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Guangjian Yang
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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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P1.01-101 - Survival Benefit of Sequential Therapy in ALK Positive Olioprogressive NSCLC Patients After Crizotinib Resistance (ID 13110)
16:45 - 18:00 | Author(s): Guangjian Yang
- Abstract
Background
Crizotinib is recommended as first-line standard therapy for advanced anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC).Despite initial efficacy of crizotinib, patients ultimately acquired resistance, which leading to tumor progression within one year of crizotinib initiation. However,optimal sequential therapy option among patients with olioprogressive disease remains unknown.Therefore, this study aimed to explore which therapy pattern was advantageous for those patients with extracranial and intracranial metastasis.
a9ded1e5ce5d75814730bb4caaf49419 Method
This retrospective single-center study enrolled 116 Chinese advanced ALK positive NSCLC patients resistant to prior crizotinib treatment,between Jan 2013 and Dec 2016.Based on the site of olioprogressive metastasis, patients were divided into two groups: extracranial (n=57,49.1%) and intracranial (n=59, 50.9%).Sequential therapies mainly included continuation of crizotinib with local therapeutics and next-generation ALK inhibitors. The primary end-point was median overall survival (OS) from the time of crizotinib resistance to death or last follow-up.
4c3880bb027f159e801041b1021e88e8 Result
Among 116 patients,45 patients (38.8%) had died. For extracranial group,26 patients continued crizotinib with local treatment (local radiotherapy or ablation therapy),31 received next-generation ALK inhibitor. Patients followed by next-generation ALK inhibitor beyond crizotinib resistance exhibited a longer OS of 27.6 months than crizotinib continuation with local therapy of 10.8months(p=0.009).Among intracranial group,36 patients continued crizotinib with local treatment including whole brain radiotherapy or stereotactic radiotherapy,23 were next-generation ALK inhibitors users. Continution of crizotinib with local therapy had a non-inferior OS than next-generation ALK inhibitors (28.9 month vs 32.8months, p=0.538) .
8eea62084ca7e541d918e823422bd82e Conclusion
Next-generation ALK inhibitors had more survival benefit than continuation of crizotinib with local therapy for extracranial olioprogressive patients.While crizotinib continuation with local therapy might be a feasible strategy among patients with intracranial olioprogressive metastasis after crizotinib resistance.
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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P2.01-109 - Treatment Duration—A More Reasonable Definition to Evaluate the Efficacy of Crizotinib in ALK Positive Advanced NSCLC (ID 13216)
16:45 - 18:00 | Presenting Author(s): Guangjian Yang
- Abstract
Background
Crizotinib has demonstrated its superior efficacy in ALK positive NSCLC patients when used as first-line regimen, with a median overall survival (OS) of more than 4 years, whereas a median progression-free survival (PFS) of only 10.9 months. Patients who continued crizotinib beyond progressive disease (CBPD) could still obtain additional survival benefits of 6-8 months after disease progression. In terms of that, PFS, the frequently used primary endpoint in clinical trials, may not be able to provide accurate information on impact of this intervention in multiple lines therapy. Here we proposed “treatment duration” as an intermediate clinical endpoint between PFS and OS that further define efficacy of crizotinib in multiple lines of treatment and reported the exploratory data in a real-world cohort.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively enrolled 150 ALK positive NSCLC patients who had acquired crizotinib resistance from Aug 2011 to May 2017. The median PFS of crizotinib and median OS (from crizotinib initiation) were analyzed. Treatment duration of crizotinib, the time from crizotinib initiation to discontinuation, was also calculated.
4c3880bb027f159e801041b1021e88e8 Result
The median PFS of crizotinib in the 150 ALK positive advanced NSCLC patients was 14.4 months (95% CI: 11.3-17.4). Overall, 58 patients (38%) continued CBPD and the median post-progression PFS was 10.4 months, resulting in a median treatment duration of crizotinib in the total cohort of 20.2 months (95% CI: 14.3-26.0). And median OS was 30.1months (95% CI: 21.3-38.8). 77 (51%) patients who received crizotinib as first-line therapy exhibited both longer median PFS (17.7 months, 95% CI: 12.5-22.9; vs. 12.2months, 95% CI: 7.6-16.8) and median OS (35.2 months, 95% CI: 23.2-47.1; vs. 25.4 months, 95% CI: 14.4-36.3) compared to those selected crizotinib as second- line and above therapy. The treatment duration among them were 23.1 months (95% CI: 14.7-31.4) and 18.9 months (95% CI: 11.4-26.3), respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
Crizotinib showed superior efficacy in ALK positive NSCLC patients. Treatment duration may be more reasonable to define the efficacy of crizotinib in multiple lines therapy of ALK positive NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)
- 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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P2.16-49 - Which Nomogram is More Reliable to Predict Recurrence of Pathological Stage IA Lung Adenocarcinoma Treated by Surgery? (ID 13307)
16:45 - 18:00 | Author(s): Guangjian Yang
- Abstract
Background
Previous recurrence risk models offered individualized prediction using a more diverse set of factors than traditional staging measures American Joint Committee on Cancer Tumor Node Metastasis (AJCC TNM) Staging System. Several studies have demonstrated gene mutation as a new prognostic factor, such as EGFR, KRAS and so on. This study aimed to analyze a comprehensive and reliable Nomogram prognostic model to predict recurrence in stage IA lung adenocarcinoma (ADC) with radical resection.
a9ded1e5ce5d75814730bb4caaf49419 Method
This was a retrospective, single-center and case-control study. Clinicopathologic, genetic, therapeutic features and survival status were collected. Univariate and multivariate Cox proportional hazards model was conducted. The nomogram for recurrence prediction was developed using Cox proportional hazards regression. Three nomograms were established based on a) AJCC 8th TNM Staging, b) multivariate analysis results and c) risk factors recorded in published references. The higher concordance index (C-index) of model identified better performance of nomogram.
4c3880bb027f159e801041b1021e88e8 Result
1499 patients with pathological stage IA ADC from Cancer Hospital, Chinese Academy of Medical Sciences from October 2012 to December 2015 were enrolled in this study. The recurrence rate was 3.5% (53/1499). No recurrence of 180 patients randomly selected and analyzed in this study. Median DFS was not reached. The C-index of AJCC 8th TNM staging and the nomogram based on multivariate analysis was 0.598 (95% CI 0.538-0.659) and 0.696 (95% CI 0.629- 0.764), respectively. The nomogram established on prognostic factors in previous studies, which included gene mutation such as EGFR, KRAS and ALK, showed higher discrimination with C-index 0.833 (95% CI 0.786-0.880).
8eea62084ca7e541d918e823422bd82e Conclusion
This was the first individualized nomogram combining clinicopathologic features with genetic information to predict recurrence in ADC. The nomogram added with gene mutation status demonstrated superior predictive capability comparing to other nomograms based on traditional AJCC T staging and multivariate analysis. Our nomogram was more reliable to guide prognostic factors and recurrence rate in stage IA ADC patients.
6f8b794f3246b0c1e1780bb4d4d5dc53
