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V. Patil



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    Epidemiology and outcomes (ID 57)

    • Event: ELCC 2018
    • Type: Poster Discussion session
    • Track:
    • Presentations: 1
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      72PD - MR imaging radiomics of NSCLC brain metastases: A potential targetable imaging biomarker for EGFR status (ID 319)

      14:45 - 15:45  |  Author(s): V. Patil

      • Abstract
      • Slides

      Background:
      Brain is a common site of metastases with EGFR mutated lung cancer. Oral targeted therapies have broadened the treatment options in the advanced setting with the potential for periods of long term response. Literature on MR imaging metrics or feature analysis of NSCLC brain metastasis as a biomarker for predicting EGFR mutation is limited and less investigated. The purpose of the study was to study MRI imaging biomarkers of brain metastases NSCLC and their correlation with molecular subtyping (EFGR status). To correlate these imaging features with response to therapy and clinical outcomes.

      Methods:
      We analyzed clinical data on 75 patients who were tested for EGFR mutation and underwent brain MR imaging at diagnosis. Multiparametric MRI was performed in all cases. The associations between EGFR mutation status and clinical features, specifically age, sex, smoking, TNM stage, and imaging variables, as well as brain metastasis, were analyzed using logistic regression analysis. Clinical factors known to be associated with EGFR mutation status in NSCLC patients and staging factors of TNM were included in the logistic regression multivariate analysis.

      Results:
      38 EGFR positive and 37 EGFR negative cases. EGFR positive showed early and wide spread development of brain metastasis (within 6 months after 1st presentation) (p-0.00). Statistically significant difference (p-0.00) was observed in border/margins on T2W imaging, fuzzy and infiltrative borders in EGFR positive while well defined in EGFR negative. Lesions in EGFR wild group showed focal restriction on DW images (p-0.001). In EGFR wild cases showed good response to WBRT (p < 0.00). Incidence of recurrent metastatic disease, meningeal involvement was significantly higher in EGFR positive (p-0.00, 0.04). On multivariate analysis, statistically significant association was found between T2 border, number, restricted diffusion, meningeal positivity and TTP (p < 0.05).

      Conclusions:
      EGFR positive brain metastases have characteristic MR imaging features that can be potential non-invasive diagnostic, predictive and prognostic imaging biomarkers. These MR based Radiogenomic imaging biomarkers have potential role in personalized therapy of EGFR positive brain metastasis in NSCLC.

      Clinical trial identification:


      Legal entity responsible for the study:
      IEC TMH

      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: 2
    • Moderators:
    • Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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      151P - Maintenance therapy using tyrosine kinase inhibitor (erlotinib) or pemetrexed in metastatic/locally advanced in EGFR mutation-negative lung cancer: Comparison of results (ID 522)

      12:30 - 13:00  |  Author(s): V. Patil

      • Abstract
      • Slides

      Background:
      Maintenance therapy of locally advanced or metatstatic non-small cell lung cancer (NSCLC) other than predominantly squamous cell histology in patients whose disease has not progressed following 4 to 6 cycles of platinum-based doublet therapy has been standard of care. Pemetrexed or Tyrosine Kinase Inhibitors like Erlotinib have both been used as either continuous maintenance or switch maintenance therapy.

      Methods:
      All patients of NSCLC other than the Squamous Cell carcinoma who have completed either 4 or 6 cycles of platinum and pemetrexed and have either CR/PR/SD on response assessment scan post induction treatment and willing to participate in the study were randomized to receive either pemetrexed or TKI- Erlotinib. Patients were followed up till death. PS and OS were calculated for each arm and indirectly compared.

      Results:
      Two hundred patients were randomized to receive either pemetrexed or erlotinib fron November 2014 to March 2017. Median age of cohort was 55(28–79). Of the 200 patients, 132 patients were male and 68 were female. PS was 0–1 in 195 patients. Smokers constituted 63% (126/200). Majority of patients had stable disease (62.5%), post completion of induction chemotherapy (125/200). Median number of cycles was 4 (4–6). Median PFS in Pemetrexed arm was 4.46 month (95%CI; 3.98 to 4.95), while in Erlotinib arm the median PFS was 4.5 month (95% CI; 3.98 to 4.95) (Hazard ratio = 0.98; 95% CI, 0.714 to 1.369, p-value 0.945). Median OS from starting induction therapy was 16.6 months (15.2–17.9 months) in Pemetrexed arm versus 18.3 months (95% CI 13.75–22.91 months) in Erlotinib arm (p-0.321). [HR = 1.222 (95% CI 0.821–1.818)].

      Conclusions:
      On indirect comparison, maintenance treatment with Pemetrexed and Erlotinib has similar PFS and OS.

      Clinical trial identification:


      Legal entity responsible for the study:
      Tata Memorial Hospital Centre, Mumbai, India

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      165P - Analysis of our experience of ROS-1 patients in advanced NSCLC (ID 518)

      12:30 - 13:00  |  Author(s): V. Patil

      • Abstract
      • Slides

      Background:
      ROS1 is a receptor tyrosine kinase receptor and it belongs to insulin receptor family.[1] It acts as a driver oncogene in 1 to 2% of NSCLC patients. A homology exists between ALK and ROS1 Kinase domains. Crizotinib binds with high affinity to both ALK and ROS1, which is consistent with this homology. Crizotinib is approved for patients with the ROS1 translocation including those who have received chemotherapy and those who are treatment naïve. We report our experience in a tertiary cancer care centre in ROS-1 positive patients.

      Methods:
      Patients who were ROS-1 positive by break-apart Fluorescence In situ Hybridization (FISH) and who had advanced NSCLC being planned treatment with palliative intent were included in our study. We had a total of 22 patients whose details were obtained from the prospective lung cancer audit database that is maintained in the department of medical oncology. Details of patients demographic data (age, gender, comorbidities, smoking status and performance status), tumour characteristics (histology, stage, number and sites of metastases) treatment (crizotinib dose, sequence of treatment, dose interruptions, treatment used before and after crizotinib,) efficacy and side effects were retrieved. Response evaluation done by RECIST 1.1 criteria.

      Results:
      A total of 22 patients satisfied the predefined selection criteria. There were 13 males and 9 females in this group and the median age of the population was 53 years. 10 patients received Platinum doublet as first line and 1 received Erlotinib as first line in view of poor PS. Six patients could be started on Crizotinib as first line. A total of 16 patients took Crizotinib either in first or second line. The patients who were on Crizotinib had good tolerance with none experiencing any grade 3/4 toxicity. The median follow up was 244 days in non-crizotinib arma and 322 days in Crizotinib arm. The estimated PFS was 79 days in non-crizotinib arm and 573 days in those who received Crizotinib. The estimated OS was 79 days vs not reached in Crizotinib arm.

      Conclusions:
      In conclusion, crizotinib is effective treatment with acceptable side effect profile in patients with ROS1 rearranged advanced NSCLC with significant improvement in PFS and OS.

      Clinical trial identification:


      Legal entity responsible for the study:
      Nikhil Pande

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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