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Jiapei Ding

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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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      P3.01-68 - Early SBRT to the Primary Tumor May Overcome the Icotinib Resistance in Patients with Advanced NSCLC Harboring EGFR Mutations (ID 11985)

      12:00 - 13:30  |  Author(s): Jiapei Ding

      • Abstract


      Icotinib resistance is common in first-line setting for non-small-cell lung cancer (NSCLC) harboring EGFR mutations in China. It has been reported that 47% of EGFR-TKI drug resistance was from the primary tumor, 32.6% the primary and distant, and only 20.4% was distant alone (JTO, 2015). We hypothesized that effective local radiation to the primary tumor will delay Icotinib resistance. This study aimed to investigate the safety and efficacy of primary tumor stereotactic body radiotherapy (SBRT) in combination with the first-line Icotinib therapy in advanced NSCLC patients harbouring EGFR mutations.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a prospective pilot study (ChiCTR-OIN-17013920) from a single institution. Eligible patients included pathologically confirmed primary NSCLC with 19/21 EGFR mutation. Patients have to have no disease progression, i.e. stable disease or partial response after one month of Icotinib treatment (125 mg, three times daily). Stereotactic body radiotherapy (SBRT) was given to the primary tumor, using 50Gy/5F or 60Gy/8F for peripheral and central primary, respectively. The primary endpoint was progression free survival (PFS). The adverse events (AEs) were assessed.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 20 patients were enrolled between September 2016 and March 2018. Median age was 69 years (range 62-80). There were 9 males and 11 females. The baseline KPS was scored above 70 in 18 patients, 60 in 2 patients. Sixteen patients had stage IV disease and 4 had IIIb. There were 11 patients with 19Del and 9 patients with L858R mutations. After a median follow-up time of 10.4 months (range 3-19.3),only one patient had disease progression around the treated primary tumor. Nine patients had disease progression distantly outside of radiated region. Median PFS was 15.2 (95% CI 8.5-21.9) months for the whole cohort. At 10 months of follow-up, the rates of OS, PFS, local and distant PFS were 100%, 67.2%, 100% and 67.2% respectively. There were no acute or late grade 3+ treatment related toxicities.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Early primary tumor SBRT improved primary tumor control without causing serious side effects. SBRT may delay the development of icotinib resistance in patients with advanced NSCLC harboring EGFR mutations. Randomized study is needed to determine whether early SBRT can improve PFS and over survival.