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Jie Qian



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    Lunch & Poster Display session (ID 58)

    • Event: ELCC 2019
    • Type: Poster Display session
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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      142P - Clinical management of advanced lung adenocarcinoma with ALK rearrangement: Real-world treatment outcomes and long-term survival (ID 546)

      12:30 - 13:00  |  Author(s): Jie Qian

      • Abstract

      Background

      Anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) have been demonstrated to be effective in ALK-rearranged, advanced lung adenocarcinoma patients. However, data from a real-world setting is very limited. The aim of the study was to: a) determine long-term survival in these patients and investigate factors associated with their prognosis; and b) analyze the clinical outcomes of patients who were sequentially treated with next-generation ALK-TKIs.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      ALK-rearranged, advanced lung adenocarcinoma patients who were treated with crizotinib were included between January 2013 and December 2016. Progression-free survival (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method. The hazard ratio (HR) for the risk of progression or death was calculated using multivariate Cox regression model.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      A total of 5286 patients were screened and 176 eligible patients were included. Median PFS and OS were 12.4 months (95% CI, 10.3-14.6 months) and 45.6 months (95% CI, 37.6-53.7 months), respectively. 36.3% of patients were 5-year survivors. Extrathoracic metastasis before crizotinib treatment was independently associated with worse PFS (HR, 1.77, 95% CI, 1.24-2.53, P < 0.01) and OS (HR, 1.61, 95% CI, 1.02-2.54, P = 0.04). 45 patients were sequentially treated with newer-generation ALK-TKIs, obtaining a statistically longer OS (54.8 months, 95% CI, not calculable) than patients who were solely treated with crizotinib during clinical management (36.6 months, 95% CI, 29.2-43.9 months, P < 0.01).

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      Our study provides useful information about ALK-rearranged, advanced lung adenocarcinoma patients treated with ALK-TKIs in a real-world setting.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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      143P - Role of radiotherapy in management of brain metastases in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC): A single-center retrospective study (ID 257)

      12:30 - 13:00  |  Author(s): Jie Qian

      • Abstract

      Background

      Targeted therapies provide benefits in ALK-rearranged patients with brain metastases (BM). However, role of radiotherapy in these patients hasn’t been established. This study sought to determine if upfront radiotherapy in combination with targeted therapies can impact patient outcomes.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      A total of 60 ALK-rearranged patients with BM were included for analysis. 34 patients developed BM prior to TKIs: 20 patients received radiotherapy followed by crizotinib and 14 received upfront crizotinib. 26 patients developed BM while receiving crizotinib: 13 patients were treated with crizotinib beyond progression after brain radiotherapy and 13 received next-generation TKIs with or without radiotherapy. Overall survival (OS) and intracranial time to progression (IC-TTP) were calculated from the date of BM.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      Among patients with BM prior to TKIs, upfront radiotherapy cohort had longer IC-TTP (22.9 vs 8.9 months; p = 0.022) and longer OS (28.6 vs 23.3; p = 0.024) compared to upfront crizotinib cohort. Of patients who developed BM while receiving crizotinib, continuation of crizotinib plus radiotherapy for those without extracranial progression can give another intracranial progression-free time. However, next-generation TKIs cohort showed superior median IC-TTP compared to crizotinib beyond progression (11.4 vs 7.2 months; p = 0.006). Patients treated with radiotherapy followed by second TKIs even had much longer IC-TTP (21.8 vs 7.2 months; p = 0.009), though median IC-TTP of second TKIs without radiotherapy failed to reach statistical significance compared with crizotinib beyond progression (10.4 vs 7.2 months; p = 0.1).

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      Upfront radiotherapy provided better outcomes for ALK-positive patients who developed BM before TKIs and during treatment of crizotinib, and should be considered.

      b651e8a99c4375feb982b7c2cad376e9 Editorial acknowledgement

      We would like to acknowledge all the patients and their families for their contributions to this study.

      934ce5ff971f1ab29e840a35e3ca96e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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      149P - Efficacy of tyrosine kinase inhibitors (TKIs) in advanced lung adenosquamous carcinoma (ID 291)

      12:30 - 13:00  |  Author(s): Jie Qian

      • Abstract

      Background

      Adenosquamous carcinoma (ASC) is a rare type of lung cancers, with components of both squamous carcinoma and adenocarcinoma comprising to at least 10% of the tumor. EGFR-TKIs are playing an increasingly important role in the treatment of mutation-positive lung adenocarcinoma. However, the frequency and efficacy of multi-line EGFR-TKIs for ASC patients with sensitive EGFR mutations remain unclear.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      From January 2010 to January 2018, patients pathologically diagnosed as lung ASC in Shanghai Chest Hospital were screened. The effectiveness of EGFR-TKIs in advanced ASC patients with EGFR mutation is retrospectively analyzed.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      A total of 268 ASC patients were screened and 189 patients were tested for the presence of EGFR mutation. 101 positive patients were identified (53.0%, 95% CI, 46.3-60.6%), of which there are 43 19del, 44 21L858R mutations, 6 compound mutations or rare mutations, the rest lack of specific information. A higher frequency of EGFR mutation was found in younger, female patients who were non-smokers. We retrospectively collected consecutive survival data of 67 advanced ACS patients with EGFR-TKI therapy of different generations. Forty-six (46/52, 88.5%) patients had disease progression after first-generation EGFR-TKI treatment, with a median progression free survival (PFS) of 10.7 months (95% CI, 8.6-12.8 months) and a median duration of treatment (MDT) of 13.1 months (95% CI, 8.4-17.8 months). Median PFS for 15 eligible patients received third-generation TKI treatment was 10.2 months (95% CI, 8.3-12.1 months). Median overall survival (OS) for 14 eligible patients with multi-line EGFR-TKIs treatment was 42.1 months (95% CI, 15.7-68.5 months), compared to median OS of patients without third-generation treatment (25.1 months, 95% CI, 10.7-39.4) months.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      Our data suggests the detection of EGFR mutations in patients with ASC, especially in young, female, non-smoking patients. The third-generation EGFR-TKI treatment could be a better choice to improve outcomes of advanced patients after progression of first-generation TKI.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      Minjuan Hu.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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    Mini Oral session II (ID 63)

    • Event: ELCC 2019
    • Type: Mini Oral session
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 4/11/2019, 16:40 - 17:40, Room C
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      117O - Racial disparities in characteristics and prognosis in Asian versus white patients receiving atezolizumab: An ancillary analysis of POPLAR and OAK studies (ID 339)

      16:40 - 17:40  |  Presenting Author(s): Jie Qian

      • Abstract
      • Presentation
      • Slides

      Background

      Racial differences in characteristics and prognosis of Asiatic and White patients receiving immunotherapy have not been well described.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      We studied 390 patients from the POPLAR and OAK studies who received atezolizumab with evaluable biomarker parameters retrieved from a subsequent blood-based study. The differences of Asians versus Whites in baseline characteristics, outcomes and genetic mutations of atezolizumab therapy were assessed.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      Asiatic and White patients differed in characteristics including smoking history, baseline sum of the longest diameters (BLSLD), EGFR mutation frequency, programmed death-ligand 1 (PD-L1) expression and blood-based tumor mutational burden (bTMB) level. Overall survival (OS) was longer in Asians compared with Whites before (median OS: 18.7 vs. 11.1 mo; P = 0.005) and after (median OS: 20.9 vs. 12.6 mo; P = 0.005) propensity score matching (PSM). Race was an independent prognostic factor for OS (Asian vs White: HR 0.647, 95% CI 0.447-0.936, P = 0.021) in addition to performance status (PS), histology, BLSLD, and number of metastatic sites. The objective response rate (ORR) for Asians and Whites was 8.2% and 17.1%, respectively and disease control rate (DCR) was 51.2% and 47.7%, respectively. The blood-based mutational landscape differentiated between Asians and Whites. In the overall population, mutations of STK11, EGFR, KEAP1, POLE, GRM3, ATM and STAG2 were associated with treatment response while mutations of TP53, KEAP1, APC, RB1, CREBBP, EPHA5 and STAG2 were associated with OS. Comparing the frequency of efficacy- or prognosis- related mutations, Asians had more EGFR mutations and less TP53 and STK11 mutations than Whites.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      Asians and Whites differed in the clinicopathological features and mutational landscape which may explain the superior efficacy of atezolizumab in Asiatic patients with NSCLC. This study conveys implications for further studies on racial disparity in the treatment of immunotherapy.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Support (No. 20161434).

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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      118O - Blood tumor mutational burden as a predictor of clinical benefit in non-small cell lung cancer patients treated with docetaxel: Secondary analysis of the OAK and POPLAR randomized clinical trials (ID 222)

      16:40 - 17:40  |  Author(s): Jie Qian

      • Abstract
      • Presentation
      • Slides

      Background

      Blood-based tumor mutational burden (bTMB), which is measured by targeted next-generation sequencing (NGS) using cell-free DNA (cfDNA), shows a positive correlation with tissue-based TMB and is a predictive biomarker for non-small cell lung cancer (NSCLC) patients receiving atezolizumab. However, the role of bTMB in other treatment settings, such as chemotherapy, is unknown. We hypothesized that advanced NSCLC patients with low bTMB would derive more benefit from chemotherapy.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      The clinical and genetic data from docetaxel arm of OAK trial (n = 318, training cohort) and POPLAR trial (n = 106, validation cohort) were used. The FoundationOne CDx NGS assay was used to quantify bTMB. Efficacy was determined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Durable clinical benefit (DCB) was defined as overall survival (OS) that last more than 12 months. Gene alterations and bTMB were compared among patients with DCB and no durable benefit (NDB). The cut-off value of bTMB for predicting OS was determined by time-dependent receiver operating characteristic (ROC) curve.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      Significantly lower bTMB was observed in DCB than NDB (median, 5 vs 9 SNVs/Mb; P < 0.001) and in patients with partial response (PR) versus stable disease (SD) versus progressive disease (PD) (median, 5 vs 7 vs 10 SNVs/Mb; P = 0.007). The optimised cut-off value of bTMB for predicting OS was 7 SNVs/Mb by time-dependent ROC curve. In training cohort, the median OS of patients with low bTMB was 11.5 months and 6.4 months for those with high bTMB (HR 0.638; 95% CI 0.497-0.820; P < 0.001). The median PFS in the low bTMB group (4.3 months) was significantly longer than that in the high bTMB group (2.9 months; HR 0.588; 95% CI 0.466-0.742; P < 0.001). These results were confirmed in validation cohort. Variants in EGFR and KEAP1 associated with DCB and NDB, respectively.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      Our data showed that low bTMB (≤ 7 SNVs/Mb) was a clinically biomarker for docetaxel treatment in NSCLC.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.