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Chao Sun



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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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      EP1.01-59 - The Effectiveness of Osimertinib in a NSCLC Patient with Complex Uncommon EGFR Mutations of G719X and S768I: A Case Report (Now Available) (ID 2535)

      08:00 - 18:00  |  Author(s): Chao Sun

      • Abstract
      • Slides

      Background

      With the deeper and wider application of gene detection technology in lung cancer, an increasing number of genetic alterations have been identified, especially in the epidermal growth factor receptor (EGFR) gene, including uncommon and complex types of EGFR gene mutations; however, the efficacy of the targeted therapy in these gene mutation types is not clear.

      Method

      We report the genetic test results from the analysis of postoperative specimens from a lung adenocarcinoma patient that suggest complex EGFR mutations of G719X and S768I.

      Result

      After tumor recurrence, the patient was treated with osimertinib and achieved an excellent and long-lasting clinical response. The patient has taken osimertinib for 18.2 months with an efficacy evaluation partial response (PR), and her follow-up is still ongoing.

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      Conclusion

      Complex uncommon EGFR mutations of G719X and S768I have a good response to osimertinib.

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    EP1.04 - Immuno-oncology (ID 194)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-36 - Aggravation of Depigmentation for a NSCLC Patient with Pre-Existing Vitiligo Using Immune Check Point (PD-1) Inhibitor: A Case Report (Now Available) (ID 2517)

      08:00 - 18:00  |  Author(s): Chao Sun

      • Abstract
      • Slides

      Background

      Immune checkpoint inhibitors (ICIs) such as anti-PD-1/PD-L1/CTLA4 antibody can enhance the antitumor activity of the immune system by mainly promoting CD8+ T lymphocyte immune function. While, they can also induce immune-related adverse events (irAEs), especially the skin toxicity, such as maculopapular rash, lichenoid reactions, vitiligo and pruritus. However, the effectiveness and safety of ICIs in cancer patients who are also suffered from autoimmune diseases are still unclear.

      Method

      In our present report, we described a newly diagnostic non-small cell lung cancer (NSCLC) patient who suffered from the focal vitiligo for about ten years, her vitiligo lesions were localized in eyes and mouth circumference.

      Result

      The patient’s vitiligo was aggravated rapidly with depigmentation of the whole body skin in just half a year. Meanwhile, lung cancer focus was still in a stable status for over 14 months. The efficacy evaluation is stable disease (SD), but as the treatment time prolonged, the tumor density gradually decreased, suggesting that the immunotherapy continues to benefit.

      Conclusion

      Vitiligo, as one kind of autoimmune diseases, should be paid more attention as using with ICIs at the same time. Meanwhile, ICIs may bring more irAEs and more benefit in the pre-existing autoimmune disease population, compared with that normal population.

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    EP1.14 - Targeted Therapy (ID 204)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.14-48 - Efficacy and Safety of Afatinib Plus Apatinib Combination Therapy for a Lung Adenocarcinoma Patient with Her-2 V659D Mutation (Now Available) (ID 1706)

      08:00 - 18:00  |  Author(s): Chao Sun

      • Abstract
      • Slides

      Background

      In lung cancer,several literature report the rare transmembrane domain mutations occur in V659D of Her-2 may be effective for afatinib. This is a successful case of a lung adenocarcinoma patient with a novel Her-2 V659D mutation but unsatisfactory efficacy with afatinib treated with afatinib plus apatinib.

      Method

      A 73-year-old Chinese man with a heavy-smoking history came to our hospital due to"Intermittent cough"in eary March 2017. He was diagnosed with stage IB(T2aN0M0)lung adenocarcinoma by pathology of left upper lobectomy in 29th Mar 2017(Fig.1). An HER-2 mutation(V659D mutation)was detected in the surgical specimen by Next-generation sequencing (mutation abundance is 44.6%).

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      Recurrence of lung cancer occurred after 16 months on 30th July 2018. Pulmonary CT revealed multiple nodules in both lungs( Fig.2). The patient had no intention of chemotherapy. Daily oral doses of 40 mg of afatinib were given on 31st July 2018. Twenty-two days later, a CT scan revealed the bilateral pulmonary nodules were slightly smaller, however cough symptoms were worse than before(Fig.3). On 23rd Agu 2018, considering the efficacy and side effects, he started taking afatinib(reduced to 30mg)combined with apatinib(500mg/day). The chest CT scan revealed the metastases continued to shrink after 1 month, and necrotic cavities appeared in the middle of the lesions(Fig.4). Cough symptoms improved obviously. Therapeutic evaluation was stable. He had no progression of the disease for months.

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      Result

      On 21st Feb 2019, lung CT indicated enlargement of bilateral pulmonary nodules and new lesions suggesting disease progresses. Progression-free survival is 6.1 months. As for the side effects, he had two-grade rash on the face, three-grade oral mucositis with afatinib monotherapy. And he had one-grade rash on the face, two-grade oral mucositis and two-grade hand-foot syndrome in the combined treatment of afatinib and apatinib.

      Conclusion

      Afatinib combined with apatinib is a safe therapeutic method for rare mutation of HER-2 V659D that can increase the efficacy.

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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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      P1.12-14 - Phase II Trial of Apatinib Plus Chemotherapy for Second-Line and Above Treatment of Advanced SCLC: Focus on Efficacy and Safety (Now Available) (ID 1788)

      09:45 - 18:00  |  Author(s): Chao Sun

      • Abstract
      • Slides

      Background

      Small-cell lung cancer (SCLC), which accounts for 15% of all lung cancers, is characterised by its rapid proliferation. The clinical outcomes of second-line and above treatments are unsatisfactory, resulting in a median progression-free survival (PFS) of less than 3 months. There is currently none targeted drugs or new chemotherapeutic drugs that can achieve breakthroughs in advanced SCLC. This study aims to observe whether apatinib in combination with chemotherapy can be a new choice for second-line and above treatment of advanced SCLC.

      Method

      This is a prospective, single-center, single-arm clinical study designed to evaluate the efficacy and safety of apatinib plus chemotherapy for second-line and above treatment of advanced SCLC (ClinicalTrials.gov NCT03547804). Patients received 500mg apatinib qd orally, if the patient has a grade 3/4 adverse reaction during the treatment, it can be reduced to apatinib 250mg qd orally. Chemotherapeutic agents are limited to irinotecan or docetaxel alone. The primary endpoint was the progression-free survival (PFS). The secondary endpoints included overall survival (OS), disease control rate (DCR), objective response rate (ORR), and adverse events (AEs).

      Result

      Twenty patients were enrolled from March 2018 to March 2019. Fifteen patients were available for response evaluation. The ORR and DCR were 33.33% (5/15) and 93.33% (14/15), respectively. The predicted median PFS time was 5.8 months (95% confidence interval [CI] 5.1-6.5 months) (SPSS 20.0 software). The most common treatment-related AEs were neutropenia (45.0%), leucopenia(35.0%), abnormal liver function (20%), nausea and vomiting (20%) and thrombocytopenia (20.0%), without any treatment-related deaths. It is worth noting, 12 patients underwent apatinib reduction due to grade 3/4 adverse reactions.

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      Conclusion

      Apatinib plus single agent chemotherapy showed promising efficacy in a patients with advanced SCLC who had failed chemotherapy. And the recommended phase II dose of apatinib as combination therapy was 250 mg qd.

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    P2.03 - Biology (ID 162)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.03-46 - PI3K/AKT Signal Pathway Regulates Malignant Transformation of MPLC with EGFR-Sensitive Mutation (Now Available) (ID 2456)

      10:15 - 18:15  |  Author(s): Chao Sun

      • Abstract
      • Slides

      Background

      Multiple primary lung cancer (MPLC) is a presumed uncommon entity, but its true incidence, ranging from 0.2% to 8%, is increasing as the result of the widespread use of early detection tools. MPLC displays diverse clinical trajectories and genomic profiles. The in-depth study on the mechanism of malignant transformation of MPLC will provide new ideas for the future treatment of MPLC.

      Method

      In this study, we analyse the genomic profiles of 25 tumors and 12 adjacent tissues from 10 patients with MPLC who underwent surgical resection through the whole-exome sequencing (WES).

      Result

      Ten patients were enrolled in this study, one patient with different evolutional stages of the same disease (AAH, MIA, and IA) and one patient with completely different pathologies (adenocarcinoma and squamous cancer). Eight patients with different driver genes (EGFR exon 19 deletionexon 21 L858R mutation and exon 21 L861Q mutation) of lung adenocarcinoma. We observed different mutational landscapes between tumors in the same patient by analyzing somatic mutations, copy number variations, clonal structures, and signal transduction pathways. Most tumors showed significant APOBEC mutant patterns, especially C→T transversions (Figure 1). Moreover, we also found that EGFR exon 19 and 21 mutations enrich different signal pathways. The PI3K/AKT signal pathway is often be enriched in tumors with EGFR exon 19 deletion, which is closely related to the early progression of the tumor. While PTEN kinase activation is associated with EGFR exon 21 L858R mutation (Figure 2). MPLCs with EGFR wild-type may be associated with abnormal regulation of signal pathways, including SOS1, JAK-STAT and others.

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      Conclusion

      This study suggests that the different "gene mutation trajectories" of EGFR exon 19 and 21 mutations are closely related to the genetic heterogeneity of MPLC. Besides thatAPOBEC mediated mutations may play an important role in the initial malignant transformation of tumors.

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