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C. Chiang



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    MA 03 - Chemotherapy (ID 651)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Advanced NSCLC
    • Presentations: 1
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      MA 03.07 - The Predictive Value of Interferon-γ Release Assays (IGRA) for Chemotherapy Response in Advanced Non-Small-Cell Lung Cancer Patients (ID 8059)

      11:00 - 12:30  |  Author(s): C. Chiang

      • Abstract
      • Presentation
      • Slides

      Background:
      Background: INF-γ had recently been known to take part in cancer immunology and its interactions with chemotherapy were also described. Our previous study had showed that impaired PHA-stimulated INF-γ (PSIG) response from peripheral lymphocytes was associated with lower one-year overall survival in advanced non-small cell lung cancer (NSCLC) patients. In this study, we aimed to evaluate the correlation between PSIG and chemotherapy response.

      Method:
      Form January 2011 to August 2012, 340 newly-diagnosed lung cancer patients from 4 referral centers in Taiwan were enrolled in a prospective latent TB observational study. Patients who had advanced NSCLC and had been treated with chemotherapy were included in this study. The pretreatment PSIG levels were evaluated by Interferon-Gamma Release Assay (IGRA) with QuantiFERON-TB In-Tube (Qiagen, Germany). Patients were grouped into high PHA response group if their PSIG levels were above the median level; the others were grouped into low PHA response group. Their demographic characteristics, tumor response, and survival were investigated and correlated with PSIG levels.

      Result:
      Eighty-four patients were enrolled in this study. The response rate in high PHA response group was 45.2%, versus 35.7% in lower PHA response group (p=0.999190). The disease control rate in high PHA response group was 76.2%, versus 52.4% in low PHA response group (p=0. 023999). In multivariate analysis, PSIG response was an independent predictor for disease control rate (OR=3.017, 95% CI= 1.115-8.165). Also, the Kaplan-Meier curves and estimates survival analysis demonstrated both longer progression-free survival (p=0.008) and overall survival (p=0.003) in high PHA response group.

      Conclusion:
      Higher pre-treatment PSIG response, assayed by IGRA testing, was associated with better disease control rate and survival among advanced NSCLC patients treated with chemotherapy.

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    P2.07 - Immunology and Immunotherapy (ID 708)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Immunology and Immunotherapy
    • Presentations: 1
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      P2.07-027 - Efficacy and Safety of Nivolumab Therapy for Advanced NSCLC in the Expanded Access Named Patient Program in Taiwan (ID 8711)

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

      • Abstract
      • Slides

      Background:
      Nivolumab is current standard of care for patients with pretreated advanced non-small cell lung cancer (NSCLC). The patients’ and physicians’ experience of using nivolumab in real-world clinical practice in Taiwan is unknown. We aimed to evaluate the efficacy and safety of nivolumab therapy in Taiwan.

      Method:
      We retrospectively reviewed the medical records of the patients with age > 20 years who were diagnosed to have advanced NSCLC and received nivolumab therapy through the Expanded Access Named Patient Program in 2016. Nivolumab 3 mg/kg was administered intravenously every 2 weeks.

      Result:
      A total of 94 patients were included in this analysis. The median age was 60 years (range, 31-76), and 63.8% of these patients were non-smoker. Most of the patients (75.5%) had adenocarcinoma histology, and 34.0% of the patients harbored an EGFR mutation. The median cycle number of nivolumab therapy was 9 (range, 1-28). The median treatment duration was 4.6 months (95% CI, 3.0-6.6). Nivolumab monotherapy is still ongoing in 16 patients (17.0%) on the date of data cutoff. The objective response rate was 13.8%. The median overall survival was 12.0 months (95% CI, 9.2 to not reached). In univariate analysis, sex, age, smoking history, EGFR mutation, squamous histology, and previous extracranial irradiation therapy were not predictors of prolonged survival. Only ECOG performance status (PS) < 2 before starting nivolumab therapy was a predictor of prolonged survival (HR: 0.32; 95% CI, 0.17-0.59). The most common treatment related adverse events (AEs) included fatigue (34.0%), nausea (17.0%), rash (12.8%), asthenia (8.5%), and pyrexia (5.3%). Grade ≧ 3 AEs developed in 7.4% of the patients. All grades interstitial lung disease developed in 4.3% of the patients. One patient died of grade 5 diarrhea after one dose of nivolumab therapy.

      Conclusion:
      The efficacy and safety data in Taiwan were in line with previous clinical trial reports. Patients with PS < 2 may have better survival outcome after receiving nivolumab therapy.

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    P3.02 - Biology/Pathology (ID 620)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P3.02-043 - Clinical and Genetic Features in Lung Adenocarcinoma Without EGFR Mutation and ALK Rearrangement in Taiwan (ID 9314)

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

      • Abstract
      • Slides

      Background:
      For the majority of advanced lung adenocarcinoma patients, absence of epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement usually means platinum based doublet chemotherapy would be the standard treatment. However, treatment result of chemotherapy is suboptimal. Several driver mutations, although not common, are potential therapeutic targets which may significantly influence patients’ outcome.

      Method:
      Lung adenocarcinoma patients with neither EGFR mutation nor ALK fusion were recruited in this study. KRAS, NRAS and BRAF mutations were examined by mass spectrometry. Other 53 gene fusions and mutations were analyzed by Archer FusionPlex Solid Tumor Kit on Ion Torrent PGM next generation sequencer.

      Result:
      Forty patients were enrolled. Demographics showed a median age of 62.5 (39-88), male predominance (M/F, 24/16), and non-smoking history dominance (never/past/current, 19/9/12). The average pack-year of smoking was 22.1 (0-120). The specimens examined were from lung (20), bone (1), brain (3), pleura (1), pleural effusion (11), lymph node (2) and soft tissue (2), respectively. Collectively, we identified eight KRAS mutations (20%), one NRAS mutation (2.5%), one BRAF mutation (2.5%), one CD74-ROS-1 fusion (2.5%), two MET exon 14 splicing (5%), and all of them were mutually exclusive. There were three invasive mucinous adenocarcinomas, and two of them harbored KRAS mutation. The majority of patients had received chemotherapy and two had received immunotherapy. The patient with CD74-ROS-1 fusion, a female non-smoker, was enrolled in an entrectinib clinical trial (STARTRK2) and experienced a rapid and dramatic response.

      Conclusion:
      Survey for other driver mutations brings treatment options for lung adenocarcinoma patients without EGFR mutation and ALK rearrangement.

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