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Shuenn-Wen Kuo



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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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      P1.01-36 - Thoracic Surgery in Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor Mutant After Tyrosine Kinase Inhibitor Therapy (ID 11170)

      16:45 - 18:00  |  Author(s): Shuenn-Wen Kuo

      • Abstract
      • Slides

      Background

      Advanced stage non-small cell lung cancer (NSCLC) patients harboring epidermal growth factor (EGFR) mutation have benefit form treatment with tyrosine kinase inhibitors (TKI). However, the role of multidisciplinary management including neoadjuvant TKI therapy and thoracic surgery is uncertain in advanced stage NSCLC. This retrospective study assessed the impact of the multidisciplinary management in advanced stage EGFR mutation positive NSCLC patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Advanced stage NSCLC patients were retrospectively identified at Department of Surgery, National Taiwan University Hospital from 2006 to 2013 and prospectively observed. Patients with stage IIIA N2 (unresectable), IIIB, and IV EGFR mutation positive NSCLC treated with neoadjuvant TKI without tumor progression followed by thoracic surgery (NT group) were evaluated. Patients with stage IIIA N2 NSCLC treated with cisplatin-based neoadjuvant chemotherapy without tumor progression followed by thoracic surgery (NC group) were also evaluated. Progression-free survival (PFS) and overall survival (OS) were analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      figure.jpeg

      There were total 88 NSCLC patients in this study. There were 41 men and 47 women. The median age was 58 years. 66 patients were the NC group and 22 patients were the NT group. 60 patients and 20 patients were adenocarcinoma in the NC group and the NT group, respectively. Other patients were squamous cell carcinoma. In the NT group, EGFR status was identified before receiving neoadjuvant TKI therapy. Twelve patients (54.5%) were exon 19 deletion and ten patients were exon 21 L858R mutation. PFS was not significantly different between NC group and NT group (p = 0.645). OS was significantly longer in the NT group than in the NC group (p = 0.028). Exon 19 deletion of the NT group patients had significantly longer OS than the NC group (p = 0.014).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The multidisciplinary management including neoadjuvant TKI therapy and thoracic surgery may possibly have benefit in selected advanced stage NSCLC patients haboring exon 19 deletion.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • 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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      P2.01-113 - Prognostic Roles of Neoadjuvant and Adjuvant Chemotherapy for Treating Patients with Operable Stage III-N2  Non-Small Cell Lung Cancer (NSCLC) (ID 13455)

      16:45 - 18:00  |  Author(s): Shuenn-Wen Kuo

      • Abstract

      Background

      The therapeutic options for stage III-N2 positive NSCLC, including the diseases with ipsilateral mediastinal or subcarinal lymph node involvement, are with multidisciplinary approaches. The NCCN and ASCO guideline recommends the cisplatin-based adjuvant chemotherapy (Ad C/T). Meanwhile, some studies revealed the benefits of managing the N2 node disease with the neoadjuvant chemotherapy (Neo C/T) followed by surgery. We currently analyzed the clinical benefit of Neo C/T and Ad C/T for treating N2 positive NSCLC in a single-center cohort.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The study was done retrospectively. A total of 258 patients with N2+ who received surgical resection in dept. of surgery, National Taiwan University Hospital during 2004 to 2016 were enrolled. The mean follow-up duration was 44 months. Both the overall survival (OS) and progression-free survival (PFS) were compared between C/T (-) (patients without chemotherapy treatment) , neo C/T, and Ad C/T groups using multivariate analysis and Kaplan-Meier estimates .

      4c3880bb027f159e801041b1021e88e8 Result

      There were 77, 55 and 126 patients in C/T (-), Neo C/T, and Ad C/T groups respectively. Patient's characteristics revealed the distributions of age and operation methods among these 3 groups were significantly differences. Patients treated with chemotherapy (combining Neo C/T and Ad C/T groups) were with significant reduced hazard for death compared to C/T (-) group (HR [95 % CI]= 0.55 [0.37-0.83), P=0.004). No significantly difference in overall survival was found between neo C/T and Ad C/T groups (HR [95 % CI]= 0.84 [0.54-1.32), P=0.451). The median overall survival time after surgery for the patients in neo C/T, and Ad C/T, and C/T (-) groups were also significant different (46.2, 56.9, and 26.9 months in C/T (-), Neo C/T, and Ad C/T groups respectively, P<0.001). However, there was no significant difference in patients received C/T or not in progression-free survival.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Both Ad C/T and Neo C/T provide clinical benefit for the patients with operable stage III N2 NSCLC . These is no significantly difference between Ad C/T and Neo C/T groups in both overall and progression-free survival .

      6f8b794f3246b0c1e1780bb4d4d5dc53