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Yun Chen



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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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      P1.01-100 - Concurrent Brain Radiotherapy and EGFR-TKI Have Better Survival Benefits in Patients with Brain Metastases from EGFR-Mutant NSCLC (ID 14392)

      16:45 - 18:00  |  Author(s): Yun Chen

      • Abstract

      Background

      Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) has intracranial activity in EGFR-mutant Non-Small Cell Lung Cancer (NSCLC). The optimal timing of brain radiotherapy and appropriate patients who need early brain radiotherapy remains controversial. We performed a retrospective analysis of patients with brain metastases (BM) from EGFR-mutant NSCLC to evaluate the preferred treatment of EGFR-TKIs in this population.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Of 128 initial or recurrent patients diagnosed BM from EGFR-mutant NSCLC between Jan 1, 2012, and Dec 31, 2016, 68 EGFR-TKI combined with concurrent brain RT, and 60 upfront EGFR-TKI then brain RT. Disease-specific-graded prognostic assessment was similar between two groups. The Kaplan-Meier method and log-rank tests were used to compare overall survival rates and intracranial progression-free survival rates, and a bootstrapped Cox proportional hazards model was used to determine significant contributors to overall survival.

      4c3880bb027f159e801041b1021e88e8 Result

      Compared with upfront EGFR-TKI group, the median OS was significantly longer in EGFR-TKI combined with concurrent brain radiotherapy group (24.1 vs 17.8 months; P=0.046). According to multivariate COX analysis, KPS ( 70) and intracranial metastasis alone was associated with a longer OS. The median intracranial progression-free survival was significantly improved in patients receiving EGFR-TKI combined with concurrent brain radiotherapy compared with upfront EGFR-TKI (32.3 vs 10.2 months; P=0.022).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The present study suggests that the use of EGFR-TKI combined with concurrent brain radiotherapy may result in superior OS in patients with brain metastases from EGFR-mutant NSCLC. Also, early brain radiotherapy could significantly reduce the risk of intracranial progression compared with EGFR-TKI alone. Participation in clinical trials is essential to define the indications and relative efficacy of concurrent management and EGFR-TKI alone in a selected population. We expect that further molecular biomarkers will improve estimation of prognosis and patient selection in the future.

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • 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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      P1.16-18 - Role of ERCC1/2 Single Nucleotide Polymorphism (SNP) on Treatment Response in Patients with Lung Cancer Undergoing Radiation Therapy (ID 14476)

      16:45 - 18:00  |  Author(s): Yun Chen

      • Abstract

      Background

      Radiation therapy plays an important role in the treatment of lung cancer. The protein excision-repair cross-comlementation 1 (ERCC1) and protein excision-repair cross-comlementation 2 (ERCC2) are the key enzymes in NER pathway. Studies showed that ERCC1/2 were associated with susceptibility and efficacy of chemotherapy in lung cancer, but the association between ERCC1/2 SNPs and radiotherapy were seldom reported.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Eighty-seven peripheral blood samples were collected from patients with NSCLC before they received radiotherapy in our department from November 2014 to October 2017. The peripheral blood leukocyte DNA was isolated and SNP genotypes were detected by competitive allele-specific PCR. Seven SNPs in ERCC1/2 were analyzed. Data was collected both before and after radiotherapy from blood serum. Elisa was used to detect ERCC1 expression. The association between the changes of expression of ERCC1 during radiotherapy and efficacy, risk of RILI and SNPs in ERCC1 was analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      ERCC1 re3212961 minor allele A was associated with a better response to radiotherapy in NSCLC patients. Survival analyses showed that G/G genotype had favorable OS than A/A genotype (P=0.012). Cox regression analysis indicated that ERCC1 rs11615 G/G genotype was associated with decreased risk of death. Subgroup analyses indicated that patients with G/G genotype who received high BED radiotherapy had better OS (median not reached vs. 21.5 months, 95%CI:15.3-27.7,P=0.011) and PFS (median not reached vs. 19.9 months, 95%CI:8.6-31.2,P<0.001) than low BED subgroup. There was no significant association between ERCC1/2 SNPs and RILI. The ERCC1 expression in serum was significantly increased after radiotherapy. However, the changes of ERCC1 expression showed no association with efficacy of radiotherapy, risk of RILI or SNPs of ERCC1/2.

      8eea62084ca7e541d918e823422bd82e Conclusion

      ERCC1 rs3212961 was related with short-term curative efficacy. ERCC1 rs11615 was an independent prognostic factor in NSCLC, which could serve as biomarker, because G/G genotype had favorable OS and PFS, and was associated with decreased risk of death. There was no significant correlation between ERCC1/2 SNPs and RILI. The changes of ERCC1 expression after radiotherapy showed no association with efficacy of radiotherapy, risk of RILI or SNPs of ERCC1/2.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • 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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      P2.17-03 - A Propensity-Matched Analysis of Neoadjuvant Chemoradiotherapy and Adjuvant Chemoradiotherapy for IIIA(N2) Non-Small Cell Lung Cancer (ID 14395)

      16:45 - 18:00  |  Author(s): Yun Chen

      • Abstract

      Background

      Multidisciplinary treatment is the preferred treatment for patients with IIIA(N2) non-small cell lung cancer (NSCLC). A subset of patients with potentially resectable of this disease are managed with trimodality therapy (surgery combined with chemoradiotherapy). However, little data exist to guide which one is better between neoadjuvant chemoradiation followed by surgery and surgery followed by adjuvant chemoradiotherapy. Given that prospective comparative data on these two managements are limited, we compared the two treatments with a propensity-matched analysis.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients undergoing treatment with trimodality therapy for clinical IIIA(N2) NSCLC between January 2012 and December 2016 were reviewed. Patients received individual chemotherapy (regimens depending on the different pathological types: squamous cell carcinoma: Docetaxel 30mg/m2 d1,d8, Cisplatines 25mg/m2 d1-3, repeated every 3 weeks for 2 cycles; non-squamous cell carcinoma: Pemetrexed 500mg/m2 d1, Cisplatin 25mg/m2 d1-3, repeated every 3 weeks for 2 cycles) plus radiotherapy (46-50 Gy/23-25 fractions) at preoperation or postoperation. Age, gender, tumor characteristics, pathological types, pulmonary function, disease-free survival (DFS), overall survival (OS) data were collected. A propensity-matched analysis was performed.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 31 patients underwent neoadjuvant chemoradiation followed by surgery, and 82 received surgery followed by adjuvant chemoradiotherapy. Median follow-up was 27 months. For the entire cohort, the median OS and DFS in neoadjuvant chemoradiation followed by surgery group was 24.0 months (95%CI17.1~29.2) and 16.6 months (95%CI10.9~21.5), which is shorter than 30.6 months (95%CI20.9~39.5) and 19.3months (95%CI11.4~25.7) in surgery followed by adjuvant chemoradiotherapy group (P=0.048 and P=0.037). A propensity matched comparison in a blinded manner (1:1 ratio, caliper distance=0.005) based on age, gender, WHO performance status, pulmonary function (forced expiratory volume in 1 second [FEV1] % and FEV1), pathological types, number of mediastinal lymph nodes and T stage resulted in 22 matched pairs. There were no significant differences between neoadjuvant chemoradiation followed by surgery and surgery followed by adjuvant chemoradiotherapy groups in the median OS (25.3 Vs. 25.0 months, P=0.747) and DFS (16.9 Vs. 17.4 months, P=0.941) respectively. Toxicities associated with chemoradiotherapy and death related with treatments were similar in both groups.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This propensity-matched analysis found multidisciplinary treatment remains a suitable option for a subset of patients with IIIA(N2) disease. Upfront surgery without invasive staging, followed by adjuvant chemoradiotherapy, appears reasonable in resectable N2 disease, simplifying patient care and reducing cost. Participation in clinical trials is essential to define the indications and efficacy in a selected population.

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