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Xiaomai Wu
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P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)
- 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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P1.15-32 - Real World EGFR Mutation Profile from 1699 Non-Small Cell Lung Cancer Patients in Eastern China (ID 12526)
16:45 - 18:00 | Author(s): Xiaomai Wu
- Abstract
Background
The EGFR mutation frequency and mutation types had significant geographic differences. The purpose of this study was to evaluate prevalence, clinical characteristic in eastern China which has not been reported.
a9ded1e5ce5d75814730bb4caaf49419 Method
From March 2016 to March 2018 who were newly diagnosed or postoperative recurrence NSCLC received EGFR mutation detect were included analysis. Commercially available ARMS-PCR kits were used to detect EGFR mutations.
4c3880bb027f159e801041b1021e88e8 Result
A total of 1699 consecutive NSCLC patients included in our study. The median age was 64 years (range 23-91), with 892 (52.5%) were male and 807 (47.5%) male. There were 852 (50.2%) with EGFR mutations out of 1699 patients in the total population. EGFR mutations were more frequent in female (64.9%) patients than in males (36.8%). Considering the frequency of mutations according to histology, adenocarcinomas (835/1495, 55.9% ) show mutations more often than squamous carcinoma (4/142, 2.82%), other NSCLC histology (13/62, 21.0%). The rate of EGFR mutation in total was lower in biopsy specimen (246/613, 40.1%) than in surgical specimen (557/993, 56.1%) or cytology specimen(49/93, 52.69%). A total of 755 (88.6%) harboring a common EGFR mutation were identified: among the 755, the most EGFR mutation type was the point mutation L858R at 21 exon (49.5%), followed by exon 19 deletion (39.1%). Ninety-seven (11.48%) patients harboring uncommon EGFR mutation, the exon 20 INS (34.0%) was the most frequently observed mutation among the uncommon EGFR mutations. The detailed EGFR mutation type were show in table1.
8eea62084ca7e541d918e823422bd82e ConclusionTable1. The detailed EGFR mutation type
Mutation type
Case number
Percentage of all cases
Percentage of uncommon mutation
common mutation
L858R
422
49.53%
19-del
333
39.08%
uncommon mutation
20-Ins
33
3.87%
34.0%
L858R/T790M
18
2.11%
18.6%
G719X
14
1.64%
14.4%
L861Q
11
1.29%
11.3%
G719X/S768I
5
0.59%
5.2%
L858R+S768I
5
0.59%
5.2%
S768I
4
0.47%
4.1%
19-del/T790M
3
0.35%
3.1%
G719C
1
0.12%
1.0%
L858R/19-del
1
0.12%
1.0%
L858R/20-Ins
1
0.12%
1.0%
T790M
1
0.12%
1.0%
EGFR: Epidermal growth factor receptor.
In our eastern China cohort, the most common EGFR mutation was L858R, differing from previous reported data in Asian population describing 19 deletion was the most common EGFR mutation. The frequency of EGFR mutations in biopsy specimen population was lower than both in surgical specimen and cytology specimen.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.13 - Targeted Therapy (Not CME Accredited Session) (ID 962)
- 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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P2.13-23 - Osimertinib Treatment Result of Plasma T790M Positive in Different Clinical Failure Modes After First-Line EGFR TKI for EGFR Mutant NSCLC (ID 12847)
16:45 - 18:00 | Author(s): Xiaomai Wu
- Abstract
Background
Acquired resistance is inevitable after epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment in advanced NSCLC with EGFR mutation. Clinical modes of EGFR-TKI failure has been reported to be associated with the efficacy of subsequent treatment. More than 50% patients treated with first-line EGFR-TKI acquired resistance had a secondary EGFR Thr790Met (T790M) mutation. Osimertinib is a potent, irreversible EGFR-TKI targeting EGFR T790M mutation. This study aimed to investigate the difference of disease control rate (DCR) and progression free survival (PFS) after Osimertinib treatment and exam their association with clinical failure modes after first line EGFR-TKI.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a secondary analysis of a prospective randomized study from two clinical centers. The eligibility criteria of the trial included: NSCLC Stage IIIB/IV; EGFR mutation positive; Failed after first-line EGFR-TKI treatment; Plasma T790M Positive; Second-line Osimertinib. According to Yang et el 2013, the clinical modes of EGFR-TKI failure were classified to dramatic progression, gradual progression, local progression. The primary endpoints were DCR and PFS.
4c3880bb027f159e801041b1021e88e8 Result
From December 2016 to April 2017, a total of 48 patients enrolled: 11 patients dramatic progression,16 gradual progression, and 21 local progression. After a median follow-up of 12.6 (range 1.3-16.5) months, the DCR rate was 10 of 11(90.9%), 15 of 16 (93.8%), and 21 of 21 (100.0%), for the dramatic progression, gradual progression, and local progression groups, respectively. The mean PFS for the dramatic progression, gradual progression, local progression groups were 5.7, 13.0, 15.1 months, respectively. The median PFS for the gradual progression and local progression groups have not reached. The median PFS for the dramatic progression was 4.5 months. There was a significant difference in PFS between the three groups (p<0.0001).(Figure 1)
8eea62084ca7e541d918e823422bd82e Conclusion
Osimertinib has a significant better PFS in gradual progression and local progression groups than dramatic progression group with plasma EGFR T790M mutations acquired resistance in NSCLC.
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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P2.17-30 - Serum Lipoprotein(A) Correlates with the Effect of Endostar Combined with Concurrent Chemoradiotherapy in Patients with Locally Advanced LSCC (ID 11872)
16:45 - 18:00 | Author(s): Xiaomai Wu
- Abstract
Background
The role of vascular targeting combined with concurrent chemoradiotherapy has produced many inconsistent results in locally advanced non-small cell lung cancer, especially in Lung squamous cell carcinoma [LSCC]. Lipoprotein(a) [Lp(a)] may be critical in development of tumor angiogenesis and its levels are individualized and determined genetically. The study aimed to determine whether Lp(a) is correlated with therapeutic effects of recombinant human endostatin [Endostar] combined with concurrent chemoradiotherapy for locally advanced LSCC.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with locally advanced LSCC concurrent chemoradiation therapy in our hospital from December 2007 to December 2017 were retrospectively analyzed. Patients were divided into two groups: 1) Chemoradiotherapy group [CRT group] which received weekly vinorelbine (12.5mg/m2) / carboplatin (AUC=2) concurrently with radiotherapy 60 Gy in 30 daily treatments, and 2) Endostar combination with chemoradiotherapy group (ECRT group) which received Endostar intravenous drip 1-14 days (every three weeks) concurrently with CRT. Fasting venous blood samples were collected before the treatment for The measurement of serum Lp(a) level in all patients, the effect of Endostar was assessed by stratified analysis.
4c3880bb027f159e801041b1021e88e8 Result
94 patients were recruited in this study. There were 59 cases in CRT group and 35 cases in ECRT group. Overall, the median progression-free survival was 9.6 vs. 14.2 months (P=0.067) with overall survival 15.0 vs 20.6 months (P=0.114), in CRT and ECR groups respectively. The median of Lp(a) was 218mg/l. In patients with serum Lp(a) less than 218mg/l, the median PFS was 10.0 vs. 9.4 months (P=0.406) and OS was 15.4 vs. 16.3 months [P=0.958], in CRT and ECR groups, respectively. However, in patients with serum Lp(a) higher than 218ng/ml, the median PFS was 9.0 vs. 15.2 months [P=0.011] and OS was 14.0 vs. 21.1 months [P=0.055], in CRT and ECR groups, respectively. Patients with Grade 3 and above AE were observed in 32.2% vs. 34.3% (P=0.658) in CRT vs. ECR groups respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
The serum concentration of Lp(a) may serve as a biomarker to identify the patients who would benefit from Endostar treatment with concurrent chemoradiotherapy in stage III LSCC. Perspective study is needed to validate this finding.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.01-68 - Early SBRT to the Primary Tumor May Overcome the Icotinib Resistance in Patients with Advanced NSCLC Harboring EGFR Mutations (ID 11985)
12:00 - 13:30 | Author(s): Xiaomai Wu
- Abstract
Background
Icotinib resistance is common in first-line setting for non-small-cell lung cancer (NSCLC) harboring EGFR mutations in China. It has been reported that 47% of EGFR-TKI drug resistance was from the primary tumor, 32.6% the primary and distant, and only 20.4% was distant alone (JTO, 2015). We hypothesized that effective local radiation to the primary tumor will delay Icotinib resistance. This study aimed to investigate the safety and efficacy of primary tumor stereotactic body radiotherapy (SBRT) in combination with the first-line Icotinib therapy in advanced NSCLC patients harbouring EGFR mutations.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a prospective pilot study (ChiCTR-OIN-17013920) from a single institution. Eligible patients included pathologically confirmed primary NSCLC with 19/21 EGFR mutation. Patients have to have no disease progression, i.e. stable disease or partial response after one month of Icotinib treatment (125 mg, three times daily). Stereotactic body radiotherapy (SBRT) was given to the primary tumor, using 50Gy/5F or 60Gy/8F for peripheral and central primary, respectively. The primary endpoint was progression free survival (PFS). The adverse events (AEs) were assessed.
4c3880bb027f159e801041b1021e88e8 Result
A total of 20 patients were enrolled between September 2016 and March 2018. Median age was 69 years (range 62-80). There were 9 males and 11 females. The baseline KPS was scored above 70 in 18 patients, 60 in 2 patients. Sixteen patients had stage IV disease and 4 had IIIb. There were 11 patients with 19Del and 9 patients with L858R mutations. After a median follow-up time of 10.4 months (range 3-19.3),only one patient had disease progression around the treated primary tumor. Nine patients had disease progression distantly outside of radiated region. Median PFS was 15.2 (95% CI 8.5-21.9) months for the whole cohort. At 10 months of follow-up, the rates of OS, PFS, local and distant PFS were 100%, 67.2%, 100% and 67.2% respectively. There were no acute or late grade 3+ treatment related toxicities.
8eea62084ca7e541d918e823422bd82e Conclusion
Early primary tumor SBRT improved primary tumor control without causing serious side effects. SBRT may delay the development of icotinib resistance in patients with advanced NSCLC harboring EGFR mutations. Randomized study is needed to determine whether early SBRT can improve PFS and over survival.
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