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Joungho Han



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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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      P2.01-57 - Prognostic Implication of Clinical, Imaging, and Pathologic Parameters in N2(+) Stage IIIA Lung Cancer Patients (ID 13564)

      16:45 - 18:00  |  Author(s): Joungho Han

      • Abstract

      Background

      As a comprehensive study of large scale and long-term clinical outcomes from a single institution, we are trying to analyze any predictive or prognostic factors for survival outcomes in N2(+) NSCLC patients. The purpose of this study is to investigate the efficacy of clinical, imaging (CT and PET-CT), and pathologic parameters, as a prognostic factor in N2(+) NSCLC patients undergoing tri-modality therapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed 160 patients with N2(+) NSCLC patients between January 2008 and June 2014. All patients underwent preoperative concurrent chemoradiotherapy (CCRT) (44-45 Gy in 22-25 fractions concurrent with weekly DP chemotherapy) and surgery. Clinical, imaging (CT and PET-CT), and pathologic parameters were analyzed with respects to outcomes.

      4c3880bb027f159e801041b1021e88e8 Result

      Overall pathologic down-staging and pathologic complete response following preoperative CCRT were achieved in 66 (41.3%) and 13 patients (8.1%), respectively. The median follow-up durations of all patients was 43 months (2~106 months). The 5-year rates of disease-free survival (DFS) and overall survival (OS) were 33.3% and 53.0%, respectively. Pathologic N down-staging (HR 2.604; 95% CI 1.418-4.779; p value=0.002) was a significant factor for DFS. Histopathology (HR 0.475; 95% CI 0.242-0.930; p =0.030), GTV of nodal lesion(s) on pre-RT CT (HR 1.066; 95% CI 1.029-1.104; p <0.001), type of surgery (HR 2.985; 95% CI 1.114-7.997; p =0.030), and proportion of viable tumor on cross-section area (HR 0.986; 95% CI 0.973-0.999; p =0.034) were significant factors for OS. Neither tumor volume reduction rate (TVRR) nor SUVmax was significant for DFS or OS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In patients with N2(+) NSCLC undergoing tri-modality therapy, we proved that none of the imaging parameters correlated with prognosis, except pretreatment nodal volume. We confirmed that patients with adenocarcinoma showed prominently improved survival and pathologic N down-staging was a most important pathologic parameter as a prognosticator.

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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
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      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): Joungho Han

      • 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

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