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    MA22 - New Therapeutics, Pathology, and Brain Metastases for Small Cell and Neuroendocrine Tumour (ID 925)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 BD
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      MA22.07 - Prognostic Value of Distant Organ-Specific Metastases in Newly Diagnosed Lung Neuroendocrine Tumors: A Population-Based Study (ID 12684)

      15:55 - 16:00  |  Presenting Author(s): Min Fan

      • Abstract
      • Presentation
      • Slides

      Background

      Lung neuroendocrine tumors (Lung NETs) are rare neoplasms with inferior outcomes for patients with distant metastases. AJCC cancer staging system for the classification of NETs was first introduced in 2010. However, the prognostic impact of metastatic sites for lung NETs are poorly explored. We aimed to fill this gap of our knowledge using the SEER database.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Clinical-pathological characteristics, specific metastatic sites and outcomes of stage IV lung NETs (according to AJCC 7th edition) were extracted from the SEER database from 2010-2014. Overall survival (OS) and Lung cancer-specific survival (LCSS) were estimated by the Kaplan-Meier method and comparisons conducted using log-rank tests and Cox regression models.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 2337 stage IV lung NETs patients were identified. The 5-year OS and LCSS were 10.7% and 18.3%, respectively. Among them, 2159 patients had specific organ metastases (liver, lung, bone or brain) at diagnosis. Liver was the most common metastatic site (1183, 50.6%), followed by bone (801,34.3%), lung (701,29.9%) and brain (616,26.4%). Patients with isolated lung metastases (1-, 5-year OS: 63.2%, 43.2%; 1-, 5-year LCSS: 74.0%, 62.9%,) had significantly better outcomes comparing to other patterns of metastases. The outcomes of patients with any brain metastases was most unfavorable (1-, 5-year OS: 20.3%, 2.1%, p<0.001; 1-, 5-year LCSS: 26.8%, 7.7%, p<0.001). Multivariate Cox regression analysis on OS and LCSS revealed that age > 60 years (p<0.001), male gender (p<0.001), poorer differentiation (p<0.001) and brain metastases (p<0.001) were independently poor prognostic factors for stage IV lung NETs patients.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The prognostic impact of metastatic site was unambiguous in stage IV patients with lung NETs. Comparing other metastatic patterns, brain metastases was associated with significant worse survival outcomes. Nearly twenty-fold difference in 5-year survival was revealed between isolated lung and brain metastases. For advanced lung NETs patients, brain metastases might be considered as a distinct category of dismal outcomes.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

    • 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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      P1.01-95 - Crizotinib Treatment in 29 Advanced NSCLC Chinese Patients with ROS1 Rearrangement——A Single Chinese Cancer Institute Experience (ID 13958)

      16:45 - 18:00  |  Author(s): Min Fan

      • Abstract
      • Slides

      Background

      Approximately 1%~2% of NSCLC patients harbor ROS1 rearrangement. Crizotinib, a tyrosine kinase inhibitor that targets ALK, MET and ROS1, has shown marked antitumor activity in patients with ROS1-positive advanced NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A total of 29 patients with ROS1 rearrangement advanced or metastatic NSCLC were treated with crizotinib between Apr 1st, 2016 and Feb 6th, 2018 at Shanghai Cancer Center, Fudan University. Patients were administered with oral crizotinib at dose of 250 mg twice daily.

      4c3880bb027f159e801041b1021e88e8 Result

      The median age was 51 years old. Twenty patients (69.0%) were female. Twenty-three(79.3%) were never-smokers. Six patients (20.7%) had brain metastases. Sixteen patients (55.2%) had received chemotherapy prior to crizotinib therapy. Patients’ characteristics were showed in table 1. The ORR and DCR were 65.5% and 93.1%, respectively. The estimated median PFS has not been reached yet. Transaminases increase (15/29,51.7%), vision disorder (6/29,20.7%), blood creatinine increase (6/29,20.7%), vomiting (6/29,20.7%), fatigue (5/29,17.2%) and diarrhea (5/29,17.2%)
 were the most commonly reported adverse effects. Two patients (6.9%) discontinued crizotinib because of crizotinib-related vomiting, one of whom had reduced to 200mg twice daily.

      table 1 .jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      Crizotinib was effective and well tolerated in Chinese patients with ROS1-positive, advanced NSCLC in real-world clinical practice.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)

    • 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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      P1.17-18 - Treatment for Patients with T4 Superior Sulcus Non-Small Cell Lung Cancer: A Propensity-Matched Analysis of SEER Database (ID 12319)

      16:45 - 18:00  |  Presenting Author(s): Min Fan

      • Abstract
      • Slides

      Background

      Superior sulcus tumors (SSTs), a unique subgroup of locally advanced non–small-cell lung carcinoma (NSCLC), remain a great challenge for clinicians. T4 SSTs used to be a contraindication for operations, and the optimal treatment modality for T4 SS NSCLCs remains uncertain. The aim of our study is to evaluate the roles of surgical treatment and radiotherapy for patients with T4 SSTs.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We used the SEER database [1973-2015] to identify patients diagnosed with T4 stage SS NSCLC (according to 7th edition AJCC staging system) between 2004 and 2015, those with M1 disease were excluded. Propensity score matching with Kaplan-Meier and Cox proportional hazards model were performed to estimate prognosis.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 384 patients were included (mean 66.4±11.71 years-of-age). Among them, the majority was male (59.4%) with lesions located in the left lung (52.3%) and diagnosed with IIIB stage (56.6%). 47 patients underwent cancer-directed surgery, and radiotherapy was received by 66.9% of patients. Median overall survival (OS) and lung cancer specific survival (LCSS) was 12 and 17 months, and 5-year OS, LCSS was 15.8%, 25.4%, respectively. In the matched population, the median survival outcomes were better with receipt of surgery (OS: 51.3 vs 35.1 months; p=0.049 LCSS: 67.1 vs 36.3 months; p=0.003). Multivariate Cox analysis showed that age ≧ 66 years (hazard ratio [HR] = 1.639, 95% confidence interval [CI] 1.214-2.213, p=0.001), unmarried status (HR = 1.356, 95% CI 1.023-1.798, p=0.034), tumor sized ≧ 6.0 cm (HR = 1.694, 95% CI 1.263-2.273, p<0.001) were associated with inferior OS. Cancer-directed surgery (HR = 0.537, 95% CI 0.337-0.855, p=0.009) and radiotherapy (HR = 0.644, 95% CI 0.472-0.878, p=0.006) were independent protective factors for patients with T4 superior sulcus NSCLC. However, neither adjuvant nor neoadjuvant radiotherapy was independent prognostic factor for those received surgery (p>0.05). Conversely, in the subgroup analysis, favorable impacts of radiotherapy were observed for non-surgery patients (OS: HR = 0.58, 95% CI 0.42-0.79, p<0.001; LCSS: HR = 0.55, 95% CI 0.37-0.75, p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our study shows superior sulcus NSCLC patients with T4 stage have dismal prognosis. Surgical resection remains the optimal option for those with resectable disease. Moreover, for non-surgery tumors, the use of radiotherapy should be considered.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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