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Susama Patra
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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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P3.01-06 - Concomitant Plasma-Genotyped T790M Positivity and Small Cell Carcinoma Transformation in EGFR-Mutated NSCLC (ID 14459)
12:00 - 13:30 | Author(s): Susama Patra
- Abstract
Background
Patients of non-small cell lung cancer (NSCLC) having epidermal growth factor receptor (EGFR) gene mutation, initially show clinical response to EGFR Tyrosine-Kinase Inhibitors (TKI), but develop resistance after some months. However, the type and timing of TKI-resistance cannot be predicted as it is highly variable. Transformation to small cell lung cancer (SCLC) at progression during TKI-therapy and simultaneous acquisition of T790M EGFR-mutation is uncommonly reported.
a9ded1e5ce5d75814730bb4caaf49419 Method
Case report: Our patient is a 51 year-male, with stage IV NSCLC of adenocarcinoma subtype (TTF1 positive by IHC). He was initially treated with six cycles of pemetrexed and carboplatin to which he showed good response and was on regular follow up since September 2015. In the meantime, he was detected to have EGFR exon 21-mutation and was treated with Gefitinib for over two years. Patient was doing well and had complete disappearance of the tumour radiologically. After about 26 months of treatment he again became symptomatic. Repeat Computed tomography showed a lobulated mildly enhancing lesion 4.4 × 3 cm in right upper lobe. There were small nodules over bilateral lung fields and subpleural areas in right lower lobe, likely to be metastatic. Lytic lesions were also detected in dorsal (D2) and cervical (C5) vertebral bodies. Liquid biopsy showed T790M EGFR-mutation. Re-biopsy from right upper lobe showed transformation to neuroendocrine carcinoma (SCLC). Gefitinib was stopped and the patient was started on standard platin based doublet regimen for SCLC for the transformation. Patient has received four cycles of platin based chemotherapy and is doing well.
4c3880bb027f159e801041b1021e88e8 Result
"Section not applicable"
8eea62084ca7e541d918e823422bd82e Conclusion
This case report shows the possible underlying relationship between SCLC transformation and the T790M mutation, and that liquid biopsy approach may help overcome the problem of heterogeneity in acquired resistance to EGFR-tyrosine kinase inhibitors. In advanced NSCLC with EGFR-mutation, delayed onset of TKI-resistance can occur during TKI-treatment. Re-biopsies have increased the chance of detecting a T790M mutation and transformation. “Liquid biopsies” may potentially help identify heterogeneous genetic resistance-mechanisms; however, assessment of mechanisms such as SCLC-transformation needs tissue biopsies.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.CR - Case Reports (Not CME Accredited Session) (ID 984)
- 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.CR-02 - SBRT of Lung Primary After Complete Resolution of Metastatic Disease in Case of EGFR Mutated Adenocarcinoma Lung: A Case Report (ID 14464)
12:00 - 13:30 | Author(s): Susama Patra
- Abstract
Background
Lung cancer accounts for the highest malignancy related mortality among males worldwide. The prognosis of metastatic lung cancer is dismal and as per data from United States of America, the 5-year survival of metastatic lung cancer patients stands at mere 5 percent. Loco-regional management in metastatic lung cancer is not routinely practiced, however exceptions are made in patients who have very good response to systemic treatment. In such cases loco-regional treatment is expected to improve disease free survival.
a9ded1e5ce5d75814730bb4caaf49419 Method
Section Not applicable
4c3880bb027f159e801041b1021e88e8 Result
Fifty-six year old male, known hypothyroid[on thyroxine supplementation] without any significant history of addiction/family history presented with chronic non-productive cough and acute breathlessness. On evaluation left lung upper lobe primary mass [adenocarcinoma on histopathology] and left sided pleural and pericardial effusion[malignant on cytology]as well as multiple cervical lymphadenopathy was found on PET-CT. Hundred percent of the primary tumour tissue was found to harbour EGFR mutation while being negative for ALK mutation. After six cycles of chemotherapy with Carboplatin and Pemetrexed combination chemotherapy regimen, the patient was kept on Erlotinib for 9 months. All the metastatic diseases were found to be resolved and primary was shrunken on assessment PET-CT. Patient was advised for SBRT to primary 50Gy in 5 fractions,10Gy per fraction on alternate days over a period of 10 days following which he has been kept on Tab Erlotinib. The patient has a survival of 18 months calculated from the time of diagnosis till compilation of data and is disease free.
8eea62084ca7e541d918e823422bd82e Conclusion
High percentage of EGFR mutation can provide very good response to tyrosine kinase inhibitor therapy in case of metastatic adenocarcinoma lung. Partial response at primary with resolution of metastatic disease throws a challenge for use of loco-regional modality of management in tandem with systemic treatment.
6f8b794f3246b0c1e1780bb4d4d5dc53
