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Jiexia Zhang



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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-08 - Efficacy of Osimertinib in Patients of Advanced Non-Small Cell Lung Cancer with Brain Metastasis: A Retrospective Analysis (Now Available) (ID 1656)

      08:00 - 18:00  |  Presenting Author(s): Jiexia Zhang

      • Abstract
      • Slides

      Background

      Osimertinib (AZD9291) is an oral, irreversible, third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M resistance mutations.The aim of this retrospective study was to evaluate the efficacy of AZD9291 for advanced non-small cell lung cancer(NSCLC) patients with brain metastasis.

      Method

      We followed up patients diagnosed with advanced non-small cell lung cancer who were detected with EGFR gene mutation and who received EGFR-TKI from 1st October 2006 to 1st June 2018.Patients finally collected were divided into two groups:One group comprised of 45 patients received first-generation or second-generation EGFR-TKI alone,while other group included 45 patients were given AZD9291.And the 95% confidence interval (CI)and the median progression-free survival (mPFS)were calculated by the Kaplan-Meier method.

      Result

      The median progression-free survival(mPFS) was longer with osimertinib than with standard EGFR-TKIs (14.0 months vs. 11.0 months; 95%Cl: 10.160-13.840, P=0.017). The mPFS of patients with brain metastasis was significantly longer with osimertinib than with standard EGFR-TKIs(13.0 months vs. 7.0 months; 95%CI: 6.087-11.913, P=0.020). The mPFS of patients with osimertinib was longer with combined radiotherapy than with not receive radiotherapy(18.0 months vs. 13.0 months; 95%CI:7.066-18.934, P=0.915).

      Conclusion

      In patients with non-small cell lung cancer with brain metastases, the median progression-free time of patients with osimertinib was longer than that of patients with first- or second-generation EGFR-TKIs alone, but osimertinib combined with radiotherapy showed no statistical significance compared with no radiotherapy.

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-10 - Impact of Anti-COPD Support Treatment in Advanced NSCLC Patients with COPD Undergoing Chemotherapy as First-Line Treatment (ID 1603)

      09:45 - 18:00  |  Author(s): Jiexia Zhang

      • Abstract
      • Slides

      Background

      To investigate the impact of standardized anti-COPD support treatment of advanced NSCLC patients complicate with COPD undergoning chemotherapy as the first-line treatment, which without driver mutations. And putting forword the new concept of "simultaneous treatment of cancer and lung itself".

      Method

      The clinical data of advanced NSCLC patients complicated with COPD were analyzed retrospectively. And patients were divided into observation group and control group according to whether the patients received standardized anti-COPD support treatment. Compared the survival statistics of the two groups.

      Result

      The study consisted of 76 patients, only 31 patients received standardized anti-COPD support treatment. The courses of first-line chemotherapy in observation group were more than that of control group (4.8vs.3.8, p<0.05), and patients in observation group were more likely to received second-line chemotherapy (95.7%vs.75.0%,p<0.05). Progression-free surival (PFS) and overall survival(OS) of observation group were significantly higher than control group (6.0 months vs.3.5 months,p<0.05;18.0 months vs.15.0 months,p<0.05).

      Baseline data of two groups of patients
      Baseline data Observation group Control group Test value P value
      Sex (Male/Female) 30/1 44/1 χ²=0.072 0.789
      Age 67.0±7.2 67.8±7.8 t=0.501 0.667
      Smoker 29 43 χ²=0.148 0.700
      Smokeing index 880.0±52.5 991±68.6 t=0.76 0.387
      Stage χ²=0.473 0.492
      IIIB 10 18
      IV 21 27
      PS (1.97±0.48) (1.93±0.54) -0.285 0.42
      Pathological type χ²=0.794 0.373
      Adenocarcinoma 14 25
      Squamous 17 20
      Non-special type 1 2
      Pulmonary fuction
      FEV1%PRED(%) 61.32±6.95 63.49±6.23 t=1.421 0.159
      FEC%PRED(%) 58.81±5.73 60.82±4.69 t=1.682 0.097
      FEV1/FVC(%) 61.81±5.11 62.89±4.74 t=0.947 0.347
      DLCO(%)PRED)(%) 46.42±9.36 47.16±9.73 t=0.329 0.743
      Chemotherapy
      TP 6 12
      GP 8 9
      DP 8 5
      PP 7 16
      PP+bevacizumab 2 4
      Average courses 4.8 3.8 t=2.589 0.012
      Second-line 22 24 χ²=4.170 0.041

      The outcome of two groups of patients

      Curative effect idex

      Observation group Control group Test value P value
      PR 7 10
      SD 11 16
      PD 13 19
      DCR 58.1% 57.8% χ²=0.02 0.889
      ORR 22.6 22.2 χ²=0.01 0.971
      PFS 6.0 month 3.5 month χ²=3.947 0.047
      OS 18.0 month 15.0 month χ²=4.083 0.043

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      Conclusion

      Advanced NSCLC patients complicate with COPD, which without driver mutations, received standardized anti-COPD support treatment can complete the courses of chemotherapy more smoothly, prolong PFS and OS.

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    P1.14 - Targeted Therapy (ID 182)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.14-11 - A Prospective Multicenter Study of Target-Capture Deep Sequencing in Paired Tissue and ctDNA to Guide EGFR-Mutated Lung Cancer Treatment (Now Available) (ID 1542)

      09:45 - 18:00  |  Author(s): Jiexia Zhang

      • Abstract
      • Slides

      Background

      TKIs have significantly improved the survival of NSCLC pts carrying sensitive mutations. However, heterozygous responses were observed. We conducted a prospective multicenter clinical trial to explore factors associated with the efficacy of EGFR-TKI, and assess the mutation and TMB concordance between plasma and tissue NGS.

      Method

      Paired tumor and plasma samples were obtained from treatment naïve advanced NSCLC pts whenever applicable. DNA was sequenced by target-capture deep sequencing of 1021 tumor-related genes (pan-cancer panel). PFS was estimated using Kaplan-Meier method and compared using log-rank test. Tissue TMB (tTMB) and plasma TMB (bTMB) analysis interrogated SNVs/Indels with VAF ≥3 % and ≥0.5 %, respectively. TMB-H pts were identified with ≥9 muts/Mb.

      Result

      From Feb. 2017 to Jan. 2019, 262 advanced NSCLC pts were enrolled from 12 centers. In 224 pts with paired tumor and plasma samples, 144 had EGFR sensitive mutations in tumor samples (L858R, 46%; Ex19Indel, 42%), of whom, 106 (74%) had the identical mutations detected in plasma. The detection rate of tissue EGFR mutations in paired plasma was significantly higher in pts with extrathoracic metastasis (81% vs. 61%, p = 0.03). In 38 pts lacking paired samples, 20 pts had EGFR sensitive mutations detected. Thus, 164 pts were identified as EGFR positive by either plasma or tissue NGS. One hundred of them were treated EGFR TKIs (ORR: 70%, mPFS: 20 mo). The ORR was affected by EGFR subtypes (Ex19Indel vs. L858R: 72% vs. 45%, p = 0.02), concomitant CNV/fusion (with vs. without: 11% vs. 68%, p = 0.002) and CDKN2A mutations (with vs. without: 0% vs. 66%, p = 0.007). Mutations in p53 pathway (p = 0.02), CDK12/13 (p = 0.0002), concomitant CNV/fusion (p = 0.003), and high number of alterations (≥ 5) (p = 0.003) significantly shortened mPFS. tTMB was correlated with bTMB (rPearson = 0.9, p < 0.0001), with a concordance rate of 90% for TMB-H and TMB-L classification. Interestingly, 9.8% of the EGFR positive pts were bTMB-H, and mPFS was shorter in bTMB-H pts (6 mo, 95% CI: 5 - NR) than in bTMB-L pts (NR, 95%: 13 - NR) (p = 0.2).

      Conclusion

      Deep sequencing with the pan-cancer panel effectively detected mutations and evaluated TMB in both tissue and plasma with a high consistence. Moreover, the presence of structure variation, high tumor heterogeneity and concomitant mutations in genes such as CDKN2A were associated with worse prognosis. Further studies of predictive factors are ongoing (NCT03059641).

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    P2.12 - Small Cell Lung Cancer/NET (ID 180)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.12-22 - Risk Factors for BM Incidence in SCLC: A Predictive Model for SCLC Patients on Brain Metastasis (Now Available) (ID 1299)

      10:15 - 18:15  |  Presenting Author(s): Jiexia Zhang

      • Abstract
      • Slides

      Background

      As one of the serious complications in patients with lung cancer, brain metastasis (BM) have been demonstrated more common when patients were diagnosing with small-cell-lung cancer (SCLC). After developing a BM, patients median overall survival will be obviously shorten. Prophylactic Cranial Irradiation (PCI) used to be an optimal therapy to prevent the occurrence of BM in SCLC patients, while recently its status was shaken. This retrospective study aimed to find out the potential risk factor relative to the incidence of BM and construct a predictive mode for SCLC, also to see the efficiency of PCI on SCLC patients ICPFS.

      Method

      Patients pathologically diagnosed with SCLC were consecutively enrolled from May 1st 2006 to February 15th 2019 and reviewed. The intracranial progression-free survival (ICPFS) were calculated by a Kaplan-Meier approach. And the candidate prognosticators of the ICPFS were checked by COX regression analysis. Using these risk factor and its coefficient obtained in the multivariate analysis , a model were constructed to anticipate the incidence of BM. And the receiver-operating characteristic (ROC) curve was constructed to access the prediction ability.

      Result

      Totally 261 SCLC patients were eligible for analysis, including 78 cases had developed a BM (29.9%) after the first diagnosis. We used Cox proportional hazards to analyze and adjust the confounding factor to the incidence of BM, and got the result, that there were five factors showed the significance both in Uni-(P<0.15) and multivariate(P<0.05) analysis, including smoking index <400(P=0.017); vascular invasion (P=0.012); number of primary lesion (P=0.042); staging (P=0.018); and hyponatremia (P=0.05). And a predicative model was constructed by using these factors (except the hyponatremia), with an AUC value of 0.743. And we used this model to distinguish low and high risk group. Two groups ICPFS showed a remarkable significance (P<0.001). We also simplified it to make it more convenient in clinical work, which also showed an outstanding significance (P<0.001). However, the PCI in our study was not reach the significance, even though it prolonged the ICPFS (P=0.211).

      Conclusion

      Factors included smoking index >=400, vascular invasion, number of primary lesion, staging, and hyponatremia, increasing the risk of BM occurrence. In the era of individualized treatment, a predictive model based on smoking status and image science can give some suggestions for clinical work by anticipating the highly risky incidence of brain metastasis on SCLC patients.

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