recurrence-related factor of stage I invasive-positive non-small cell lung cancer (hazard ratio 0.914, 95% confidence interval 0.845-0.988, p=0.023). Sublobar resection was not a risk factor for recurrence.
Conclusion:
The survival between sublobar resection group and lobectomy group in small (≤2cm) non-small cell lung cancer with visceral pleural invasion or lymphovascular invasion were not different. Completion lobectomy is not necessary in small lung cancer after sublobar resection whether the tumor has visceral pleural invasion or lymphovascular invasion.
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