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Shu Xia



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    MA01 - Oligometastatic Disease (ID 114)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Now Available
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      MA01.09 - Concomitant SBRT and EGFR-TKI Versus EGFR-TKI Alone for Oligometastatic NSCLC: A Multicenter, Randomized Phase II Study (Now Available) (ID 2214)

      10:30 - 12:00  |  Author(s): Shu Xia

      • Abstract
      • Presentation
      • Slides

      Background

      NSCLC patients harboring EGFR mutation generally develop resistance to EGFR TKI less than one year. Prior studies indicated that local consolidative therapy is associated with improved outcomes in patient with limited metastatic NSCLC. Radiotherapy is one of the ideal control methods for locally progressed patients, however, the optimal intervention time in order to slow the occurrence of EGFR-TKI resistance for advanced NSCLC patients with EGFR-sensitive mutations is still unclear. Our preliminary clinical and animal studies suggest that early combined radiotherapy prior to EGFR-TKI resistance can significantly improve the prognosis of patients. Our hypothesis is that the optimal intervention time of radiotherapy for EGFR mutation patients is 3 months after the beginning of EGFR-TKI.

      Method

      This is a prospective, multicenter, randomized controlled study to evaluate stereotactic body radiation therapy (SBRT) as a potential treatment for limited stage IV NSCLC (primary plus up to 3 metastatic sites) with sensitive EGFR mutation. The patients did achieve partial response or stable disease after three months treatment of the first-generation EGFR-TKI would be randomized to TKI combined SBRT (TS) or TKI alone. The primary endpoint was PFS (the time from the beginning of EGFR-TKI treatment to disease progression or death). The secondary endpoint was overall survival (OS) and safety. TKI wasn’t interrupted during the irradiation.

      Result

      A total of 61 patients were enrolled from Feb, 2017 to Jan, 2019. Median follow up was 22.3 months. Patients who TS (n: 30) had a significantly longer median PFS compared to those with TKI alone (n: 31) (PFS: 17.4 vs. 8.9 months P =0.042). T790M mutation was observed in 57.9% acquired resistance patients for TS group, and 39.3% for TKI alone group. Median PFS of T790M mutated patients was 17.4 months compared to 10.3 months of TKI alone group (P = 0.007). Multivariable analysis revealed that radiation fields were positively associated with PFS, 21.8 months for just primary tumor; 10.6 months for metastatic lesions and 18.3 months for primary and metastatic lesions (P= 0.006). OS data was not yet mature. None experienced >= grade 3 SBRT related toxicities.

      Conclusion

      A trend of improved long term PFS was noted in patients receiving SBRT for primary tumor combined EGFR TKI at the third month after the beginning of TKI. Moreover, this data suggested that benefit from radiation might be associated with delay the occurrence of T790M mutation. Further studies are required to investigate the molecular mechanisms underlying this association.

      Clinical Trial information: NCT03595644

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    P2.11 - Screening and Early Detection (ID 178)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.11-44 - A Preliminary Study Investigating the Impact of Platelet on Circulating Tumor Cell Enumeration (Now Available) (ID 1190)

      10:15 - 18:15  |  Author(s): Shu Xia

      • Abstract
      • Slides

      Background

      Circulating tumor cell (CTC) is generally considered as the source of cancer metastasis. Blood platelet has been reported to interact with CTCs and enhance its survival. However, the masking effect of blood platelet may lead to the false-negative results in CTC test. In this preliminary study, we aimed to investigate the impact of platelet on CTC enumeration.

      Method

      A total of 73 treatment-naïve participants with indeterminate pulmonary nodules according to computed tomography scan were recruited. Three milliliters of baseline peripheral blood samples were collected from each participant for CTC enumeration. Negative enrichment and ligand-targeted polymerase chain reaction methods were used to examine the expression level of folate receptor-positive CTC (FR+CTC). All participants subsequently undergo surgery or biopsy to obtain tumor specimens for pathological assessment. ROC analysis was used to determine the diagnostic performance of FR+CTC. For the recruited lung cancer patients, the association between FR+CTC levels and platelet count was also analyzed..

      Result

      figure1.jpg47 patients with pathologically confirmed lung cancer and 26 patients with benign lung diseases (considered as the control group) were included in this analysis. In agreement with previous studies, lung cancer patients showed a significantly higher FR+CTC level compared to the control group (10.6 versus 7.7 FU/3 mL, P<0.0001). With 9.1 FU/3 mL as the cut-off threshold, the sensitivity and specificity of FR+CTC were 87.23% and 76.92%, respectively (Area under curve=0.9006, 95% confidence interval: 0.8291-0.9720). Among the 42 patients with platelet count in the lung cancer group, 36 (85.7%) were positive for CTC and 6 (14.3%) were negative for CTC. The levels of platelet count in CTC-positive group were lower than those in CTC-negative group, but the difference was not statistically significant (217.8±73.6 versus 253.5±41.4 ×109 /L, P=0.1833). Correlation was also not statistically significant between the FR+CTC level and platelet count (Spearman R=-0.2113, P=0.0993).

      Conclusion

      CTC enumeration in this study was not affected by the surface epitope masking effect of blood platelet, suggesting that FR+CTC detection has better applicability than the positive enrichment and immunocytochemical method. Further systematic study is required to validate the hypothesis.

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