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K. Chen



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    OA 04 - Surgery from Minimal to Radical (ID 661)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Surgery
    • Presentations: 1
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      OA 04.03 - Primary Tumor Resection versus Maintenance Therapy for Patients with Oligometastatic Non-Small Cell Lung Cancer  (ID 8132)

      15:45 - 17:30  |  Author(s): K. Chen

      • Abstract
      • Presentation
      • Slides

      Background:
      To evaluate (1) the potential effect of primary tumor resection, an aggressive local consolidative therapy, for patients with oligometastatic NSCLC on 3 year overall survival; (2) the surgical outcomes in the treatment of patients with oligometastatic NSCLC; (3) the potential clinical factors predicting survival in order to better select patients for surgery.

      Method:
      According to the extent of pulmonary resection, the patients were divided into two subgroups. A. intent to cure (ITC: removal of total or primary pulmonary lesions); B. intent to biopsy (ITB: preservation of major lesions, only diagnostic biopsy via minimally invasive approach). M stage classified based on 8th UICC/AJCC TNM M categories.

      Result:
      From Jan 2002 through Dec 2015, a total of 115 consecutive metastatic NSCLC patients were enrolled from Peking University Cancer Hospital. The 3-year overall survival (OS) of ITC and ITB were 64.3% and 34.9% (log-rank p = 0.0009), respectively. Multivariate cox proportional regression analysis identified multiple station lymph nodes (LN) and bone involvement may be prognostic indicators. Figure 1Figure 2





      Conclusion:
      The current findings suggest that aggressive surgical therapy can extend the survival in selected stage IV NSCLC patients, and should be further explored in phase 3 trials as a standard treatment option in this clinical scenario.

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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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      P2.03-047 - The Main Treatment Failure Pattern for Completely Resected Stage II–IIIA (N1–N2) EGFR-Mutation Positive Lung Cancer (ID 9743)

      09:30 - 16:00  |  Author(s): K. Chen

      • Abstract
      • Slides

      Background:
      ADJUVANT (CTONG 1104) is the first randomized trial shows significantly prolonged disease-free survival (DFS) in completely resected stage II-IIIA (N1-N2) epidermal growth factor receptor (EGFR)-mutation positive non-small-cell lung cancer (NSCLC) through adjuvant gefitinib compare with vinorelbine plus cisplatin (VP). Further we aim to analyze the treatment failure pattern in ADJUVANT study.

      Method:
      In the ADJUVANT trial, a total of 222 patients with completely resected stage N1–N2 EGFR-mutation positive NSCLC were randomized 1:1 into gefitinib group (250mg, QD, 24 months ) or vinorelbine (25mg/m[2] Day 1/Day 8) plus cisplatin (75mg/m[2] Day 1) group (every 3 weeks for 4 cycles) respectively. Any recurrence or metastases occurred during the follow-up period was defined as treatment failure. Recurrent pattern in both group were analyzed with follow-up data (until Mar 9[th] 2017) integrated.

      Result:
      At the Data cut-off date for the primary analysis of DFS, 124 progression events (55.9% maturity overall) had occurred; 114 patients had disease recurrence,10 patients died before disease recurrence. Analysed recurrent pattern include lung, brain, liver, bone adrenal gland, pleura, pericardium, spleen and regional lymph nodes metastasis. Even no significant differences were found, highest proportion of patients in both group(18.9% for VP and 26.1% for gefitinib, p=0.199) surfer brain metastasis with lung metastases being the second common recurrent site. Time to brain metastases showed no significantly difference between the two groups (not reach vs 40.8m, p>0.05). Among the 29 brain metastases patients with gefitinib, the brain metastases occurred in 17 patients during the gefitinib treament, and 12 patients relapse after the gefitnib termination. Figure 1



      Conclusion:
      Compared with other site metastases, lung, brain and regional lymph nodes metastases account for major proportion of recurrence in ADJUVANT study. (NCT01405079)

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    P3.05 - Early Stage NSCLC (ID 721)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P3.05-003 - Serum Thioredoxin Reductase 1 as a Diagnostic Biomarker for Non-Small Cell Lung Cancer (ID 8235)

      09:30 - 16:00  |  Author(s): K. Chen

      • Abstract
      • Slides

      Background:
      Non-invasive diagnostic biomarkers for patients with suspicious non-small cell lung cancer (NSCLC) may provide needed guidance on invasive diagnostic and therapeutic decisions. Thioredoxin reductase 1 (TrxR1) is a pivotal intracellular redox sensor and antioxidant enzyme, and plays an important part in tumor growth, progression, metastasis, and chemotherapy resistance. The goal of this study is to test the feasibility of developing plasma TrxR1 as a novel diagnostic biomarker for NSCLC.

      Method:
      The plasma TrxR1 activity was determined spectrophotometrically by monitoring the NADPH-dependent production of 2-nitro-5-thiobenzoate at 412nm and at 37℃. A random forests method was adopted to identify and measure the important diagnostic variables for NSCLC. A nomogram that allowed more accurate prediction of probability for NSCLC was developed.

      Result:
      In this study, the plasma levels of TrxR1 were measured in 102 treatment-naïve NSCLC patients and 11 individuals with benign tumor-like pulmonary diseases. The random forest analysis identified that TrxR1, PET SUVmax, smoking and drinking history were potentially significant variables for NSCLC diagnosis and differentiation. After cross validation, the nomogram for the cohort was accurate and discriminating, with an area under the receiver operating characteristic (ROC) curve of 0.70. Figure 1



      Conclusion:
      Our data suggest that plasma TrxR1 activity is a useful non-invasive diagnostic marker for NSCLC. We developed a user-friendly nomogram that uses information commonly available to the clinician to easily and accurately calculate the likelihood of NSCLC.

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    P3.16 - Surgery (ID 732)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P3.16-053 - Genomic Challenges for Lung Cancers with Multiple Pulmonary Sites of Involvement (ID 9918)

      09:30 - 16:00  |  Author(s): K. Chen

      • Abstract
      • Slides

      Background:
      Patients with lung cancer who harbor multiple pulmonary sites of disease have been challenging to classify. Although the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee propose to tailor TNM classification of multiple pulmonary sites of lung cancer to reflect the unique aspects of four different patterns of presentation, tough challenges faced by clinicians are still not easily overcome.

      Method:
      Surgical tumor and normal tissue specimens were collected from six patients who were diagnosed with pathologically confirmed multiple lung cancers, with each tumor in the separate lobe, and treated at Beijing Cancer Hospital, Peking University, Beijing, China. Whole-exome sequencing was used to depict the genomic profiles of each tumor, and the average sequencing depth was 123× per sample (range, 84× to 154×; s.d., 19×).

      Result:
      In this study, we analyzed genomic profiles of 12 tumors from 6 patients with multiple lung cancers. Eight tumors from 4 patients demonstrated distinct genomic profiles, suggesting all were independent primary tumors, which were consistent with comprehensive histopathological assessment. Noteworthy common genomic characteristics were seen in 4 tumors from 2 patients. Compared with TCGA lung cancer cohort, one out of 6 patients carried significantly higher somatic nonsynonymous mutational burden, which were also discrepant between two separate lesions. Figure 1



      Conclusion:
      The current findings suggest that the tailor TNM classification of multiple pulmonary sites of lung cancer still encounter real-world challenges. A deeper understanding of the spatial and temporal dynamics of the carcinogenesis and evolution of lung cancer will be required to address these challenges.

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