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Jindong Guo



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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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      MA01.10 - Additional Local Consolidative Therapy Showed Survival Benefit Than EGFR-TKIs Alone in Bone Oligometastatic Lung Adenocarcinoma Patients (Now Available) (ID 398)

      10:30 - 12:00  |  Author(s): Jindong Guo

      • Abstract
      • Presentation
      • Slides

      Background

      Whether epidermal growth factor receptor tyrosine-kinase inhibitors (EGFR-TKIs) plus local consolidative therapy (LCT) has better survival benefit than EGFR-TKIs alone remains controversial in lung adenocarcinoma patients with EGFR mutation and bone oligometastases.

      Method

      We conducted a retrospective study to assess the effects of LCT on bone oligometastases lung adenocarcinoma patients with EGFR mutation. The primary endpoint was overall survival (OS); The secondary endpoints was progression-free survival (PFS).

      Result

      A total of 127 lung adenocarcinoma patients with EGFR mutation and bone oligometastases were identified. There were 65 patients received EGFR-TKIs alone (monotherapy group) and 62 patients received EGFR-TKIs plus local consolidative therapy (LCT) (combination group). Addition of LCT was associated with a significantly longer OS (36.3 vs. 21.0 months, P=0.01, hazard ratio [HR]=0.537, 95% confidence interval [CI]:0.360-0.801, p=0.01) and PFS (14.0 vs. 8.1 months, P=0.01, HR=0.613, 95%CI: 0.427-0.879, p=0.01) in the whole cohort (Figure 1). All subgroups showed OS benefit in faver of combination therapy except for PS scores greater than or equal to 2 group, and all subgroups analyzed derived PFS benefit in favor of combination therapy (Figure 2).

      Conclusion

      In patients with EGFR-mutant lung adenocacinoma and bone oligometastases, LCT plus EGFR-TKIs therapy was associated with significantly longer OS and PFS than EGFR-TKIs therapy alone, indicating that LCT plus EGFR-TKIs therapy might be a better therapeutic option for those patient population.

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    P1.12 - Small Cell Lung Cancer/NET (ID 179)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.12-24 - Comparison of Four Prognostic Scores for Patients with Brain Metastases from Small-Cell Lung Cancer (Now Available) (ID 1851)

      09:45 - 18:00  |  Author(s): Jindong Guo

      • Abstract
      • Slides

      Background

      Prognostic indexes are useful to guide tailored treatment strategies for cancer patients with brain metastases(BMs). Primary tumors have different biological behavior justifying separate scoring systems for different tumors. The purpose of this study was to compare four prognostic scores [recursive partitioning analysis(RPA), graded prognostic assessment(GPA), score index for radiosurgery(SIR), and basic score for brain metastases(BSBM)] for patients with BMs from small-cell lung cancer(SCLC).

      Method

      Pathological diagnosis of SCLC patients with radiologically confirmed BMs were enrolled except those who received surgery of primary lesion. Clinical data, including age, KPS, primary tumor control, extracranial disease status, number of BMs, systemic disease status, and the largest lesion volume were recorded. The score of RPA, GPA, SIR and BSBM were calculated separately. Overall Survival(OS) was calculated from the date of diagnosis of BMs to the date of death from any case, or the last follow-up. OS was estimated by the Kaplan-Meier method. Cox’s regression analysis was performed using a backward elimination approach to determine the best model predicting survival. P<0.05 was considered statistically significant.

      Result

      From Jan 2011 to Oct 2014, 224 patients were eligible for the study. For the entire cohort, median OS was 9 months (95%CI, 7.7-10.3). The median survival was 10 months for RPA Class I, 9 months for RPA Class II, and 4 months for RPA Class III(P=0.039). Using the SIR, the median survival was 11, 9, and 6 months for a score of 8-10, 4-7, and 0-3, respectively(P=0.008). In addition, the median survival was 10 months for GPA Class I, 12 months for GPA Class II, 8 months for GPA Class III, and 6 months for GPA Class IV(P=0.136). Using the BSBM, the median survival was 10, 8, 9, and 4 months for a score of 3, 2, 1, and 0, respectively(P=0.099). The backward elimination model in multivariate Cox analysis identified SIR as the only variable significantly associated with survival(P=0.012).

      Number of patients OS P
      RPA I 31 10±1.4 0.039
      RPA II 184 9±0.7
      RPA III 9 4±0.4
      GPA I 22 10±1.4 0.136
      GPA II 30 12±2.2
      GPA III 136 8±0.8
      GPA IV 36 6±1.3
      BSBM 0 6 4±1.2 0.099
      BSBM 1 85 9±1.3
      BSBM 2 88 8±0.7
      BSBM 3 45 10±0.7
      SIR I 14 11±2.5 0.008
      SIR II 182 9±0.7
      SIR III 28 6±1.3

      Conclusion

      The SIR score was more prognostic than the RPA, GPA, and BSBM scores. For patients with BMs from SCLC, SIR was the most accurate for estimating survival. As it was mainly used for radiosurgery in BMs, maybe a new disease-specific prognostic score should be generated in this particular population.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-26 - Opportunity of WBRT in EGFR-Mutated Lung Adenocarcinoma Patients with Multiple Brain Metastases: A Retrospective Study Based on DS-GPA (Now Available) (ID 1070)

      10:15 - 18:15  |  Presenting Author(s): Jindong Guo

      • Abstract
      • Slides

      Background

      Whole-brain radiotherapy (WBRT) and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are effective treatment options for multiple brain metastases (BM) in patients with EGFR-mutant adenocarcinoma. This study evaluated the optimal treatment sequence between EGFR-TKI and WBRT in patients with EGFR mutation adenocarcinoma and multiple BM

      Method

      A total of 195 patients with EGFR-mutant adenocarcinoma with multiple BM were enrolled in the study. Patients were treated with EGFR-TKI for over 4 weeks after WBRT,received EGFR-TKI concurrently in phase with WBRT or within 4 weeks after WBRTor treated with WBRT during intracranial progression after EGFR-TKI initiation. Overall survival (OS) and disease-specific Graded Prognostic Assessment (DS-GPA) was measured.

      Result

      For the entire cohort, the median OS was 27 months (95% CI, 24.6 to 29.4). GPA-based subdivided patients : upfront WBRT of GPA, 0 to 1.5 (median: 30 months; n=36; 18%); upfront WBRT of GPA, 2.0 to 3.5 (median:48 months; n=31; 16%); EGFR-TKI concurrently with WBRT of GPA, 0 to 1.5 (median:20 months; n=38; 19%); EGFR-TKI concurrently with WBRT of GPA 2.0 to 3.5 (median:37 months; n=26; 13%); upfront EGFR-TKI of GPA 0 to 1.5 (median:26 months; n=45; 23%); and upfront EGFR-TKI of GPA, 2.0 to 3.5 (median:17 months; n=19; 10%).The prognosis of patients in different GPA groups differed significantly (p<0.0001). The data by these parameters and the results showed no imbalance with respect to the number of patients on GPA scores ( T=1.786,p=0.076).In groups at EGFR-TKI concurrently with WBRT and upfront EGFR-TKI, patients with GPA score 2-3.5 demonstrated a significantly longer OS than those at score 0-1.5 (P=0.023) , patients with EGFR-TKI concurrently with WBRT is longer than those with upfront EGFR-TKI in subgroup at GPA score 2-3.5(P=0.023).There was no difference in the OS at 0-1.5 score level between the EGFR-TKI concurrently with WBRT group and the upfront EGFR-TKI group (P=0.141).2019wclc.png

      Conclusion

      For EGFR-mutated lung adenocarcinoma patients with multiple BM,the use of upfront WBRT achieved a significantly longer OS in high DS-GPA scores groups.

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