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Rameej Revanta Thapa
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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: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-30 - Clinico-Pathological Profile of Adenocarcinoma of the Lung – A Prospective Study in a Nepalese Population (Now Available) (ID 722)
08:00 - 18:00 | Author(s): Rameej Revanta Thapa
- Abstract
Background
Lung cancer represents the most common cause of cancer related mortality in developing countries including Nepal where patients (pts) often present in advanced stage. The purpose of this study was to determine the incidence and clinico-pathological profile of pts with adenocarcinoma of the lung (ACL) presented to a tertiary care center of Nepal.
Method
An IRB approved prospective study was conducted in pts with ACL over a period of 15 months from April 2017 to July 2018 at a tertiary care center, Bir Hospital, Kathmandu. Demographic data, history of smoking, histological type, presence and type of epidermal growth factor receptor (EGFR) mutations were studied. EGFR-analysis was performed using TheraScreen EGFR mutation kit.
Result
A total of 253 pts were diagnosed with lung cancer in the period. Of the 83 (33%) diagnosed with ACL, 45 (54%) were males and 38 (46%) females. The mean age at diagnosis was 59.4 years, and 74 (89%) were in stage III/IV. Forty eight (58%) pts were smoker of whom 30 (63%) pts had less than 10 pack years. Sixty one percent (61%) were illiterate. Eighteen (22%) pts had wrongly received anti-tuberculosis treatment before the diagnosis of ACL was made. All ACL pts were tested for EGFR-mutations which were found in 24 (29%) pts, the most common mutation being exon 21 (L858R) (42%) followed by exon 19 deletion (38%). Exon 18 and exon 20 (T790M) mutation were found in 2 pts (8%) each. One pt had dual mutation in exon 20 (T790M) and exon 21 (L858R).
Conclusion
The frequency of EGFR-mutations in ACL in this Nepalese cohort was lower than in Eastern Asian studies, but higher than in western population. EGFR mutation testing of ACL has to be encouraged in developing countries like Nepal as presence of these mutations predict durable response to oral tyrosine kinase inhibitors. Interestingly, lung cancer is often mistreated as tuberculosis leading to delay in diagnosis and treatment.
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EP1.01-40 - Outcome of EGFR-Mutated and Non-Mutated Lung Adenocarcinoma Receiving Standard Therapy - A Nepalese Cohort (Now Available) (ID 941)
08:00 - 18:00 | Author(s): Rameej Revanta Thapa
- Abstract
Background
Lung cancer represents major health challenges worldwide including Nepal where patients (pts) often present in advanced stage. The purpose of this study was to compare the objective response rates (ORR), progression free survival (PFS), and quality of life (QoL) of EGFR-mutated (EGFR-mut) and non-mutated (EGFR-wt) pts with adenocarcinoma of the lung (ACL) receiving standard therapy.
Method
An IRB approved comparative analytical study was performed in pts with ACL. Newly diagnosed stage IV ACL pts were enrolled and ORR, PFS and QoL was compared between EGFR-mut and EGFR-wt (33 pts in each arm) pts. EGFR-mut pts were given gefitinib and EGFR-wt pts were given systemic chemotherapy (pemetrexed/cisplatin or cisplatin/etoposide). Response evaluation was done using RECIST criteria in both arms. PFS was calculated from the date of starting treatment to the date of progression and QoL was evaluated using EORTC QLQ-C30 (version 3) questionnaire and compared between two arms. Adverse effects were assessed using CTCAE criteria. Pts were followed for 1 year.
Result
Complete response (CR) was achieved in 9.1% vs 3.0 % (p=0.46), and ORR was 27.3% vs 15.2% (p=0.23) in EGFR-mut vs EGFR-wt. The median PFS was 11 and 9 months for EGFR-mut and EGFR-wt respectively (p = 0.045). The mean score of global health status from EORTC QLQ-C30 was 68.1 vs 61.6 in EGFR-mut pts vs EGFR-wt pts (p = 0.036). Skin toxicities were more common in pts receiving gefitinib. One pt had grade 3 skin toxicity. Febrile neutropenia and peripheral neuropathy (either grade 1 or grade 2) were the most common toxicities in pts receiving standard chemotherapy.
Conclusion
EGFR-mut pts treated with EGFR-TKI had improved ORR, PFS and QoL in comparison with EGFR-wt pts treated with chemotherapy. EGFR-mutational analysis and EGFR-directed therapy is feasible and provides survival benefit, also in developing countries as Nepal.
