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Hiromitsu Ohta



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    OA07 - Precision Medicine Involves Biology and Patients (ID 132)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
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      OA07.03 - Clinical Outcome of Non-Small Cell Lung Cancer with EGFR/HER2 Exon 20 Insertions Identified in the LC-SCRUM-Japan (Now Available) (ID 629)

      11:00 - 12:30  |  Author(s): Hiromitsu Ohta

      • Abstract
      • Presentation
      • Slides

      Background

      In-frame insertions in exon 20 (Ex20ins) of EGFR/HER2 occur in 2-5 % of non-small cell lung cancer (NSCLC). There is no approved targeted therapy for patients with these mutations. Historical control data would be valuable for the development of novel targeted therapies for these rare cancers.

      Method

      A nationwide genome screening project in Japan (LC-SCRUM-Japan) has been established for the development of molecular-targeted therapies for lung cancers. In this project, 161 cancer-related genes have been analyzed by a next-generation sequencing (NGS) system, Oncomineā„¢ Comprehensive Assay. The therapeutic efficacy and survival of the patients with non-squamous (non-sq) NSCLC harboring EGFR/HER2 Ex20ins were evaluated using a large-scale clinico-genomic database in the LC-SCRUM-Japan.

      Result

      A total of 3441 advanced non-sq NSCLC patients were successfully analyzed from 2015 to 2018. EGFR Ex20ins were detected in 73 patients (2%; M766_A767insASV/A767_S768insSVD/H773_V774insH/D770_N771insNPH/N771_P772insPH/others=22/17/5/4/4/21) and HER2 Ex20ins were detected in 128 patients (4%; A775_G776insYVMA/G776delinsVC/P780_Y781insGSP/others=95/16/10/7). The median age of the patients was 62 (range, 33-90) years. Eighty-one patients (40%) were male and 114 (57%) were never smoker. Two-hundred patients (99%) were diagnosed as adenocarcinoma and 1 as adenosquamous-cell carcinoma. Based on our database, the median overall survivals in patients with EGFR Ex20ins were 22.4 (95%CI, 15.3-36.8) months, and those with HER2 Ex20ins were 18.8 (13.6-30.3) months. In the patients with EGFR/HER2 Ex20ins, the objective response rate (ORR) and median progression-free survivals (mPFS) of 1st-line platinum-containing chemotherapies were 32% and 6.0 (5.7-7.0) months, respectively. The ORR and mPFS of docetaxel with or without ramucirumab were 26% and 5.1 (3.8-5.9) months, respectively. The ORR and mPFS of PD-1 inhibitor were 0% and 2.0 (1.6-2.6) months, respectively. No significant difference in the therapeutic efficacy of these drugs was observed between the patients with EGFR Ex20ins and HER2 Ex20ins. In 19 patients with EGFR Ex20ins treated with 1st/2nd generation EGFR-TKIs, the ORR was 5% (a M766_A767insASV-positive tumor responded to afatinib) and the mPFS was 2.1 (1.3-4.2) months.

      Conclusion

      The patients with EGFR/HER2 Ex20ins-positive NSCLC showed poor responses to PD-1 inhibitors and 1st/2nd generation EGFR-TKIs. These historical data are highly informative in evaluating the efficacy of novel targeted therapies for EGFR/HER2 Ex20ins-positive NSCLC.

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    P2.01 - Advanced NSCLC (ID 159)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.01-76 - Bone Metastasis and Pleural Dissemination as a Potential Marker for Predicting of T790M Mutation in Advanced Non-Small Cell Lung Cancer Patients (Now Available) (ID 508)

      10:15 - 18:15  |  Author(s): Hiromitsu Ohta

      • Abstract
      • Slides

      Background

      Acquired resistance in epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC)-patients after tyrosine kinase inhibitor (TKI)-treatment is a major clinical problem. In the majority of these patients, the T790M-mutation is detected at time of acquired TKI-resistance. However, it is less clear if the location of metastatic site may influence the ability to identify T790M mutation in NSCLC patients.

      Method

      We retrospectively screened patients with NSCLC harboring EGFR mutations with progressive disease who were rebiopsied between January 2016 and December 2018. EGFR T790M mutation status after EGFR-TKIs failure was assessed using liquid biopsy or tissue rebiopsy sample. Clinical factors influencing T790M status were evaluated by univariate and multivariate analysis.

      Result

      Among 39 rebiopsied patients for whom EGFR mutation status was available, 21 (53.8%) had T790M mutations. Patient characteristics at rebiopsy were not significantly different between T790M-positive and -negative groups, except for bone metastasis. Total duration of EGFR-TKI treatment before rebiopsy, EGFR-TKI treatment history immediately before rebiopsy, progression-free survival after initial TKI treatment, and rebiopsy site (other than fluid samples) significantly influenced T790M status. The incidence of T790M mutation was shown by multivariate analysis to be significantly higher in patients with bone metastasis and pleural dissemination (odds ratio, 26.4; 95% confidence interval (CI), 3.80-184 and odds ratio, 12.1; 95% CI, 1.57-92.4, respectively).

      Conclusion

      Bone metastasis and pleural dissemination may represent useful predictive markers for T790M detection. In patients with these clinical factors, rebiopsies may be more recommended to detect T790M mutation.

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