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R. Qiao
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Immunotherapy and next-generation TKIs: From second to frontline treatment (ID 55)
- Event: ELCC 2018
- Type: Poster Discussion session
- Track:
- Presentations: 1
- Moderators:P. Garrido Lopez, S. Ekman, S. Ortiz-Cuaran, E. Wauters
- Coordinates: 4/12/2018, 07:45 - 09:00, Room A
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140PD - Complex epidermal growth factor receptor (EGFR) mutations and responses to tyrosine kinase inhibitors (TKIs) in advanced lung adenocarcinomas (ID 411)
07:45 - 09:00 | Author(s): R. Qiao
- Abstract
Background:
Two or more different epidermal growth factor receptor (EGFR) mutations can be detected within a single tumor sample, which represents complex mutations. However, the frequency and efficacy of tyrosine kinase inhibitor (TKI) treatments for patients harboring these mutations are unknown.
Methods:
From January 2011 to January 2017, patients diagnosed with EGFR mutation were screened. The effectiveness of TKIs in patients with complex mutations was retrospectively analyzed.
Results:
A total of 16,840 subjects were screened, with 5898 positive patients. 187 patients (3.2% of all EGFR mutant patients) had complex EGFR mutations with 95 of advanced lung adenocarcinoma patients were treated with TKIs. The objective response rate (ORR) for patients who had Del-19 + 21L858R (Group A, n = 27), Del-19/21L858R + atypical mutations (Group B, n = 28), double atypical mutations (Group C, n = 20) and complex mutations with primary drug-resistant pattern (Group D, n = 20) were 72.7%, 54.2%, 66.7% and 15.0%, respectively. Median progression free survival (PFS) in the four groups were 18.2 months (95% CI, 12.0 months to 24.4 months), 10.1 months (95% CI, 6.5 months to 13.7 months), 11.1 months (95% CI, 6.8 months to 15.4 months) and 1.4 months (95% CI, 0.2 months to 2.5 months), respectively.
Conclusions:
These results suggest on the largest sample size that EGFR–TKI therapy is effective in patients with Del-19 + 21L858R, Del-19/21L858R + atypical mutations and double atypical mutations, but less effective in patients with primary drug–resistant pattern. Patients with the Del-19 + 21L858R mutations may therefore benefit more from treatment with first–generation TKIs.
Clinical trial identification:
Legal entity responsible for the study:
Bo Zhang
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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Poster Display session (Friday) (ID 65)
- Event: ELCC 2018
- Type: Poster Display session
- Track:
- Presentations: 4
- Moderators:
- Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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100P - Prognostic factors in surgically resected N2 small cell lung cancer: Significance of the subcarinal node (ID 316)
12:30 - 13:00 | Presenting Author(s): R. Qiao
- Abstract
Background:
Surgical resection is being increasingly used for stage IIIA-N2 small cell lung cancer (SCLC). The aim of this study was to determine the prognostic factors in patients with pathologic N2 (pN2) stage IIIA SCLC.
Methods:
A retrospective analysis of 163 consecutive patients with pN2 stage IIIA SCLC who underwent pulmonary resections and systemic lymphadenectomies was conducted. Potential clinicopathological factors that could influence OS were statistically analyzed. The prognostic significance was examined by Cox regression analysis.
Results:
The median overall survival (OS) was 10.6 months. Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (p = 0.003). With respect to the station of lymph node metastasis, the OS was only related to the involvement of the subcarinal node, regardless of tumor location (p < 0.05). Multivariate analysis showed two statistically significant risk factors for survival, including multiple-station lymph node and subcarinal node metastasis (hazard ratio [HR] = 1.76, 95% confidence interval [CI]:1.11–2.78, p = 0.015; HR = 1.61, 95% CI: 1.03–2.50, p = 0.036, respectively).
Conclusions:
We found multiple-station N2 metastases and subcarinal node involvement were independent prognostic factors for worse survival in pN2 stage IIIA SCLC patients, which may be helpful to identify a valid subpopulation of N2 patients who can benefit from surgical intervention and guide postoperative adjuvant therapy.
Clinical trial identification:
Legal entity responsible for the study:
Shanghai Chest Hospital
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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104P - Adjuvant chemotherapy may improve prognosis in surgically resected stage I NSCLC with lymphovascular invasion (ID 481)
12:30 - 13:00 | Author(s): R. Qiao
- Abstract
Background:
The 8[th] edition of the TNM classification for non-small cell lung cancer (NSCLC) has recently been approved. Lymphovascular invasion (LVI) has been reported to be a strong risk factor for stage I patients. Meanwhile, the efficacy of adjuvant chemotherapy for surgically resected pathologic stage I NSCLC is controversial. This study aimed at exploring the association between adjuvant chemotherapy and survival in stage I NSCLC patients with LVI.
Methods:
A total of 2600 patients with stage I NSCLC treated in the Shanghai Chest Hospital (2008–2012) were included in the analysis, of which 221 were pathologically diagnosed with LVI. We divided these patients into an ACT (adjuvant-chemotherapy) group and a surgery alone group. By using the Kaplan–Meier method and Cox proportional hazard regression model, we explored whether lymphovascular invasion was a poor prognostic factor and the application of adjuvant chemotherapy could improve the prognosis.
Results:
For all stage I NSCLC patients, it was observed that patients with LVI had an unfavorable Lung-cancer specific survival (LCSS) (hazard ratio [HR]: 1.604; 95% confidence interval [CI]: 1.124–2.289; P = 0.009) and recurrence-free survival (RFS) (HR: 1.943; 95% CI: 1.491–2.532; P < 0.001). The presence of LVI was suspected to be correlated with larger tumor size, and adenocarcinoma. Analysis of 221 patients with LVI indicated an increased LCSS (HR: 0.31; 95% CI: 0.161–0.595; P < 0.001) and RFS (HR: 0.53; 95% CI: 0.530–0.286; P = 0.044) with adjuvant chemotherapy treatment. We saw significant differences in LCSS and RFS in patients treated with adjuvant chemotherapy with both stage IA and stage IB disease.
Conclusions:
For all stage I NSCLC patients, LVI was correlated with poorer prognosis, which was improved by adjuvant chemotherapy. Our preliminary study suggests that adjuvant chemotherapy might be an appropriate option for stage I NSCLC patients with LVI.
Clinical trial identification:
Legal entity responsible for the study:
Wang Shuyuan
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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162P - Responses to EGFR TKIs and ALK TKIs in advanced NSCLC patients harboring concomitant EGFR and ALK alterations (ID 503)
12:30 - 13:00 | Author(s): R. Qiao
- Abstract
Background:
Previous studies indicated that Epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement are mutually exclusive in non-small cell lung cancer (NSCLC). However, cases diagnosed with concomitant EGFR and ALK alterations has been occasionally reported. This study aimed to assess the prevalence of this small subset patients and optimize clinical management.
Methods:
We retrospectively collected clinical outcomes of 29 cases who had concomitant EGFR and ALK alterations from 5816 lung cancer patients tested EGFR mutation and ALK rearrangement between 2011–2017 in the Shanghai Chest Hospital. Meanwhile, we identified 103 cases harboring double positive mutations from a literature search. Of these 132 cases, 81 patients received EGFR tyrosine kinase inhibitor (EGFR-TKI) or ALK-TKI treatment.
Results:
The frequency of EGFR/ALK co-alterations was 0.5% (29/5816; 95%CI:0.3%-0.7%) in NSCLC in our center. For all 132 cases, there is a prevalence of women (67 female, 46 male, 19 not reported), Asian (87Asian, 44 Caucasian, 1 not reported) and never smoker patients (77 never smokers, 21 smokers, 34 not reported). We divided the patients into three groups according to EGFR or ALK TKIs treatment: A: single EGFR TKI group (36 cases), B: single ALK TKI group (14 cases) and C: both TKIs (31 cases). All patients were assessed for TKIs responses. The disease control rate (DCR) of EGFR-TKI was 81.5%, whereas the DCR of ALK-TKI was 89.1%. The median PFS of three groups were 12.4, 15.9 and 24.1months, respectively (P = 0.02). The PFS of group A and C had statistically sigificant difference (P = 0.006). But the PFS of group A and B, B and C did not have statistical significance (P = 0.338, P = 0.335).
Conclusions:
EGFR mutations and ALK rearrangement do coexist in NSCLC. In cases with double positive mutations, our preliminary study suggests that PFS of those who received double TKIs is longer than those who received only one TKI. Combination of both TKIs might be an appropriate choice. The result of the study indicates that ALK TKI might be preferentially administered when TKI is initiated as first-line treatment.
Clinical trial identification:
Legal entity responsible for the study:
Wang shuyuan
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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167P - Efficacy of pemetrexed-based chemotherapy in advanced lung adenocarcinoma patients with ROS-1 rearrangement (ID 413)
12:30 - 13:00 | Author(s): R. Qiao
- Abstract
Background:
When chemotherapy is commenced as first-line treatment in advanced lung adenocarcinoma patients with ROS-1 rearrangement, it is unclear that which agent should be preferentially administered. The aim of this study is to compare the therapeutic efficacy of pemetrexed-containing (Pem-C) and non-pemetrexed-containing (Non-Pem-C) chemotherapy in these patients.
Methods:
We retrospectively identified patients who were demonstrated to be ROS-1 positive by multiplex reverse-transcriptase polymerase chain reaction (RT-PCR) between October 2014 and December 2016. Those who received platinum-based dual agent chemotherapy as palliative treatment were included for further analysis.
Results:
A total of 4596 consecutive individuals were screened and 55 eligible individuals were enrolled into this study. In first-line treatment, patients who received Pem-C treatment (n = 39) derived a higher objective response rate (ORR, 40.0% vs. 7.1%, P = 0.02) and progression-free survival (PFS1, 7.0 months vs. 3.9 months, P < 0.01) compared with those who received Non-Pem-C treatment (n = 16). However, in later-line treatment, progression-free survival (PFS2) was not statistically superior in the Pem-C group (3.1 months, 95% CI: 0.6–5.6 months) compared with the Non-Pem-C group (1.9 months, 95% CI: 0.1–3.1 months, P = 0.12).
Conclusions:
Pem-C treatment resulted in better clinical outcomes compared with other agents in patients with ROS-1 rearrangement when initiated as first-line treatment.
Clinical trial identification:
Legal entity responsible for the study:
Bo Zhang
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
