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Hong Kwan Kim



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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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      P1.16-14 - Impact of Smoking on Treatment Outcome in Early Squamous Cell Lung Cancer (T1N0) (ID 13823)

      16:45 - 18:00  |  Author(s): Hong Kwan Kim

      • Abstract

      Background

      Smoking is the major risk factor for squamous cell lung cancer. However, squamous cell lung cancer in never-smoker is known to have poor survival outcomes. We compared clinicopathologic features and outcomes between smokers and never-smokers in resected early squamous cell lung cancer (T1N0).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      An institutional database was reviewed retrospectively between 1994 and 2016 (N = 445). Eligible patients included completely resected squamous cell lung cancer, less than 3 cm in tumor size, and without N1 or N2 involvements. Patients were stratified by gender and smoking status.

      4c3880bb027f159e801041b1021e88e8 Result

      423 (95%) smokers and 20 (5%) never-smokers were identified. The median age of never-smokers was 66 years (range, 39 - 83), and 11 of these patients were female (55%). The median age of smokers was 66 (range, 42 - 84), and most of them were male (97.9%). The T stage were distributed equally in both groups. In smokers, 84 (19.9%) patients experienced recurrence whereas only 1 patient (5%) of never-smokers occurred distant metastasis (p < 0.001). Distant metastasis was most frequent recurrence pattern in smokers (n= 40), but locoregional recurrence also a fairly frequent pattern (n = 30). The 5-year overall survival rates and recurrence free survival rates were 70.9% and 61.5% in smokers and were 64.1% and 64.1% in never-smokers respectively (p = 0.65, and 0.34, respectively).

      8eea62084ca7e541d918e823422bd82e Conclusion

      There was no significant differences in clinicopathologic features and outcomes between smokers and never-smokers in early squamous cell lung cancer.

      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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      P2.01-56 - Metastases in Residual PET Uptake of Lymph Nodes After Treatment: Added Value of CT Radiomic Approach for Prediction (ID 12595)

      16:45 - 18:00  |  Author(s): Hong Kwan Kim

      • Abstract
      • Slides

      Background

      Although substantial decrease of FDG uptake on positron emission tomography-computed tomography (PET-CT) holds promise metabolic response, predicting pathologic complete response of lymph nodes still remains challenging. We investigated the potential of CT radiomics features to predict pathologic complete response of lymph nodes showing residual uptake on PET-CT after neoadjuvant concurrent chemoradiotherapy (CCRT) in stage IIIa non-small cell lung cancer (NSCLC).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From 2004 through 2013, all consecutive patients who underwent neoadjuvant CCRT for stage IIIa NSCLC, post-treatment PET-CT, and curative operation were included. As for all lymph nodes which showed remaining positive FDG uptake on restaging PET-CT, 161 CT Radiomic features from physical, shape, histogram, texture, regional feature categories were extracted. Positive and negative lymph node metastases were compared with respect to clinicopathologic characteristics as well as CT radiomic features using the Pearson χ2 test or the Fisher exact test Multivariate logistic regression was used to explore the predictive model for the the detection of metastatic lymph nodes, for which receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 237 patients undergoing neoadjuvant CCRT for stage IIIa NSCLC, 135 patients (56.9%) showed residual PET uptake on 177 lymph nodes after treatment. Among those 177 lymph nodes, 70 lymph nodes were proven to be malignant (39.5%, 70 of 177). On multivariate analysis, metastatic lymph nodes were significantly tended to be more squamous cell carcinoma than adenocarcinoma (odds ratio [OR] = 0.370, 95% confidence interval [CI] = 0.190 to 0.722; reference of adenocarcinoma, P value = 0.004) and higher entropy-GLCM (OR = 1.437, 95% CI = 1.147 to 1.802, P value = 0.002), where the predictive model for metastasis showed discrimination performance with an area under the receiver operating characteristic curve (AUC) of 0.770 (95% CI = 0.700 to 0.839, P value < 0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Radiomic approach allows for noninvasive detection of lymph node metastases in lymph nodes showing residual PET uptake after treatment in NSCLC patients

      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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      P3.01-81 - Long-Term Outcome of Surgically Resected Unsuspected N2 Lung Adenocarcinoma (ID 14381)

      12:00 - 13:30  |  Author(s): Hong Kwan Kim

      • Abstract
      • Slides

      Background

      This study was performed to assess the long-term outcome of lung adenocarcinoma in patients without clinical suspicion of mediastinal lymph node involvement and whose tumors were finally proven to be pathologic N2.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a retrospective study of a prospective lung cancer database at our institution from January 2004 to December 2014. We retrospectively reviewed the medical records of 299 patients with unsuspected pathologic N2 disease.

      4c3880bb027f159e801041b1021e88e8 Result

      The median follow-up time was 51.5 months (range, 1.1 to 172.3 months). The median recurrence-free survival (RFS) was 25.3 months and the 1-year, 3-year, and 5-year RFS rates were 78.2%, 41.0%, and 29.5%. The median overall survival (OS) was 75.2 months and the 1-year, 3-year, and 5-year OS rates were 92.6%, 85.9%, and 62.7%, respectively. The most common type of resection was lobectomy (88.6%). Adjuvant therapy was administered in 255 patients (85.3%). N2 involvement was single station without N1 involvement (“skip” metastasis, N2a1) in 73 (24.4%), single station with N1 involvement (N2a2) in 148 (49.5%), and N2 at multiple stations (N2b) in 78 (26.1%). The median RFS and 5-year RFS rate of N2a1 were 42.9 months and 44.8%. The median and 5-year OS and OS rate of N2a1 were 86.2 months and 69.0%. In multivariate analysis, N2a1, low T-stage, and adjuvant therapy were significantly associated with a longer RFS, whereas pneumonectomy was significantly associated with a worse RFS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The long-term outcome of unsuspected pN2 group of patients with lung adenocarcinoma was better than expected. Especially the RFS and OS of pN2a1 group of patients were similar to the those of N1 group of patients reported for survival in our group. Therefore, resection of properly staged unsuspected pathologic N2 lung adenocarcinoma is reasonable and should not be avoided if a complete resection without pneumonectomy can be done.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.13 - Targeted Therapy (Not CME Accredited Session) (ID 979)

    • 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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      P3.13-29 - Patient-Derived Xenograft Models(PDX) of Lung Squamous Cell Carcinoma(SCC) for Preclinical Studies (ID 14278)

      12:00 - 13:30  |  Author(s): Hong Kwan Kim

      • Abstract
      • Slides

      Background

      Non-small cell lung cancer is the most prevalent type of lung cancer, and one of its subtype, squamous cell carcinoma has limited targeted therapeutic options in comparison with adenocarcinoma. For this reason, we established the patient-derived xenograft models of primary lung cancer and then focused on the SCC PDX models to be used for the discovery of target mutations through the molecular profiling of lung tumors and their association of therapeutic responses

      a9ded1e5ce5d75814730bb4caaf49419 Method

      PDX models were established using the tissues of patients who underwent surgery as primary lung cancer at Samsung Medical Center during the period between October, 2014 and September, 2017. Briefly, tumor tissues from patients were subcutaneously engrafted and passaged two more times in NOD-scid-IL2Rγnull mouse. Then we are analyzing histological characteristics and molecular profiles of established SCC PDX by whole exome sequencing and whole transcriptome sequencing.

      4c3880bb027f159e801041b1021e88e8 Result
      Mutation profiles of squamous cell carcinoma Patient Tumors and their PDX models

      Patient tumor

      PDX

      ID

      Gene

      Mutation

      Frequency

      Gene

      Mutation

      Frequency

      PDL-040

      HRAS

      JAK1

      PTEN

      TP53

      GNAQ

      U2AF1

      G13V

      N136fs

      -78fs

      Y236C

      T96S/M59L

      G167C

      1.000

      0.397

      0.488

      1.000

      0.143/0.080

      0.080

      PDL-041

      CTNNA2

      FRG1

      M672I

      C159Y

      0.278

      0.042

      PDL-089

      EP300

      AMER1

      RB1

      EP300

      AMER1

      RB1

      0.473

      0.576

      0.500

      AMER1

      RB1

      EP300

      R142K

      I425fs

      G438V

      0.851

      0.472

      0.479

      PDX-073

      PDX-079

      DNMT3A

      BRAF

      TP53

      FRG1

      F571L

      V600E

      R249S

      Q137K

      0.606

      0.524

      0.571

      0.521

      BRAF

      TP53

      FRG1

      DNMT3A

      V600E

      R249S

      Q137K

      F571L

      0.377

      1.000

      0.026

      0.444

      PDX-100

      DDR2

      BRAF

      GNAS

      TP53

      E757D

      G469A

      Q286P

      156_157RV>L

      0.484

      0.388

      0.583

      0.671

      BRAF

      DDR2

      TP53

      GNAS

      G469A

      E757D

      156_157RV>L

      Q286P

      0.941

      0.212

      0.500

      0.180

      PDX-114

      PDX-186

      KEAP1

      PIK3R1

      L281M

      M200fs

      1.000

      0.464

      PDX-190

      PDX-205

      PDX-207

      TP53

      ATRX

      C176F

      S1944R

      0.617

      0.537

      TP53

      C176F

      1.000

      PDX-231

      MET

      STK11

      KEAP1

      RPSAP58

      GNAS

      L829V

      D115N

      G333C

      Q113H

      V57M

      0.494

      0.410

      0.551

      0.426

      0.488

      KEAP1

      MET

      STK11

      GNAS

      RPSAP58

      SMO

      G333C

      L829V

      D115N

      V57M

      Q113H

      R138L

      1.000

      0.485

      1.000

      0.318

      1.000

      0.400

      PDX-252

      HLA-A

      HLA-A

      HLA-A

      HLA-A

      HLA-A

      HLA-A

      TSC1

      FRG1

      ATRX

      EEF1B2

      R38W

      G80R

      A114D

      S129P

      T187P

      T187R

      S487C

      Q137K

      Q929E

      R122H

      0.500

      0.267

      0.617

      0.611

      0.091

      0.231

      0.293

      0.026

      0.870

      0.227

      PDX-271

      TSC1

      KDR

      M322T

      V297I

      0.357

      0.300

      PDX-302

      JAK1

      TP53

      E667Q

      N268I

      0.514

      0.488

      PDX-318

      ARID1A

      NF1

      TP53

      FRG1

      SMO

      SOX17

      TRRAP

      H203Q

      R2556T

      LRKKGEPHH289fs

      A151G

      F332fs

      R147L

      A598V

      0.125

      0.168

      0.472

      0.048

      0.456

      0.200

      0.349

      PDX-364

      TSC2

      T927I

      0.575

      PDX-366

      KDR

      TP53

      NOTCH1

      FRG1

      A1103D

      V173L

      L107F

      Q137K

      0.494

      0.609

      0.600

      0.496

      NOTCH1

      TP53

      FRG1

      CHD4

      KDR

      L107F

      V173L

      Q137K

      R1825L

      A1103D

      0.160

      1.000

      0.035

      0.061

      0.270

      PDX-372

      CDKN2A

      TP53

      D33H

      A161fs

      0.377

      0.534

      CDKN2A

      TP53

      D33H

      A161fs

      1.000

      0.461

      PDX-402

      PIK3CA

      FRG1

      FRG1

      FRG1

      V344G

      L150S

      A151T

      C159Y

      0.503

      0.443

      0.445

      0.455

      PIK3CA

      GNAQ

      FRG1

      V344G

      T96S

      C159Y

      0.173

      0.098

      0.050

      PDX-409

      DNMT3A

      KEAP1

      KMT2D

      F511L

      G158C

      P1912fs

      0.653

      0.467

      0.669

      KEAP1

      KMT2D

      GNAQ

      FRG1

      DNMT3A

      G158C

      P1912fs

      T96S

      C159Y

      F511L

      0.917

      0.446

      0.063

      0.043

      0.460

      PDX-410

      TP53

      KEAP1

      KEAP1

      C124G

      G480V

      G186R

      0.564

      0.585

      0.737

      KEAP1

      KEAP1

      TP53

      G480V

      G186R

      C124G

      0.298

      0.656

      1.000

      PDX-415

      DNMT3A

      NFE2L2

      NFE2L2

      CREBBP

      TP53

      APC

      CDKN2A

      I247F

      R18Q

      D11N

      S2356F

      R337L

      ENDNG1530fs

      R52fs

      0.494

      0.584

      0.568

      0.600

      0.469

      0.559

      0.531

      AMER1

      AMER1

      APC

      CDKN2A

      CREBBP

      NFE2L2

      NFE2L2

      TP53

      DNMT3A

      FLT3

      H619R

      H619N

      -1530fs

      R52fs

      S2356F

      R18Q

      D11N

      R337L

      I247F

      M799I

      0.703

      0.698

      0.478

      0.462

      1.000

      0.364

      0.250

      1.000

      0.628

      0.076

      PDX-420

      HLA-A

      NOTCH1

      TP53

      K292E

      G427C

      H179R

      0.067

      0.575

      1.000

      PDX-434

      NOTCH2

      RRAS2

      KEAP1

      KMT2D

      TP53

      V968L

      Q72L

      Y54F

      D4400fs

      P301fs

      0.366

      0.422

      0.512

      0.509

      0.482

      IGF1R

      KEAP1

      NOTCH2

      TP53

      RRAS2

      P266S

      Y54F

      V968L

      P301fs

      Q72L

      0.204

      1.000

      1.000

      0.477

      0.792

      PDX-454

      TNFAIP3

      R52T

      0.431

      NF1

      TNFAIP3

      TP53

      LTTILKN58fs

      R52T

      P152fs

      0.476

      0.458

      0.455

      PDX-473

      CREBBP

      FLT3

      Q913R

      I920V

      0.410

      1.000

      PDX-480

      TSC2

      NF1

      NF1

      NF1

      TP53

      RRAS2

      EEF1B2

      V1695E

      N793S

      K798Q

      F1287L

      R158L

      Q143R

      R122S

      0.831

      0.169

      0.160

      0.210

      0.828

      0.034

      0.166

      NF1

      TP53

      TSC2

      W784L

      R158L

      V1695E

      0.838

      0.875

      0.516

      rsquare3.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      In PDX models of 49 patients, successful lung SCC PDX engraftment and identical histomorphology was achieved. And the 30 sets of exome sequencing analyses showed that the somatic mutations were relatively preserved. Among them, some interesting targetable mutations including BRAF(V600E) were identified. We identified consistency of transcriptome profiles of PDX models during the passages.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
    • +

      P3.16-41 - Postoperative Pembrolizumab for the Patients with Pathologic Stage I Adenocarcinoma with Solid or Micropapillary Pattern (ID 14418)

      12:00 - 13:30  |  Author(s): Hong Kwan Kim

      • Abstract

      Background

      Prognosis of surgically resected stage I adenocarcinoma was relatively fair with up to 75% of 5 year disease free survival rate. However, in some cases, in spite of the very small-sized tumor, recurrence as systemic metastasis is found. Solid or micropapillary subtype adenocarcinoma are reported as poor prognostic subtypes, additional treatment after surgical resection for those subgroup was required to improve survival. We reported that incidence of PD-L1 strong positivity is significantly higher in solid-predominant subtype of adenocarcinoma, PD-L1 inhibitor can be more effective adjuvant treatment modality in those subtype.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Design: Open-label, single arm, single center, phase 2 trial. (NCT03254004)

      Eligibility: The subject must have primary lung adenocarcinoma with stage I and less than 4 centimeter, whose tumor should be solid-predominant or micropapillary (>5%) by postsurgical pathological examination.

      Objective: The primary objective of this study is to assess the improvement of disease-free survival rate by adjuvant therapy with pembrolizumab for solid or micropapillary adenocarcinoma with pathologic stage I and tumor size less than 4 cm. The secondary objective is to assess the safety profile of adjuvant pembrolizumab in adjuvant setting.

      Treatment: Pembrolizumab 20mg IV infusion every 3 weeks for 12 months until disease progression or prohibitive toxicity. The treatment should be started within 8 weeks after surgery.

      Statistics: The hypothesis is that adjuvant pembrolizumab will improve 3-year disease-free survival from 65% to 80% in pathologic stage Ia lung adenocarcinoma patients with solid/micropapillary subtypes. Assuming that the subject enrollment period is 1.5 years, follow-up of last registered subject period is 4 years, and the disease free survival period follows the exponential distribution, a significance level 5% (one side) and 63 peoples are required 85% at the power of test. At this time, assuming that the dropout rate is 10%, it is necessary to register 70 subjects

      Assessment : Chest CT (covering up to both adrenals) will be done every 3 months till 1 year since the study treatment, and then every 4 months afterward till 2 years and thereafter every 6 months till 3 years. Brain MRI and bone scan will be done at 1 year and 2 years since the study treatment. This study is an investigator-initiated trial with support from MSD.

      4c3880bb027f159e801041b1021e88e8 Result

      Section not applicable

      8eea62084ca7e541d918e823422bd82e Conclusion

      Section not applicable

      6f8b794f3246b0c1e1780bb4d4d5dc53