Author of

• 28971

  +

  Lunch & Poster Display session (ID 58)

  • Event: ELCC 2019
  • Type: Poster Display session
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1

  • 29111

    +

    177P - Real-world experience of ALK positive NSCLC from India (ID 296)

    12:30 - 13:00  |  Author(s): Amit Joshi
    • Abstract
    • Slides

    Background
    

    ALK gene rearranged lung cancer is a rare subset of NSCLC. However, treatment with ALK inhibitors leads to a drastic improvement in outcomes. In this study, we have audited the outcomes of patients with ALK-rearranged NSCLC at our institute.

    a9ded1e5ce5d75814730bb4caaf49419 Methods
    

    We conducted an audit of patients with ALK-rearranged NSCLC diagnosed between November 2011–December 2017 from a prospective database of lung cancer patients maintained by the authors. The basic demographic characteristics, treatment received, and the outcomes were noted. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan Meier method. This study was approved by the institutional ethics committee and was carried out in accordance with good clinical practice guidelines and the Declaration of Helsinki.

    20c51b5f4e9aeb5334c90ff072e6f928 Results
    

    We diagnosed 318 ALK-positive patients during November 2011–December 2017. The median age was 50 years (23-77 years); 189 patients (59.4%) were male and 129 (41.6%) were female. Only 57 (17.9%) were smokers. The ECOG PS was 0-1 in 195 patients (61.3%), 2 in 46 (14.5) and 3-4 in 33 (10.4%). Data on PS was missing in 44 patients (13.8%). The median number of sites of metastasis was 2 (0-7); brain metastases were seen in 38 patients (11.9%). The first line treatment received was as follows: crizotinib (either upfront or as a switch after a few cycles of doublet chemotherapy) in 202 patients (63.5%), pemetrexed platinum in 72 (22.6%), taxane platinum in 5 (1.6%), gemcitabine platinum in 5 (1.6%) and others in 33 (10.7%). The median PFS and median OS for the entire cohort was 11.0 months and 34.2 months, respectively. The hazard ratio (HR) favoured using crizotinib upfront (0.5, 95% CI 0.38-0.67, p < 0.001). Patients receiving upfront crizotinib had better PFS compared to those who received crizotinib as a switch after a few cycles of chemotherapy (HR: 0.66 (0.44-0.99) p-0.040). However, the median OS was similar between the two treatment strategies for crizotinib (p-0.964). The median OS in patients who never received crizotinib was 11.0 months while OS was not reached in patients who received crizotinib in any line (p< 0.001). The 5-year OS in patients receiving crizotinib in any line was 50.0%.

    fd69c5cf902969e6fb71d043085ddee6 Conclusions
    

    Crizotinib substantially improves outcomes in patients with ALK-rearranged NSCLC and is a suitable option where other ALK inhibitors are not available.

    b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
    

    IEC, TMH.

    213f68309caaa4ccc14d5f99789640ad Funding
    

    Has not received any funding.

    682889d0a1d3b50267a69346a750433d Disclosure
    

    All authors have declared no conflicts of interest.

    cffcb1a185b2d7d5c44e9dc785b6bb25

    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.

• 29151

  +

  Proffered Paper session II (ID 61)

  • Event: ELCC 2019
  • Type: Proffered Paper session
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 4/11/2019, 09:00 - 10:30, Room A

  • 29157

    +

    55O - Radiogenomic signatures of NSCLC brain metastases: A potential non-invasive imaging marker for ALK mutation (ID 284)

    09:00 - 10:30  |  Author(s): Amit Joshi
    • Abstract
    • Presentation
    • Slides

    Background
    

    NSCLC harbouring ALK rearrangement has a higher risk of developing brain metastases. Literature on MR Imaging radiogenomics (MRI-R) as predictors of ALK mutation is limited and less investigated. The aim of our study was to evaluate the semantic MRI-R parameters of NSCLC brain metastases and their correlation with ALK status.

    a9ded1e5ce5d75814730bb4caaf49419 Methods
    

    We analyzed clinical data on 75 patients who were tested for ALK mutation and underwent MR imaging at diagnosis. Multiparametric MRI was performed in all cases. The associations between ALK mutation status and clinical features specifically age, sex, smoking, histology, TNM stage and imaging variables of brain metastasis, were analyzed using descriptive analysis (chi-square test) and univariate logistic regression analysis.

    20c51b5f4e9aeb5334c90ff072e6f928 Results
    

    There were 46 ALK positive and 29 ALK negative cases that were subjected to MRI-R analysis. ALK positive were predominantly young (83%) and non-smokers (87%) (p < 0.001). Statistically significant difference (p < 0.001) was observed in lesion morphology and its T2W border, fuzzy and infiltrative border with hypointense peripheral solid rim in ALK positive while well defined border and no solid rim in ALK negative. Predominant signal on T1W imaging was hypointense (p < 0.001) in ALK negative, whereas heterogeneity was marker of ALK positive status on T1W (p < 0.001). Lesions in ALK negative group showed central restriction on DW images (p-0.001) and peripheral restriction of the solid rim was characteristic of ALK positive (p < 0.001). ALK positive showed thick ring enhancement while patchy enhancement favoured ALK negative. Incidence of meningeal involvement was significantly higher in ALK positive and was absent in 80% of ALK negative (p-0.02). On univariate logistic regression analysis, statistically significant association was found between age, smoking history, T2W lesion morphology, T2W border, restricted diffusion, enhancement and meningeal positivity (p < 0.05).

    fd69c5cf902969e6fb71d043085ddee6 Conclusions
    

    ALK positive brain metastases have peculiar MR imaging features that can be non-invasive diagnostic and predictive imaging biomarkers. MR radiogenomics have potential role in individualised management of ALK positive NSCLC brain metastasis.

    b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
    

    IEC TMH.

    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.