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Takashi Kijima



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    OA02 - A New Vision of Targets and Strategies (ID 120)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
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      OA02.06 - The Sequential Therapy of Crizotinib Followed by Alectinib: Real World Data of 840 Patients with NSCLC Harboring ALK-Rearrangement (WJOG9516L) (Now Available) (ID 2145)

      10:30 - 12:00  |  Author(s): Takashi Kijima

      • Abstract
      • Presentation
      • Slides

      Background

      Previous clinical trials demonstrated that alectinib (ALEC) had a longer time-to-progression than crizotinib (CRZ) in 1st-line settings. Information on long-term overall survival (OS), however, is still limited with a few studies having reported that the sequential strategy of “CRZ followed by other ALK-inhibitor” can provide extended OS. In Japan, ALEC was approved for a 1st-line setting earlier than in other countries.

      Method

      We reviewed the clinical data of ALK-rearranged NSCLC patients who received CRZ or ALEC between May 2012 and Dec 2016. Patients were divided into two groups according to the first-administered ALK inhibitor, the CRZ or ALEC group. In order to evaluate the efficacy of the sequential strategy of “CRZ followed by ALEC”, the combined time to treatment failure (TTF) was calculated in the CRZ group as defined by the sum of the “TTF of CRZ” plus the “TTF of ALEC” if patients were treated with ALEC followed by CRZ. In the ALEC group, the “TTF of ALEC” was calculated. The primary endpoint is the comparison between the combined TTF in the CRZ group with the TTF in the ALEC group.

      Result

      Of 864 patients enrolled from 61 institutions, 840 patients were analyzed. Median age was 61 (range, 20-94); 56% were female; and 95% had adenocarcinoma. There were 535/305 patients in the CRZ/ALEC group. In the CRZ group, 282 patients received ALEC after CRZ failure. The combined TTF in the CRZ group was significantly longer than TTF in the ALEC group; median, 34.4 vs 27.2 months (mo); hazard ratio (HR), 0.709 [95%CI;0.559- 0.899]; P=0.0044. However, there was no significant difference in OS between the patients who received ALEC after CRZ in the CRZ group and the patients in the ALEC group; median, 88.4 months vs. not reached; HR 1.048 [95%CI;0.758-1.451]; P=0.7770. In the whole population, the CRZ group had a significantly shorter OS than the ALEC group; median, 53.6 mo vs not reached HR, 1.821 [95%CI;1.372-2.415]; P<0.0001.

      Conclusion

      The combined TTF in the CRZ group was significantly longer than TTF in the ALEC group, however, OS benefit of sequential therapy of CRZ followed by ALEC was not shown.

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    P1.06 - Mesothelioma (ID 169)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.06-05 - Clinical Features and Outcomes of Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma (ID 1182)

      09:45 - 18:00  |  Author(s): Takashi Kijima

      • Abstract

      Background

      Malignant pleural mesothelioma (MPM) is an aggressive tumor while most patients experience recurrence after multimodality treatment. However, few clinical studies have been conducted to evaluate the recurrence pattern and survival after Pleurectomy/decortication (P/D) for MPM.

      Method

      We reviewed the patients who registered in the prospective MPM database of our hospital surgery program between September 2012 and December 2017. Eligibility criteria were age ≤80 years, histological subtype on pleural biopsy was epithelioid, clinical stage T1-3N0-1M0 (8th edition), an Eastern Cooperative Oncology Group performance status of 0-1, no major comorbidity. Neoadjuvant chemotherapy (NAC) consisted of pemetrexed followed by cisplatin was performed in all patients who met previously mentioned inclusion criteria. After NAC for three cycles, curative-intent surgery was planned in patients who showed no apparent tumor progression. In our hospital, P/D was introduced in September 2012, and since then P/D was main operative method for MPM. After P/D, If the patients keep good general condition, the patients underwent adjuvant chemotherapy consisted of pemetreced follow by cisplatin. The subjects were 90 patients who underwent NAC followed by P/D from September 2012 to December 2017. Survival and recurrence were calculated by the Kaplan-Meier method using the log rank test. Clinical factors related to survival after recurrence was assed by a multivariable analysis using Cox proportional hazards model.

      Result

      Between September 2012 and December 2017, 140 consecutive patients were eligible for multimodality treatment. All patients completed neoadjuvant chemotherapy. Of these, 112 patients proceeded to surgery, and the remaining 28 patients didn’t because of progressive disease (N= 20) or because they refused to provide consent (N= 8). Of 112 patients who proceeded to surgery, 12 patients underwent Extrapleural pneumonectomy, 10 patients underwent exploratory thoracotomy. Finally, 90 patients underwent P/D.

      Of 90 patients, 65 patients (72.2%) completed multimodality treatment. The 1-year and 3-year overall survival rates after diagnosis were 93.3% and 65.3%, respectively. A recurrence developed in 57 (63.3%). The median time to recurrence was 19.0 months. 1-year and 3-year recurrence free survival were 69.7% and 34.0%, respectively.

      In the initial recurrence, local recurrence only was developed in 39 patients (68.4%), distant recurrence only in 6 patients (10.5%), and both local and distant recurrence in 12 patients (21.1%). 1-year survival rates after recurrence was 59.5%. 43 patients (75.4%) received a treatment for recurrence. On multivariable analysis, treatment for recurrence (hazard ratio, 0.16; 95% confidence interval, 0.06–0.41: P < 0.0001) and disease-free interval greater than 12 months (hazard ratio, 0.34; 95% confidence interval, 0.14 –0.79; P = 0.01) were identified as independently significant prognostic factors of survival after recurrence.

      Conclusion

      The local recurrence remain the most frequent pattern of recurrence after P/D. Most of patients who had recurrence after P/D enabled treatment for recurrence. Treatment for recurrence and disease-free interval greater than 12 months are important prognostic factors of survival after recurrence.