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Kai Wang

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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): Kai Wang

      • Abstract
      • Slides


      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)

      figure 1.jpg

      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.


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