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C. Zhang



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    P1.01 - Advanced NSCLC (ID 757)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 2
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      P1.01-042 - Dynamic ctDNA Assay by Next Generation Sequencing to Guide Targeted Therapy in Advanced Non-Small Cell Lung Cancer (ID 10387)

      09:30 - 16:00  |  Author(s): C. Zhang

      • Abstract

      Background:
      It is difficult to identify tumor driving genes in advanced non-small cell lung cancer (NSCLC) patients especially for those who were unable to obtain cancer tissue samples and had developed treatment resistance. Circulating tumor DNA (ctDNA) has garnered much excitement over the past few years for its potential clinical utility as a tumor therapy monitoring tool. Our study aims to evaluate the usefulness of ctDNA for serial monitoring actionable genetic alterations in NSCLC patients.

      Method:
      34 pairs of matched cancer tissue and plasma samples were collected from patients with advanced NSCLC and applied to capture-based next generation sequencing (NGS) using the lung panel, consisting of critical exons and introns of 168 genes. Additional, serial monitoring of ctDNA was conducted in 11 NSCLC patients with actionable genetic alterations using the above NGS assay.

      Result:
      ctDNA yielded a close agreement of 85.3% (29/34) on actionable genetic alteration status when compared to cancer tissue at baseline in this study. Analysis of ctDNA at different time points showed a strong correlation to treatment efficacy. Interestingly, secondary genetic alterations such as EGFR mutation T790M were detected in 45.5% (5/11) of the patients during monitoring.

      Conclusion:
      ctDNA may be a potential alternative to conventional primary tissue based NGS assay. ctDNA assay by NGS could be clinically used to monitor the efficiency of personalized target therapy for NSCLC patients.

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      P1.01-069 - Clinical Experience with IBM Watson for Oncology (WFO) Cognitive System for Lung Cancer Treatment in China (ID 9774)

      09:30 - 16:00  |  Author(s): C. Zhang

      • Abstract

      Background:
      IBM Watson for Oncology (WFO) is a Memorial Sloan Kettering-trained cognitive computing system. Watson provides evidence-based treatment options and ranks them into three categories for oncologist decision making as "Recommended ","For Consideration" and "Not Recommended". We examined the concordance of treatment options in Lung cancer patients between WFO and tumor board in the Affiliated Hospital of Qingdao University, China.

      Method:
      33patients with stage I-IV lung cancer were enrolled in this study. By tumor stage, 15.1% (5 of 33) patients are Phase I or II, 15.1% (5 of 33) are Phase III and the rest of the patients (23 of 33) are Phase IV. By histology, 18.2% (6 of 33) are small cell lung cancer (SCLC) and 81.8% (27 of 33) are non-small cell lung cancer (NSCLC). Options were considered concordant when it was included in the “Recommended” or “For Consideration” categories.

      Result:
      Overall, treatment recommendations were concordant in 96.9% (32 of 33) of cases. By histology, 100% of SCLC patients’ therapy regimes were concordant with the recommended one, and treatment recommendations were concordant in 96.3% of NSCLC patients. By tumor stage, treatment recommendations were concordant in 100% of I- III and 96% of Phase IV lung cancer. Of the whole cases, 69.7% were recommended and 27.3% were for consideration (figure1). The majority reason for choosing consideration option is that the immunotherapy drugs targeted PD-1 or PD-L1 such as Nivolumab, Pembrolizumab and Atezolizumab recommended by Watson for Oncology had not been launched in China.Figure 1



      Conclusion:
      Treatment recommendations made by the Affiliated Hospital of Qingdao University and Watson for Oncology were highly concordant in lung cancer. We’ll make further analysis for this cognitive computing system in more cases and other types of carcinomas.

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    P2.03 - Chemotherapy/Targeted Therapy (ID 704)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Chemotherapy/Targeted Therapy
    • Presentations: 1
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      P2.03-034 - EGFR Exon 19 Deletion Is Associated with Favorable Overall Survival After First-Line Icotinib Therapy in Advanced NSCLC Patients (ID 9281)

      09:30 - 16:00  |  Author(s): C. Zhang

      • Abstract

      Background:
      Although previous studies demonstrated that the PFS of geftinib, erlotinib and afatinib as first line treatment is superior to chemotherapy in advanced NSCLC patients harboring activating EGFR mutation, the efficacy of icotinib therapy as first line therapy has not yet been elucidated.

      Method:
      Patients with IIIB/IV NSCLC and a confirmed activating mutation of EGFR (exon 19 deletion or exon 21 L858R substitution) received oral icotinib (125 mg, three times per day) until disease progression or unacceptable toxic effects. The primary outcome was overall survival (OS), and the second endpoint were progression-free survival (PFS), objective response rate(ORR), disease control rate(DCR).

      Result:
      1615 patients with advanced NSCLC receiving icotinib from Oct. 2012 to Apr. 2016 were screened in four cancer centers in Qingdao city, P R.China, and 79 patients with intact follow-up data received icotinib in first-line setting and were enrolled.Of them, the number of women and men were 51 (64.56/%) and 28 (35.44/%) respectively. 27 (34.18%)patients were with EGFR exon 19 deletion, and 52(65.82%) patients with exon 21 L858R mutation. The median follow-up period at the time of analysis was 24.50 months. The objective response rate(ORR) was 45.57% (36/79) , and the disease control rate(DCR) reached 89.87%(71/79). One (1.27%) patient had CR, and 35(44.30%) patients had PR, 35(44.30%) patients had SD, 8(10.13%) patients with PD. The median PFS and OS were 13.61 months and 31.11 months respectively of overall population. The median PFS was 12.30 months in EGFR exon 19 mutation subgroup and 14.00 months in exon 21 mutation subgroup respectively(p=0.441). The exon 19 mutation group had a significantly longer median overall survival than exon 21 mutation group (34.72 months, vs. 28.66 months,log-rank p=0.006, hazard ratio, 0.31 95% CI, 0.13 to 0.71). Meanwhile, there is significant difference of overall survival during different ECOG PS subgroups(ECOG PS 0-1 versus ECOG PS 2-3,32.59 months versus 20.59 months,p=0.002,HR 3.09,95%CI, 1.46 to 6.52).

      Conclusion:
      The study illustrate that icotinib is effective as first-line treatment for patients with advanced NSCLC and sensitive EGFR mutation. The patients harboring EGFR exon 19 deletion mutation yield similar PFS, but longer OS compared to those harboring exon 21 L858R mutation.