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Fedja Djordjevic



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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: 2
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.01-85 - Real-World Gefitinib 1st Line Treatment of Patients with Advanced NSCLC and EGFR Mutations - Serbian Single Center Experience (ID 12555)

      12:00 - 13:30  |  Author(s): Fedja Djordjevic

      • Abstract

      Background

      Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) revealed their efficacy in advanced non-small cell lung cancer (NSCLC), in patients with EGFR mutated tumors, in large scale of clinical trials. Here we present data from clinical practice, patient characteristics and clinical outcome of consecutive patients treated with gefitinib in first-line setting at the Institute for Oncology and Radiology of Serbia between 2011-2016.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Previously untreated patients with lung adenocarcinoma in stages IIIB and IV and PS 0 or 1 have been reviewed by institutional multidisciplinary tumor board and selected for molecular EGFR testing since 2011. Patients with activating EGFR mutations (9.5%) received gefitinib, at that time the only approved EGFR TKI for the first line treatment

      4c3880bb027f159e801041b1021e88e8 Result

      Sixty consecutive patients were included in this analysis. M/F ratio was 21/39, median age 60 years, non-smokers 48%, PS 0/1 85%, metastatic sites (more than 5% of patients) were lungs and pleura in 40%, bones in 27%, liver in 15%, pericardium in 10%, brain in 7% of patients. Only one metastatic site was present in 56% of patients, two sites in 35% and three sites in 6%. Del19 and L858R were detected in 82% of patients (del19 55% and L858R 27%) and umcommon mutations in 18%. Median duration of gefitinib treatment was 8 months, median follow-up 12.5 months. Partial response (PR) was achieved in 33% of patients, stable disease (SD) in 47%, progressive disease (PD) in 18%. Type of progression was a new lesson(s) in 20% of patients, progression of existing lesion(s) in 42% and both in 10%. Second-line treatment was administered to 38% of patients, and 63% were dead at the time of analysis. Median overall survival was 19 months, median progression-free survival 12 months. In patients with PR median OS was 26 months, in SD patients 22 months and in PD patients only 5 months. No statistically significant differences were shown in OS with regards to age, gender, M1a/M1b stage, exon19/21 mutations, common/uncommon mutations or different sites of metastatic disease.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Serbian patients with EGFR mutated lung adenocarcinoma treated with gefitinib in first-line have similar characteristics and outcome compared with published data, particularly when compared with similar analysis on Caucasian population. Probably due to small number of patients, we were not able to select subpopulations of patients with greater benefit from receiving gefitinib

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      P3.01-92 - Blood Test Parameters as Prognostic Factors In EGFR-Mutated Non-Small Cell Lung Cancer Treated With TKIs (ID 12414)

      12:00 - 13:30  |  Author(s): Fedja Djordjevic

      • Abstract

      Background

      Systemic inflammation is an important factor contributing to tumor progression. High neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of host inflammation whose association with worse overall survival (OS) in non-small cell lung cancer (NSCLC) has been shown in various studies. However, there are few studies investigating the association of these, and other haematological parameters of inflammation with prognosis of EGFR mutated NSCLC treated with tyrosine-kinase inhibitors (TKIs). We therefore examined the association between various blood test parameters and prognosis in this group of patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This retrospective analysis included 74 consecutive advanced lung adenocarcinoma patients of caucasian descent, stage IIIB or IV, treated with EGFR TKIs in the first line at the Institute for oncology and radiology of Serbia within a five year period. The analysed haematological parameters were derived from the absolute differential counts of a complete blood count (CBC) taken within one week of TKI treatment initiation. Parameters included in this analysis were NLR, PLR, lymphocyte-to-monocyte ratio (LMR), mean platelet volume (MPV), lymphocyte-to-white blood cell ratio (LWR) and neutrophil-to-white blood cell ratio (NWR). Cut-off values were determined using ROC curves. Correlation between each haematological parameter and progression-free survival (PFS) and OS was examined by Kaplan-Meier method and Cox regression

      4c3880bb027f159e801041b1021e88e8 Result

      Median PFS in the whole group was 13.6 months (10.25-16.95, CI 95%) and median OS was 19.48 months (15.91-23.05, CI 95%). Low LWR (< 0.14) was associated with a shorter PFS in this group of patients (9.2 vs 14.29 months, p=0.008). High NLR (≥ 2.63), high MPV (≥ 8.1) and low LWR (< 0.14) were associated with shorter OS (18.0 vs 27.6 months, p=0.05; 15.57 vs 22.18 months, p=0.04 and 16.13 vs 22.19, p=0.038 respectively). No other analysed parameters showed an association with either PFS or OS

      8eea62084ca7e541d918e823422bd82e Conclusion

      Pre-treatment NLR, LWR and MPV could be reliable, simple and easy to reproduce parameters for prediction of survival and outcome of targeted therapies in caucasian EGFR-mutated NSCLC patients. Further prospective trials are needed to definitively confirm this possible prognostic and predictive role

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