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Masami Sato



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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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      P2.01-08 - Conversion Surgery for Locally Advanced Lung Adenocarcinoma Harboring Driver Gene Mutation After TKI Followed by Cytotoxic Agent (ID 13784)

      16:45 - 18:00  |  Author(s): Masami Sato

      • Abstract
      • Slides

      Background

      The optimal treatment of locally advanced non-small cell lung cancer including stage IIIA still remains controversial. For lung adenocarcinoma harboring driver gene mutation, it has been reported that tyrosine kinase inhibitor (TKI) shows great tumor response and downstaging. Moreover, some reports showed its usefulness of salvage surgery after TKI treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between January 2016 and April 2017, we performed surgical resection for five non-small cell lung cancer patients who underwent TKI followed by platinum agent and pemetrexed treatment at Kagoshima University Hospital. All patients were diagnosed as having c-stageIIIA (three patients with c-T2aN2M0 and each one patient with c-T4N1M0 and c-T3N2M0) lung adenocarcinoma harboring driver gene mutation (four patients with EGFR mutation and one patient with EML4-ALK rearrangement) by preoperative examinations (Computed Tomography, 18F-fluorodeoxyglucose Positron Emission Tomography, brain Magnetic Resonance Imaging and bronchoscopic examination). Because these patients initially had locally advanced tumor burden or mediastinal lymph nodes metastasis, one-stage radical surgery would not have been feasible. Therefore, these patients received TKI administration for less than six months, followed by two cycles of platinum agent and pemetrexed treatment before the operation. After the operation, three patients received two or four cycles platinum agent and pemetrexed treatment, however, the other two patients did not receive additional treatment. We obtained informed consent from all the patients before the beginning of treatment.

      4c3880bb027f159e801041b1021e88e8 Result

      In all patients, the effect on tumor response of TKI followed by platinum agent and pemetrexed treatment was shown. In addition, the complete resection was confirmed microscopically. None of these patients experienced disease flare after stopping TKI administration. The exon 20 T790M mutation gene was not found in all resected specimens with EGFR mutation. There were no postoperative major complications and mortality. Brain metastasis appeared in one patient who did not receive postoperative chemotherapy six months after the operation. This patient was managed successfully with gamma knife radiotherapy. All the five patients are now under follow-up treatment with no local recurrence.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conversion Surgery after TKI followed by platinum agent and pemetrexed treatment can become feasible and useful strategy for locally advanced lung adenocarcinoma harboring driver gene mutation.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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