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Huijuan Wang
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OA07 - Oligometastasis: What Should Be the State-Of-The-Art? (ID 905)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 15:15 - 16:45, Room 107
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OA07.03 - Addition of Local Therapy to EGFR TKI Showed Survival Benefit in EGFR-Mutant NSCLC pts with Oligometastatic or Oligoprogressive Liver Metastases (ID 12263)
15:35 - 15:45 | Author(s): Huijuan Wang
- Abstract
- Presentation
Background
Our previous study demonstrated that EGFR-mutant NSCLC patients (Pts) with liver metastases (LM) showed poor response to EGFR-TKIs than those without LM, suggesting that additional treatment is warranted. Recently, several clinical studies indicated that local therapy (e.g. surgery and radiotherapy) could significantly improve progression-free survival (PFS) in NSCLC Pts with oligometastatic or oligoprogressive disease. This study aimed to investigate whether addition of local therapy to EGFR-TKIs could provide a better survival benefit than TKIs alone in EGFR-mutant NSCLC Pts with oligometastatic or oligoprogressive LM.
a9ded1e5ce5d75814730bb4caaf49419 Method
Pts with EGFR-mutant NSCLC and LM were enrolled. Oligometastatic LM was defined as < 5 sites in liver without extrahepatic metastases at initial diagnosis. Oligoprogressive LM was defined as < 5 sites in liver without extrahepatic metastases during TKIs therapy. For oligoprogressive cohort, PFS1 was calculated from time of initiation of TKI therapy to first RECIST 1.1 defined progress disease (PD) or death. PFS2 was calculated from time of initiation of TKI therapy to off-TKI PD.
4c3880bb027f159e801041b1021e88e8 Result
Totally, 135 cases with EGFR-mutant NSCLC and LM were eligible (64 with oligometastatic LM and 71 with oligoprogressive LM). In oligometastatic cohort, 20 Pts received EGFR-TKIs (E) and 23 Pts received EGFR-TKIs plus local therapy (E+LT) as first-line treatment. The addition of local therapy showed a significantly longer PFS (12.9 vs. 7.9 m, P = 0.041) and OS (36.8 vs. 21.3 m, P = 0.034) than EGFR-TKIs alone. In oligoprogressive cohort, 24 Pts received continuation of EGFR-TKIs plus local therapy (cE+LT) and 25 Pts received switch therapy (ST). Median PFS1 was similar. Median PFS2 (13.9 vs. 9.2 m, P = 0.007) and OS (28.3 vs. 17.1 m, P = 0.011) was significantly longer in cE+LT group than in ST group. Multivariate analysis revealed that addition of local therapy was independently associated with prolonged PFS (HR = 0.435, P = 0.028) and OS (HR = 0.434, P = 0.071) in Pts with oligometastatic LM. Distant metastatic sites were the major pattern of failure in EGFR-TKI plus local therapy group while locoregional recurrence including primary lesions and LM was the major reason in TKI alone group.
8eea62084ca7e541d918e823422bd82e Conclusion
The current study suggested that EGFR-TKIs plus local therapy demonstrated the prolonged survival benefit than EGFR-TKIs alone in EGFR-mutant NSCLC Pts with oligometastatic or oligoprogressive LM. These findings suggest that local therapy should be further explored in large-scale, strictly designed clinical trials as a standard treatment option in this clinical scenario.
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P1.05 - Interventional Diagnostics/Pulmonology (Not CME Accredited Session) (ID 937)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.05-24 - Clinical Characteristics and Prognostic Analysis of Multiple Primary Malignant<br /> Neoplasms in Patients with Lung Cancer (ID 12840)
16:45 - 18:00 | Presenting Author(s): Huijuan Wang
- Abstract
Background
To investigate the clinical characteristics, survival status and prognostic factors of multiple primary malignant neoplasm (MPMN) patients with lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
The clinical and pathological data of 14,528 lung cancer patients who were diagnosed and treated in the affiliated cancer hospital of Zhengzhou University from January 2008 to August 2015 were retrospectively analyzed.
4c3880bb027f159e801041b1021e88e8 Result
Of the total lung cancer patients, 2.5% (364/14,528) were MPMN cases and 3.6% (13/364) were diagnosed with 3 primary malignancies, 0.3% (1/364) with 4 primary malignancies and 96.2% (350/364) with 2 primary malignancies. Among the
8eea62084ca7e541d918e823422bd82e Conclusion
350 lung cancer patients diagnosed with 2 primary malignancies, 26.6% (93/350) had lung cancer diagnosed first (LCF) and 73.4% (257/350) had other cancers diagnosed initially (OCF), whereas synchronous MPMN (SMPMN) accounted for 21.1% (74/350) and metachronous MPMN (MMPMN) accounted for 78.9% (276/350) of cases.Detection of first primary neoplasms were at an early stage for LCF patients and the age of the first lung cancer diagnosis was 59.3 years vs 55.4 years in the OCF group (P = 0.008), whereas the onset age of second primary neoplasm diagnosis was similar in both groups (62.5 and 61.6 years, P = 0.544). The median survival times of the OCF and LCF groups were 86 months vs 58 months (P < 0.001). The median survival times of MMPMN and SMPMN patients were 94 months vs 27 months (P < 0.001).Multivariate analysis showed that SMPMN, LCF and the age of the primary cancer diagnosed first (≥ 60 years) were independent factors for inferior prognosis of patients.
Though LCF was diagnosed in earlier stages than OCF, the survival rate was inferior and the time until the development of the second primary malignancy was shorter than in the OCF group. SMPMN patients had a worse prognosis than MMPMN
6f8b794f3246b0c1e1780bb4d4d5dc53
patients in both the LCF and OCF groups. Also ≥ 60 years of age at the time of the primary cancer diagnosis was an independent factor for inferior prognosis in all patients.
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P3.13 - Targeted Therapy (Not CME Accredited Session) (ID 979)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.13-24 - <sub>Efficacy of EGFR-TKIs Compared with Chemotherapy as First-Line Therapy in Patients with EGFR Rare Mutation Advanced Lung Adenocarcinoma </sub> (ID 12903)
12:00 - 13:30 | Presenting Author(s): Huijuan Wang
- Abstract
Background
Clinical activity of epithelial growth factor receptor tyrosine kinase inhibitors or platinum-based chemotherapy as firstline therapy in patients with EGFR rare mutation advanced lung adenocarcinoma remains unknown, This retrospective study assesses the activity and long-term survival of the two treatment regimens.
a9ded1e5ce5d75814730bb4caaf49419 Method
3856 patients diagnosed with lung adenocarcinoma from Henan Cancer Hospital received EGFR gene detection during January 2, 2012 to November 1, 2017. 1643 patients with EGFR mutation and phase IIIB/IV were identifed. Among them, 130 cases (7.9%) with EGFR rare mutations, excluded 64 patients（4 cases of patients coexist with uncommon mutations and common mutations, 17 cases of insertions in exon 20, 42 cases of T790m and T790m complex mutations, and 1 loss of follow-up）, 66 cases of EGFR uncommon mutations（G719X, L861Q, S768I and compound mutations）enrolled in the evaluation of efficacy, of whom 34 patients received EGFR-TKIs alone and 32 patients received platinum-based chemotherapy as frstline therapy. All EGFR-TKIs were first-generation drugs, details were gefitinib (250 mg/day), erlotinib (150 mg/day) and eclectinib (125 mg tid/day), all patients received at least 4 weeks of EGFR-TKIs. All chemotherapy drugs were third-generation in combination with platinum, details were pemetrexed (500 mg/m2), vinorelbine (25 mg/m2 d1, 8), or gemcitabine (1000 mg/m2 d 1, 8) platinum-based chemotherapy, every 3 weeks as a treatment cycle.
4c3880bb027f159e801041b1021e88e8 Result
Regardless of whether EGFR-TKIs or chemotherapy, the objective response rate (ORR: 28.6% vs 36% P>0.05) and disease control rate (DCR: 82.1% vs 84% P>0.05) were similar. EGFR-TKIs showed superior progression-free survival than chemotherapy group (7.1 vs 4.9 mts; HR=0.717, P=0.166), but there was not statistically difference. However, compared with chemotherapy, we found that overall survival (OS: 14.6 vs 20.3 mts; HR=1.879, P=0.019) was significantly lower in patients with EGFR-TKIs, which was statistically significant. In multivariate analysis, first-line use of targeted therapy (HR = 0.447 P = 0.006) and smoking history (HR = 3.824 P = 0.003) were found to be a signifcant independent prognostic factor for OS in lung adenocarcinoma patients with EGFR uncommon mutation.
8eea62084ca7e541d918e823422bd82e Conclusion
Compared with chemotherapy, first-line use of the first generation of EGFR-TKIs can improve the short-term efficacy of patients with EGFR rare mutation advanced lung adenocarcinoma, but longer survival in patients with first-line platinum-based chemotherapy.
6f8b794f3246b0c1e1780bb4d4d5dc53
