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Jingbo Wang



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    MA25 - Oligometastasis: Defining, Treating, and Evaluating (ID 929)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 13:30 - 15:00, Room 203 BD
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      MA25.07 - Effectiveness of Systemic Therapy Combined with Thoracic Radiotherapy for Patients with Oligometastatic NSCLC: A Pooled Analysis (ID 12572)

      14:10 - 14:15  |  Author(s): Jingbo Wang

      • Abstract
      • Presentation
      • Slides

      Background

      Local therapy combined with systemic therapy for oligometastases or oligo-recurrence (≤ 5 lesions) in NSCLC has become one of the hottest spots in recent years. At present , there is lack of results from randomised phase III trial in this regard. Therefore, we performed a pooled analysis, aiming to evaluate the effectiveness of the combination of systemic therapy and local thoracic radiotherapy for patients with oligometastatic NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Computerized search of the Pubmed database was performed using the following key words: non-small cell lung cancer, metastasis, stage IV, thoracic radiation. Abstracts were ruled out. In addition, we also reviewed the references listed in the identified articles and included eligible studies for integrity of the literature search. Combination therapeutic modality should include systemic therapy (chemotherapy or targeted therapy) and thoracic radiotherapy. Authors with more than 1 publication involving the same study population were included only once, and the one with most relevant and complete data were included. Literature retrieval was terminated by April 2018. All the analysis was performed in the Stata/SE 12.0.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 32 articles with full text were retrieved in our initial literature search. After reviewing these articles and corresponding references, 16 studies (9 retrospective studies vs. 7 prospective phase II studies) with a total of 791 oligometastatic NSCLC patients were finally identified as eligible for this analysis. The median progression free survival (PFS) ranged from 6.6 to 16.0 months and median overall survival OS ranged from 10.0 to 27.1 months. Four studies involving 256 patients reported the post-radiotherapy response, resulting in a pooled objective response (CR + PR) rate of 58% (95% CI: 0.41, 0.76). A total of 3 studies involving 168 patients provided comparison data on PFS between systemic therapy alone and systemic therapy plus thoracic radiotherapy, leading to a pooled hazard ratio (HR) of 0.42 (95% CI: 0.28, 0.64) for the combined modality group.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Consolidative thoracic radiotherapy in addition to systemic therapy may offer significant outcome benefits for oligometastatic NSCLC, leading to a numerically comparable response and survival to locally advanced NSCLC. Results from phase III randomized controlled trials are awaited.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • 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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      P3.01-65 - First-Line Radical Local Therapy May Provide Additional Survival Gain for Patients with EGFR-Mutant Metastatic NSCLC Receiving TKIs (ID 12140)

      12:00 - 13:30  |  Presenting Author(s): Jingbo Wang

      • Abstract
      • Slides

      Background

      Tyrosine kinase inhibitors (TKIs) have been widely accepted as first-line therapy for patients with EGFR-mutant metastatic non-small cell lung cancer (NSCLC), achieving a median progression free survival (PFS) and overall survival (OS) of 8.0 to 13.1 months and 19.3 to 30.9 months respectively. Patterns-of-failure studies suggest that the first progression after first-line TKIs occurs most often at sites of disease known to exist at the baseline. In this retrospective study, we aimed to investigate whether the radical local therapy could offer survival benefit in addition to st

      a9ded1e5ce5d75814730bb4caaf49419 Method

      NSCLC patients with activating EGFR mutations and treated with TKIs as first-line management after the diagnosis of stage IV disease (either synchronous or metachronous) between 2010 and 2017 at our institution were reviewed. All enrolled patients should receive radical local therapy (either surgery or radiotherapy with curative intent) at least to the main site of disease. We defined the main site as the primary site for synchronous IV-stage patients and at least 1 progression site for metachronous IV-stage patients. OS and PFS were calculated from the first day of IV-stage treatment. Kaplan-Meier method was used for survival estimation and Log-rank test was rendered for survival comparison between groups.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 45 patients entered into the final analysis, including 18with synchronous stage IV diseases and 27patients with metachronous diseases. A total of 208 gross tumor sites were identified and 130 of them received local treatment, including 90 sites treated with radical approaches and another 30 sites with palliative therapy. At a median follow-up period of 37.8months, the median OS was 51.4 months, with 1-, 3- and 5-year rate of 97.7%, 58.7% and 25.2%, respectively. The median PFS was 16.4months, with 1-, 2- and 3-year rate of 64.7%, 29.1% and 6.8%, respectively. There was no difference between synchronous and metachronous groups. In 38patients who progressed, 19 (42.2%) involved new metastatic sites only, 12(26.6%) involved initial sites only, and 3 (6.7%) involved both.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Metastatic EGFR-mutant NSCLC patients who received TKIs and radical local therapy in our study obviously provided longer OS and PFS compared with historical results using TKIs alone. Prospective randomized evidences are warranted to clarify the clinical efficacy of additional local therapy to first-line TKIs for this highly selective subgroup of patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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