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G. Wiest



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    Poster Display session (Friday) (ID 65)

    • Event: ELCC 2018
    • Type: Poster Display session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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      163P - The influence of 2<sup>nd</sup> and 3<sup>rd</sup> generation TKI in EGFR mt+ and ALK+ patients on OS and PFS: Results of the NOWEL network (ID 402)

      12:30 - 13:00  |  Author(s): G. Wiest

      • Abstract
      • Slides

      Background:
      EGFR TKI treatment is standard of care in patients with metastasized NSCLC carrying an activating EGFR mutation. Targeted therapies achieve a higher ORR, OS, PFS and a better quality of life than chemotherapy in mt+ patients. With the advent of 2[nd] and 3[rd] generation TKÍs effective in 1[st] generation TKI resistant tumors, we wanted to study the impact of these drugs on the outcome of patients in a real life setting in 3 lung cancer centers.

      Methods:
      1477 patients from three cancer centers diagnosed with non-squamous cell NSCLC stage IV (UICC 7) were examined. Methods for the mutation testing was performed according to the German Oncopedia guidelines using either Sanger Sequencing or COBAS® or Next Generation Sequencing (hybrid capture NGS, New Oncology Cologne).

      Results:
      945/1477 (64%) consecutive patients with non-squamous cell NSCLC from three cancer centers were studied for the presence of tumor mutations, especially for EGFR and ALK mutations. The EGFR mutation rate was 16% (149/912), and the ALK-translocation rate 4% (26/700). Median OS in EGFR mt+ patients was 23 months (n = 154) compared to 11 months (n = 763) in patients with EGFR WT (p < 0.001). Median OS in EGFR mt+ patients depending on the center was 23 (n = 102) vs. 28 (n = 38) vs. 16 (n = 14) months respectively (center 1 vs. center 2 vs. center 3). Median OS in ALK mt+ patients was 24 months (n = 19) in center 1, 11 months (n = 5) in center 2 and in center 3 median OS was not reached (p < 0.025). The use of 3[rd] generation TKI Osimertinib lead to a significantly higher OS (n = 21, median OS 55 months) than the use of only 1[st] and 2[nd] generation TKI (n = 118, median OS 22 months, p < 0.001). The hazard ratio HR for patients treated without Osimertinib was 2.77 [95% CI 1.454–5.305] (p < 0.002). Similarly, use of 2[nd] and 3[rd] generation ALKi impacted significantly on median OS: Crizotinib alone (n = 7), 17 months, Crizotinib followed by Ceritinib and/or Brigatinib/Alectinib (n = 13) median OS was not reached and 3 months for other therapies (n = 6) (p < 0.000).

      Conclusions:
      Small differences in OS were observed, depending on the treatment centers, but the use of multiple EGFR and ALK-I impacted highly significantly on the outcome of patients with EGFR and ALK-alterations in a real life setting.

      Clinical trial identification:


      Legal entity responsible for the study:
      University of Oldenburg

      Funding:
      Has not received any funding

      Disclosure:
      M. Netchaeva: Advisory Boards: Roche, AstraZeneca, BMS Travel: Boehringer-Ingelheim, Celegene, Pharma Mar, Amgen Consultant: Boehringer-Ingelheim. M. Falk: Advisory boards: Boehringer Ingelheim, Pfizer, Roche. M. Tiemann: Advisory boards: Novartis, Boehringer, Roche, Astra Zeneca Scientific Support: Novartis F. Griesinger: Advisory Boards: Ariad, Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myer-Squibb, Celgene, Clovis, Lilly, Merck-Sharp-Dome, Novartis, Pfizer, Roche Travel Support: Ariad, Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myer-Squibb, Celgene, Lilly, Merck-Sharp-Dome, Novartis, Pfizer, Roche Scientific Support: Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myer-Squibb, Celgene, Lilly, Merck-Sharp-Dome, Novartis, Pfizer, Roche Shares: none. All other authors have declared no conflicts of interest.

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