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Nathaniel James Myall

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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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      P1.01-71 - Co-Mutations, Natural History, and Outcomes of BRAF-Mutated Non-Small Cell Lung Cancer at a Single Academic Cancer Center (ID 12392)

      16:45 - 18:00  |  Presenting Author(s): Nathaniel James Myall

      • Abstract
      • Slides


      Mutations in the BRAF oncogene occur in 2-4% of cases of non-small cell lung cancer (NSCLC). Based on recent trials, combination therapy targeting BRAF and MEK within the MAPK pathway is now approved for BRAF V600E-mutated NSCLC. As BRAF mutations occur infrequently, however, the natural disease history of BRAF-mutated NSCLC remains an area of ongoing study. Our aim was to describe the natural history and outcomes of patients with BRAF-mutated NSCLC seen at our institution.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      An IRB-approved protocol was used to query the Stanford Cancer Registry and Stanford Cancer Institute Research Database (SCIRDB) for patients with BRAF­-mutated NSCLC presenting between January 1, 2006 and July 31, 2015. Each patient chart was then retrospectively reviewed.

      4c3880bb027f159e801041b1021e88e8 Result

      The cohort included 18 patients (median age 66.5 years, 72% male). V600E mutations were most common (72%; 13/18) while non-V600E mutations included G469A (n = 2), G466V, K601E, and V600_W604delinsR. Most patients (69%; 9/13) with V600E mutations were light or never smokers whereas most patients with non-V600E mutations (80%; 4/5) were heavy smokers (>15 pack-years). Secondary mutations occurred most commonly in TP53 (28%; 5/18). With respect to treatment, no patients received BRAF-targeted therapy upfront. Median duration of first-line platinum-based chemotherapy was 9 months (range 1.5-21.5). In the second-line setting, median duration of chemotherapy was 6 months (range 1-52) and median duration of BRAF-targeted therapy was 5.5 months (range 5.5-6.5). Median overall survival of the entire cohort was 34.8 months. Median survival from the onset of metastases (n = 16) was 26.8 months (range 2-130.5) (Table). Among patients diagnosed with stage III-IV disease, survival at 2-years was 53%, with many showing slow progression and control of oligometastatic or intrathoracic disease with systemic therapy or localized radiation.

      Stage BRAF Mutation Co-occurring Mutations Overall Survival (months) Post-Metastases Survival (months)
      1 IA V600E None 83.5+ 39.5+
      2 IIIB V600E None 8.5 7
      3 IV G469A None 37 37
      4 IIIB V600E None 40+ 26.5+
      5 IIIA G469A TP53 41 27
      6 IV V600E None 14 14
      7 IV V600E None 130.5 130.5
      8 IIA V600E None 65 NA
      9 IV V600E CTNNB1 2 2
      10 IV V600E PIK3CA 47.5 47.5
      11 IIIA G466V Multiple (incl. TP53) 39.5 32.5
      12 IA V600E TP53 32.5+ NA
      13 IV V600_W604 None 22.5 22.5
      14 IV V600E None 28 28
      15 IV V600E Multiple (incl. TP53) 13.5 13.5
      16 IV V600E None 88.5 88.5
      17 IV K601E TP53 6.5 6.5
      18 IV V600E NKX2-1 19.5 19.5

      8eea62084ca7e541d918e823422bd82e Conclusion

      BRAF-mutated NSCLC can be associated with prolonged survival in some patients. Future research should aim to identify factors predicting longer outcomes.


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