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Qinghua Xu
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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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OA07.05 - Local Ablative Therapy Improves Survival in Patients with Synchronous Oligometastatic NSCLC Harboring EGFR Mutation Treated with EGFR-TKIs (ID 11141)
16:00 - 16:10 | Author(s): Qinghua Xu
- Abstract
- Presentation
Background
Non-small-cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. Patients with oligometastatic disease can represent an indolent phenotype that could benefit from local ablative therapy(LAT). Howerver, whether first-line continual EGFR-TKIplus LAT could have potential benefit in EGFR-mutant NSCLC patients with oligometastatic disease remains undetermined.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with stage IV EGFR-mutant NSCLC and no more than five metastases at diagnosis in 2 months were enrolled. All patients were treated with first-line EGFR-TKIs. Consolidation LAT included radiotherapy or surgery. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier curves.
4c3880bb027f159e801041b1021e88e8 Result
From October 2010 to May 2016, 145 patients were enrolled, including 51 (35.2%) who received consolidation LAT to all oligometastatic sites (All-LAT group), 55 (37.9%) who received consolidation LAT to either primary tumor or oligometastatic sites (Part-LAT group), and 39 (26.9%) who did not receive any consolidation LAT (Non-LAT group). The median PFS in All-LAT, Part-LAT, and None-LAT group were 20.6 months, 15.6 months, and 13.9 months, respectively (P<0.001). The median OS in All-LAT, Part-LAT, and None-LAT group were 40.9 months, 34.1 months, and 30.8 months, respectively (P<0.001). The difference was significant between All-LAT group and Part-LAT or Non-LAT group but was not significant between Part-LAT and Non-LAT group. The median OS was significantly improved with consolidation LAT for primary tumor (40.5 versus 31.5 months, P<0.001), brain metastases (38.2 versus 29.2 months, P=0.002), adrenal metastases (37.1 versus 29.2 months, P =0.032). Adverse events (Grade≥3) due to radiotherapy included pneumonitis (7.7%) and esophagitis (16.9%).
8eea62084ca7e541d918e823422bd82e Conclusion
The current study demonstrated that consolidation LAT to all sites was a feasible option among patients with EGFR-mutant oligometastatic NSCLC during first-line EGFR-TKI treatment, with significantly improved PFS and OS compared with consolidation LAT to partial sites or observation alone.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.13 - Targeted Therapy (Not CME Accredited Session) (ID 945)
- 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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P1.13-26 - First-Line Continual EGFR-TKI Plus LAT Demonstrated Survival Benefit in Egfr-Mutant Nsclc Patients with Oligoprogressive Disease (ID 11143)
16:45 - 18:00 | Presenting Author(s): Qinghua Xu
- Abstract
Background
The effect of local ablative therapy (LAT) for oligoprogressive epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC) remains undetermined. This study aimed to investigate the survival benefit of addition of LAT to EGFR-TKIs in EGFR-mutant NSCLC patients with oligoprogression during TKI therapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with stage IIIB/IV EGFR mutant NSCLC who had oligoprogressive disease during the first-line EGFR-TKI therapy from March 2011 to February 2016 were identified. The primary research point were progression-free survival1 (PFS1), defined as time of initiation of TKI therapy to Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 defined progress disease (PD) or death and PFS2, defined as time of initiation of TKI therapy to off-TKI PD. The second research piont inclued overal survival (OS) and safety.
4c3880bb027f159e801041b1021e88e8 Result
A total of 206 patients were included. The median follow-up time was 42 months (20.0-69.6 months). The median PFS1, median PFS2 and median OS for the related cohort were 10.7 months (95% CI, 10.1-13.3 months), 18.3 months (95% CI, 17.4-19.2 months) and 37.4 months (95% CI, 35.9-38.9 months) respectively. Survival rates of 1 year, 2 years and 3 years were 94.1%, 78.9%, and 54.7%, respectively. Multivariate analysis revealed that female, EGFR exon 19 mutation, one metastatic lesion, partial or complete response to prior EGFR TKIs therapy were the independent prognostic factors. No unexpected toxicities were observed.
8eea62084ca7e541d918e823422bd82e Conclusion
The current study suggested that the addition of LAT to EGFR-TKI could provide satisfactory survival benefit for EGFR-mutant NSCLC patients with oligoprogression during first-line EGFR-TKI treatment.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)
- 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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P1.16-18 - Role of ERCC1/2 Single Nucleotide Polymorphism (SNP) on Treatment Response in Patients with Lung Cancer Undergoing Radiation Therapy (ID 14476)
16:45 - 18:00 | Author(s): Qinghua Xu
- Abstract
Background
Radiation therapy plays an important role in the treatment of lung cancer. The protein excision-repair cross-comlementation 1 (ERCC1) and protein excision-repair cross-comlementation 2 (ERCC2) are the key enzymes in NER pathway. Studies showed that ERCC1/2 were associated with susceptibility and efficacy of chemotherapy in lung cancer, but the association between ERCC1/2 SNPs and radiotherapy were seldom reported.
a9ded1e5ce5d75814730bb4caaf49419 Method
Eighty-seven peripheral blood samples were collected from patients with NSCLC before they received radiotherapy in our department from November 2014 to October 2017. The peripheral blood leukocyte DNA was isolated and SNP genotypes were detected by competitive allele-specific PCR. Seven SNPs in ERCC1/2 were analyzed. Data was collected both before and after radiotherapy from blood serum. Elisa was used to detect ERCC1 expression. The association between the changes of expression of ERCC1 during radiotherapy and efficacy, risk of RILI and SNPs in ERCC1 was analyzed.
4c3880bb027f159e801041b1021e88e8 Result
ERCC1 re3212961 minor allele A was associated with a better response to radiotherapy in NSCLC patients. Survival analyses showed that G/G genotype had favorable OS than A/A genotype (P=0.012). Cox regression analysis indicated that ERCC1 rs11615 G/G genotype was associated with decreased risk of death. Subgroup analyses indicated that patients with G/G genotype who received high BED radiotherapy had better OS (median not reached vs. 21.5 months, 95%CI：15.3-27.7，P=0.011) and PFS (median not reached vs. 19.9 months, 95%CI：8.6-31.2，P<0.001) than low BED subgroup. There was no significant association between ERCC1/2 SNPs and RILI. The ERCC1 expression in serum was significantly increased after radiotherapy. However, the changes of ERCC1 expression showed no association with efficacy of radiotherapy, risk of RILI or SNPs of ERCC1/2.
8eea62084ca7e541d918e823422bd82e Conclusion
ERCC1 rs3212961 was related with short-term curative efficacy. ERCC1 rs11615 was an independent prognostic factor in NSCLC, which could serve as biomarker, because G/G genotype had favorable OS and PFS, and was associated with decreased risk of death. There was no significant correlation between ERCC1/2 SNPs and RILI. The changes of ERCC1 expression after radiotherapy showed no association with efficacy of radiotherapy, risk of RILI or SNPs of ERCC1/2.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.04 - Immunooncology (Not CME Accredited Session) (ID 953)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.04-18 - The Association Between IDO Activity and Clinical Prognosis in Patients with Non-Small Cell Lung Cancer After Radiotherapy (ID 14394)
16:45 - 18:00 | Author(s): Qinghua Xu
- Abstract
Background
Immunity affects the efficacy of radiotherapy and prognosis of patients. indoleamine 2,3-dioxygenase (IDO), a limiting enzyme in the IDO/kynurenine pathway, could converts the tryptophan (T) into kynurenine (K), which promotes immune suppression and assist tumor cells in immune evasion. The aim of this study was to investigate the association between the IDO activity and kynurenine and clinical outcome in non-small cell lung cancer (NSCLC) patients who received radiotherapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
Blood serum K and T in 114 NSCLC patients were measured by high performance liquid chromatography and mass spectrometer in time before and after radiotherapy. The ratio of K: T represents the activity of IDO. Kaplan-Meier curve and log-rank test were performed to evaluated the correlation with Overall survival (OS) or progression-free survival (PFS) and IDO activity. The Cox proportional hazards model was used for univariate and multivariate analyses.
4c3880bb027f159e801041b1021e88e8 Result
On average, both the K and the ratio of K: T were increased after radiotherapy (P<0.001 and P=0.006). The patients with reduced K: T after radiotherapy had better OS than who with increased K: T (not reached vs. 20.2 months，P=0.004). In subgroup of patients who received Stereotactic Body Radiation Therapy (SBRT), patients with reduced K: T after radiotherapy had better OS and PFS than who with increased K: T (median OS: not reached vs. 20.2 months，P=0.008 and median PFS: not reached vs. 10.9 months，P=0.006, respectively). Multivariate analysis also showed that IDO activity was a factor for OS and PFS （HR=6.667，95%CI：1.515~29.411，P=0.012 and HR=5.348，95%CI：1.427~20.000，P=0.013, respectively).
8eea62084ca7e541d918e823422bd82e Conclusion
The change of IDO activity after radiotherapy is associated with prognosis in NSCLC. The patients with reduced IDO activity after radiotherapy had better OS than who with increased. Especially for patients who received SBRT, patients with reduced IDO activity had better OS and PFS than those increased after radiotherapy. IDO is a potential molecular marker of NSCLC to evaluated the prognosis after radiotherapy.
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