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A. Mahajan



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    P1.01 - Advanced NSCLC (ID 757)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P1.01-021 - FISH and IHC Discordance in ALK Rearranged Non Small Cell Lung Cancer (ID 10474)

      09:30 - 16:00  |  Author(s): A. Mahajan

      • Abstract
      • Slides

      Background:
      There is a small proportion of lung cancer patients who are ALK positive by IHC but negative by FISH, or vice versa. Outcome of this subset of patients when treated with crizotinib is not well known. This analysis was planned to study the FISH and IHC discordance in ALK rearranged NSCLC.

      Method:
      We retrospectively collected data from a prospectively maintained database in medical oncology department. We analyzed 257 patients who had been diagnosed with ALK rearranged NSCLC cancer. Patients who had discordant FISH and IHC findings for ALK were selected for this analysis. Their response rates, progression free survival and overall survival were calculated. Progression free survival and overall survival were estimated using Kaplan Meier method.

      Result:
      Out of 257 patients, 28 patients (10.9%) had discordance. 7 patients had IHC -ve status while had FISH positive status for ALK rearrangement. 21 patients had vice-versa. The response rate for crizotinib in IHC-/ FISH+ was 57.1% versus 71.4% in IHC+/FISH - group ( p-0.331). The overall median progression free survival was 8.7 months and median overall survival was not reached. There was no statistical difference in PFS and OS between the 2 groups.

      Conclusion:
      In around 1/10th of ALK rearranged NSCLC patients, FISH and IHC have discordant findings, however these patients also benefit from crizotinib.

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    P3.03 - Chemotherapy/Targeted Therapy (ID 719)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Chemotherapy/Targeted Therapy
    • Presentations: 1
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      P3.03-015 - ROS-1 Rearranged Non Small Cell Lung Cancer and Crizotinib: An Indian Experience (ID 9315)

      09:30 - 16:00  |  Author(s): A. Mahajan

      • Abstract
      • Slides

      Background:
      ROS1 is a receptor tyrosine kinase that belongs to insulin receptor family.It acts as a driver oncogene in 1 to 2% of NSCLC patients. ALK and ROS1 Kinase domain share 77% amino acid identity within the ATP-binding sites. Crizotinib binds with high affinity to both ALK and ROS1, Crizotinib is approved for patients with the ROS1 translocation including those who have received chemotherapy and those who are treatment naive. This is based on a phase 1 expansion study which enrolled 50 patients with ROS1 rearrangement. Over 80 percent of patients had received one or more prior chemotherapy treatment regimens. The objective response rate was 72 percent. The median duration of response was 17.6 months, and the median progression-free survival was 19.2 months.A retrospective series from Europe which included 32 patients reported 80% response rates and a PFS of 9.1 months.In this paper, we report our experience with ROS1 rearranged NSCLC from India.

      Method:
      Advanced NSCLC with the presence of ROS1 fusion (FISH) patients whose demographic data were retrieved from prospective lung cancer audit database Response by RECIST 1.1 criteria, side effects using CTCAE v 4.02

      Result:
      Among 11 patients more than 1/4[th] of patients had PS of ≥2. Nearly 1/2 of patients had comorbidities and extrathoracic disease while none with brain or adrenal metastasis.Eight received platinum-based doublet chemotherapy, two oral EGFR TKI, and one upfront crizotinib. Four patients among those who received platinum doublet were subsequently exposed to crizotinib Among the 4 patients platinum-based doublet, 2 (PR)and 2 (SD).Out of 5 patients who received crizotinib, 3 patients experienced grade ½ fatigue and grade ½ vomiting. Grade ½ transaminitis, visual symptoms, grade ½ diarrhea, grade ½ neutropenia and asymptomatic bradycardia, grade ½ neutropenia and thrombocytopenia were seen in 1 patient each. Out of 8 patients who received chemotherapy 3 patients had grade ½ anemia, grade ½ vomiting. There was one mortality in non-crizotinib group.Out of 5 patients who received crizotinib, 4 patients had PR (80%).With a median follow-up of 9 months, median PFS and OS were 5.4 months and 8.5 months respectively for the entire cohort.Median PFS and OS was not reached for those who received crizotinib compared to median PFS of 2.5 months and median OS of 4.2 months(<0.01).Estimated 1 year OS was 80% for those who received crizotinib and 18% for who did not.

      Conclusion:
      In conclusion, Crizotinib is effective with acceptable side effect profile in patients with ROS1 rearranged NSCLC in our population

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