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Emilie Le Rhun



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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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      P1.01-19 - Efficacy of Tyrosine Kinase Inhibitors in EGFR Mutated Non-Small Cell Lung Cancer with Leptomeningeal Metastases. (ID 13820)

      16:45 - 18:00  |  Author(s): Emilie Le Rhun

      • Abstract
      • Slides

      Background

      Leptomeningeal dissemination (LM) in patients with non-small cell lung carcinoma (NSCLC) is usually associated with dismal prognosis. However, survival data and optimal management of tyrosine kinase inhibitors (TKI) in EGFR-mutated (EGFRm) patients (pts) are unknown.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Pts with EGFRm NSCLC with LM treated in 2 institutions were included. Clinical, pathological and radiological data were retrospectively collected. We performed overall survival (OS) analysis from LM diagnosis. We assessed survival, clinical response rate (CRR) and disease control rate (DCR; stable disease > 2 months or clinical response) in patients who received a subsequent TKI after experiencing LM progression with first-line TKI.

      4c3880bb027f159e801041b1021e88e8 Result

      Seventy pts were included between Apr. 2003 and Feb. 2018. Median age was 54 [26-79], 60 (85%) were non-smokers, 51 (73%) female and median number of prior systemic treatments before LM diagnosis was 2 [1-7].

      Median OS from LM diagnosis was 7 months (m) [95% CI 6-9], with a 1 year-OS of 29%. Pts received a median of 2 [1-6] lines of subsequent systemic therapy and 19 had additional intrathecal treatment.

      At first LM progression, 40 pts received subsequent TKI treatment with a median PFS of 3m [95% CI 2-not reached]. DCR and CRR were 73% and 38%, respectively. In patients without T790M mutation (N=36), median OS was 7 months [95% CI 4-7] with 2nd-line erlotinib (N=21) and 3 months [2-17] with 2nd-line afatinib or gefitinib (N=5). Eight patients received high-dose erlotinib as 2nd-line treatment after prior erlotinib with a median OS of 3 months [1-3] and a DCR of 75%. Four patients with T790M mutation received 2nd-line osimertinib with a median OS of 10 months [6-10] and a DCR of 100%.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Pts with LM from EGFRm NSCLC have prolonged survival with 1st generation TKI. Second-line erlotinib after LM progression is an efficient approach in T790M-negative pts. Erlotinib dose increase is a suitable strategy in erlotinib-refractory T790M-negative pts.

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