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Dongqing Lv
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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): Dongqing Lv
- 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): Dongqing Lv
- 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): Dongqing Lv
- 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 | Presenting Author(s): Dongqing Lv
- 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.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)
- 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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P3.11-26 - Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer from a Single-Institution in China (ID 12841)
12:00 - 13:30 | Author(s): Dongqing Lv
- Abstract
Background
Lung cancer screening using low-dose computed tomography (LDCT) has been reported to reduce lung cancer-specific mortality for smokers at high risk in patients of the United States. However, there are very few LDCT screening results from Chinese patients. We here report the screening findings at the initial round of LDCT screening program from a single-institution population-based cohort in China.
a9ded1e5ce5d75814730bb4caaf49419 Method
We conducted a retrospective study of a single-institution population-based LDCT screening program for lung cancer. Patients participated LDCT in Taizhou Hospital of Enze Medical Center were eligible. All noncalcified nodules with long-axis diameters of 4mm or greater in the axial plane were considered to be positive for potential lung cancer according to NLST definition. If more than three nodules were found, one dominant nodules were selected for this analysis.
4c3880bb027f159e801041b1021e88e8 Result
From July 2017 through December 2017, a total of 8611 participants with LDCT screening were included in this report. A total of 78 participants with history of cancer and 437 participants were follow-up procedures were excluded in this analysis. Of the remaining 8096 participants, the median age was 51 years (range, 16-97 years). A total of 1516 (18.8%) participants were younger than 40 years, 5264 (65.2%) were 40-64 years and 1316 (16.3%) were greater than 64 years. The total proportion of positive nodules was 21.8%, slightly higher in females (535/2258, 23.7%) than males (1233/5838, 21.1%). Lung cancer was diagnosed in 26 participants (0.32%) (11 males and 14 females) of the 1768 positive nodules. The comprehensive demographics of 26 lung cancer patients (included one patients with multiple metastases tumor from pancreas) is shown table 1.
Table 1 Comprehensive demographics of 26 lung cancer patientsNo.
Sex
Age
(y)
Smoking
Type of nodules
Histology
Type of EGFRm
TNM
Treatment
1
M
70
Never
8mm GGN, RUL
ADC in situ
Wild
pT1isN0M0
Wedge resection
2
M
47
Current,
40 pack-year
16mm solid, RUL
ADC
19-del
pT1aN0M0
Lobectomy
3
M
70
Never
Multiple nodules;
12mm solid, RLL
Metastatic ADC from pancreas
unknown
pT1bN0M0
without
4
M
53
Current,
60 pack-year
21mm sub-solid, LLL
ADC
unknown
pT1cN0M0
Lobectomy
5
M
49
Never
6mm GGO, RLL
ADC
L858R
pT1aN0M0
Wedge resection
6
M
62
Former,
45 pack-year
30mm, LLL
SCC
unknown
cT2aN2M0
chemotherapy
7
M
62
Former,
24pack-year,
32mm solid, RLL
ADC
19-del
pT4N0M0
Lobectomy
8
F
44
Never
12mm GGO, LUL
ADC
unknown
pT1bN0M0
Segmental Resection
9
F
68
Never
8mm GGO,RML
ADC
unknown
pT1aN0M0
Lobectomy
10
M
74
Current,
60 pack-year
14mm solid, RUL
ADC
L858R
pT1aN0M0
Wedge resection
11
M
74
Former,
40 pack-year
15mm sub-solid, LLL
SCC
unknown
pT1bN2M0
Lobectomy
12
F
55
Never
12mm GGN, RUL
ADC
unknown
pT1aN0M0
Lobectomy
13
F
64
Never
11mm GGO,RUL
8mm GGO, RUL
ADC
ADC
Wild
pT3N0M0
Lobectomy
14
F
78
Never
18mm solid, RLL
ADC
19-del
cT1bN0M0
Gefitinib
15
F
67
Never
14mm GGO, RUL
12mm GGO, RUL
ADC;
ADC
unknown
pT3N0M0
Lobectomy
16
F
73
Never
18mm GGO, LUL
ADC
unknown
pT1bN0M0
Wedge resection
17
M
75
Never
10mm sub-solid, RUL
ADC
unknown
pT1aN0M0
Lobectomy
18
M
71
Current,
60 pack-year
30mm solid, LLL
NSCLC
unknown
cT2aN2M
Lobectomy
19
F
60
Never
8mm solid, RLL
ADC
19-del
pT1aN0M0
Lobectomy
20
F
78
Never
17mm solid, RUL
ADC
L858R
pT1bN0M0
Wedge resection
21
F
56
Never
11mm GGN,RUL
ADC
unknown
pT1bN0M
Lobectomy
22
F
58
Never
13mm solid, RUL
ADC
L858R
pT1bN0M0
Lobectomy
23
F
46
Never
13mm sub-solid, LUL
ADC
Wild
pT1bN0M0
Lobectomy
24
M
65
Current,
40 pack-year
50mm solid, LUL
SCC
unknown
pT3N0M0
Lobectomy
25
F
67
Never
9mm solid, RUL
5mm solid, RUL
ADC;
ADC in situ
L858R
pT3N0M0
Wedge resection
26
F
47
Never
7mm GGO, RUL
ADC
20-INS
pT1bN0M0
Wedge resection
GGO=Ground-glass opacity; GGN=ground glass density nodule; RML=right middle lobe; RLL=right lower lobe; RUL=right lower lobe; LUL=left upper lobe; LLL=left lower lobe; tis=carcinoma in site; EGFRm= EGFR mutation
8eea62084ca7e541d918e823422bd82e Conclusion
The overall rate of positive nodules is similar to previous reports, and the overall cancer detection rate by LDCT in our cohort was lower than previous reports from others (0.36-3.3%).
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