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Jing Zhao
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MA15 - Colliding Approaches - EGFR and Immunotherapy (ID 916)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 107
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MA15.09 - Dynamic Monitoring and Predictive Value of Circulating Tumor Cells in EGFR Mutant Advanced NSCLC Patients Treated with First-Line EGFR-TKIs (ID 13236)
14:30 - 14:35 | Author(s): Jing Zhao
- Abstract
- Presentation
Background
We proposed a non-invasive, folate receptor (FR)-based circulating tumor cell (CTC) assay counts to predict and dynamically monitor the therapeutic response to first-line EGFR-TKIs in patients with EGFR-mutant non-small cell lung cancer (NSCLC).
a9ded1e5ce5d75814730bb4caaf49419 Method
Eligible patients were enrolled and three milliliter (mL) of blood were obtained prior to initial treatment, after one month, and follow-up every two months hereafter. CTCs were isolated based on negative enrichment by immunomagnetic beads and detected by a ligand-targeted polymerase chain reaction (LT-PCR) method.
4c3880bb027f159e801041b1021e88e8 Result
232 patients with EGFR mutations treated with first-line EGFR-TKIs were included. The objective response rate (ORR) of patients with low baseline CTC level (<20.5 FU/3 mL) were significantly higher than those with high baseline CTC level (≥20.5 FU/3 mL) (55.8% vs 38.5%, P = 0.030). Moreover, patients with low baseline CTC level had a markedly longer progression-free survival (PFS) than those with high baseline CTC level (HR = 0.50, P < 0.001). This difference remained significant after multivariate analysis (P = 0.003). Dynamic change of CTC value was significantly associated with partial response (PR) (P = 0.042) and stable disease (SD)/progression disease (PD) (P = 0.032). Of note, dynamic monitoring of CTC provided evidence of resistance to EGFR-TKIs before CT scanning, median: 113 days; range: 45 to 169 days.
Table 1. Clinical and molecular characteristics of included patients.
CTC < 20.5 (n = 165)
%
CTC > 20.5 (n = 52)
%
P value
Age, years
Median
61
63
Range
27-85
40-83
Sex
Male
79
47.88
28
53.85
0.453
Female
86
52.12
24
46.15
Smoking status
Never-smoker
122
73.94
35
67.31
0.351
Current/ever Smoker
43
26.06
17
32.69
Pathological type
ADC
150
90.91
47
90.38
0.909
ADS
4
2.42
1
1.92
NOS
13
7.88
4
7.69
Clinical stage
Ⅲb
9
5.45
3
5.77
0.794
Ⅳ
156
94.55
49
94.23
Distant metastases
Brain
43
26.06
15
28.85
0.953
Bone
78
47.27
21
40.38
Liver
10
6.06
1
1.92
Other sites
109
66.06
34
65.38
No metastases
12
7.27
3
5.77
Mutation type
19DEL
76
46.06
24
46.15
0.012
L858R
79
47.88
19
36.54
Rare mutations
10
6.06
9
17.31
Response rate
Complete response
0
0.00
0
0.00
Partial response
92
55.76
20
38.46
Stable disease
48
29.09
21
40.38
Progressive disease
25
151.50
11
21.15
Disease control rate
140
84.85
41
78.85
0.310
Objective response rate
92
55.76
20
38.46
0.030
ADC, adenocarcinoma; ADS, adenosquamous carcinoma; CTC, circulating tumor cell.
8eea62084ca7e541d918e823422bd82e Conclusion
The current evidences suggest that FR-positive CTCs can be used for both the dynamic monitoring and prediction of outcome in EGFR-mutant NSCLC patients treated with EGFR-TKIs, which could serve as an alternative or supplement to CT scanning.
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