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Anatoli Semkov



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    P3.08 - Oligometastatic NSCLC (Not CME Accredited Session) (ID 974)

    • 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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      P3.08-12 - Long-Term Outcome After Adrenalectomy for Isolated Adrenal Metastasis in Otherwise Operable Patients With NSCLC - Two Institutions Study (ID 12418)

      12:00 - 13:30  |  Author(s): Anatoli Semkov

      • Abstract
      • Slides

      Background

      Isolated adrenal metastasis (IAM) from non-small cell lung cancer (NSCLC) is a rare event and the management in such patients remains controversial. Our objective is to evaluate the long-term outcome after resection of IAM in operable NSCLC patients as a part of multimodality treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Twelve patients (mean age 58.4 years) underwent adrenalectomy for NSCLC IAM. IAMs were synchronous (7) and metachronous (5), 4 of them were contralateral and 8 ipsilateral. Locoregional pStages I-II were found in 11 patients and pStage IIIA - in 1 patient. One-stage left lower lobectomy and left adrenalectomy through phrenotomy was performed in 1 patient. In 10 cases the curative lung resection was carried out first, followed by adrenalectomy via laparotomy (3), transperitoneal laparoscopy (1) and retroperitoneal endoscopic adrenalectomy (REA) (5). Two years after left lower lobectomy, the metachronous ipsilateral adrenal and contralateral lung metastases were eradicated by REA (first stage) and right polysegmentectomy S7-S10 in 1 patient from this subset. In the last case REA was performed at a first stage, followed by right lower lobectomy. The mean interval between the lung resection and the adrenalectomy was 6 months. All patients were followed up for the mean period of 42 months. The survival was studied by Kaplan-Meier method. Log-Rank test for comparisons was applied.

      4c3880bb027f159e801041b1021e88e8 Result

      There was no perioperative mortality. The mean overall survival (OS) time is 42.0 months (95% CI 33.8-50.3). One-year and 3-years OS rate is 90.9% and 64.6%, respectively. Six patients are still alive until the last follow-up, four of them are with progression. One of the patients underwent radio- and immunotherapy with good response for local recurrence 20 months after left upper lobectomy. Brain metastases were found in one patient 2 years after initial surgery, which were treated by stereotactic radiosurgery and metastasectomy. Preaortic intraabdominal metastatic lymph node was extirpated in one patient 19 months after left pneumonectomy. One patient underwent irradiation for local recurrence on the bronchial stump 27 months after left pneumonectomy. Mean progression free survival (PFS) time is 25.1 months (95% CI 19.9-30.4). One-year and 2-years PFS rate is 80.0% and 40%. There is no significant difference in mean OS and PSF time between synchronous vs metachronous IAM (p=0.208; p=0.364), ipsilateral vs contralateral IAM (p=0.366; p=0.156) and laparoscopic vs conventional adrenalectomy (p=0.163; p=0.754).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Long term survival is possible after resection of IAM in carefully selected NSCLC patients with early locoregional stages without involvement of mediastinal lymph nodes.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.13 - Targeted Therapy (Not CME Accredited Session) (ID 979)

    • 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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      P3.13-19 - Surgery for  cIIIB Lung Adenocarcinoma After Response to Erlotinib, Survival and Management of Postoperative Oligoprogressions (ID 12911)

      12:00 - 13:30  |  Author(s): Anatoli Semkov

      • Abstract
      • Slides

      Background

      Down-staging of epidermal growth factor receptor (EGFR) activating mutation-positive (EGFR M+) advanced non-small-cell lung cancer (NSCLC) after first-line EGFR tyrosine kinase inhibitor (TKI) therapy may lead to primary tumor resection. Unfortunately, most patients’ disease will progress postoperatively even with the use of adjuvant TKI therapy mainly due to EGFR T790M mutation. Osimertinib, a third-generation inhibitor of EGFR T790M mutation, is with reduced toxicity profile as compared to non-selective EGFR TKI. Our aim is to assess a survival benefit of salvage lung resection in Stage IIIB lung adenocarcinoma after response to TKI and a management of oligoprogressions in the postoperative period.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A Caucasian age 56 female lung adenocarcinoma patient (ECOG PS-0) was initially staged as cT2aN3M0 on October 10, 2015. Pretreatment biopsy specimens from ipsilateral scalene lymph node harbored EGFR mutation (exon 19 E746-T751insI deletions). After six months of first-line treatment with erlotinib150 mg/daily, which patient tolerated very well, a FDG-PET scan showed a 21/16 mm formation of the left upper lobe with SUV-2 without other abnormalities, down-staging with cT1cN0M0. Radical left upper lobectomy with 20 negative dissected mediastinal lymph nodes was carried out (May 17, 2016). Postoperative pathomorphological and mutational studies of residual tumor revealed adenocarcinoma and EGFR exon 19 mutation.

      4c3880bb027f159e801041b1021e88e8 Result

      Adjuvant erlotinib therapy was started for 3 months. Four months after its discontinuation by patient decision a 3 cm left supraclavicular mass (SUV-2.0 on FDG-PET) was diagnosed and totally resected. Adenocarcinoma involvements of 3 lymph nodes, as well as EGFR exon 19 mutation, were confirmed. The patient continued on erlotinib, but after 6 months on FDG-PET scan 2 left cervical lymph nodes (SUV 4.6 and 6.1 on FDG-PET) were diagnosed. Systematic left cervical dissection was performed with resection of four metastatic lymph nodes. Again adenocarcinoma histology was confirmed, but EGFR T790M mutation was identified as well. Three months later, even without signs of residual tumor mass on computerized tomography scan, Osimertinib therapy in dose 80 mg orally once daily was administered. The last follow-up FDG-PET scan revealed no signs of progression (April 30, 2018). The patient is with ECOG PS-0 and perfect quality of life without drug-related adverse events.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Radical surgery of oligoprogression following salvage surgery for Stage IIIB (EGFR M+) lung adenocarcinoma after response to TKI, while continuing to use TKIs (specifically osimertinib in EGFR T790M mutation), can result in prolonged overall survival. The pending question is whether the EGFR-TKI therapy can be discontinued in these patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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