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Yasuhiro Hiyoshi



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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
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-68 - Impact of EGFR Genotype on the Efficacy of Osimertinib in Patients with Non-Small Cell Lung Cancer: A Prospective Observational Study (ID 271)

      08:00 - 18:00  |  Author(s): Yasuhiro Hiyoshi

      • Abstract
      • Slides

      Background

      A T790M of the epidermal growth factor receptor (EGFR) is the most frequently encountered mutation occurring acquired resistance to EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). The aim of this study was to assess the differential clinical outcomes of osimertinib therapy in NSCLC patients with T790M according to the type of active EGFR mutation, i.e. exon 19 deletion or L858R point mutation.

      Method

      We conducted a prospective observational cohort study to evaluate the efficacy and safety of osimertinib in patients with major EGFR mutation and T790M-positive advanced NSCLC who had disease progression after first-line EGFR-TKI therapy. The efficacy of osimertinib was evaluated according to the type of EGFR mutation.

      Result

      A total of 51 patients were included in this study. The exon 19 deletion was found in 33 (65%) patients, and the L858R point mutation in 18 patients (35%). An objective response was obtained in 29 patients, indicating an objective response rate of 58.8%. The response rate was 69.7% in patients with exon 19 deletion and 38.9% in patients with L858R point mutation, indicating a statistically significant difference (P =0.033). The median progression-free survival (PFS) and overall survival (OS) of the entire patient population were 7.8 and 15.5 months, respectively. Median PFS in the exon 19 deletion and L858R point mutation groups was 8.0 months and 5.2 months, respectively, indicating a statistically significant difference (P =0.045). Median OS in the exon 19 deletion and L858R point mutation groups was 19.8 months and 12.9 months, respectively, indicating a statistically significant difference (P =0.0015). Multivariate analysis identified exon 19 deletion as a favorable independent predictor of PFS and OS.

      Conclusion

      Investigators should consider the proportions of sensitive EGFR mutation types as a stratification factor in designing or reviewing clinical studies involving osimertinib.

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    P2.04 - Immuno-oncology (ID 167)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.04-87 - Efficacy of Immune Checkpoint Inhibitors for Locally Advanced Non-Small Cell Lung Cancer Patients Before Durvalumab Approval (Now Available) (ID 878)

      10:15 - 18:15  |  Author(s): Yasuhiro Hiyoshi

      • Abstract
      • Slides

      Background

      Standard treatment for patients with locally advanced (LA) non-small cell lung cancer (NSCLC) was concurrent chemoradiotherapy (CRT) with 40-70% of 2-year overall survival (OS). Immune checkpoint inhibitors (ICIs) have been shown efficacy in advanced or recurrent NSCLC and approved on December 2015 in Japan. After that, the ICI durvalumab was approved as maintenance therapy after concurrent CRT even in unresectable LA-NSCLC on July 2018 in Japan.

      Method

      To investigate the feasibility of concurrent CRT for LA-NSCLC patients and efficacy of ICI treatment for the relapsed patients after CRT, we assessed consecutive LA-NSCLC patients treated with concurrent CRT between July 2013 and June 2018 (before durvalumab approval), retrospectively.

      Result

      108 eligible patients (81 males and 27 females with median age of 65 years old, including 7 patients with targeted mutations; 2 EGFR, 4 ALK and 1 ROS1) were analyzed. All patients received radical thoracic radiotherapy using 3D planning system and concurrent with platinum-based chemotherapy. 79 (73%) received one or two cycles of consolidation chemotherapy of same regimen. 105 (97%) patients completed planned radiotherapy, and radiation pneumonitis was observed in 93 (85%) patients with median 130 (range, 41-317) days from initiation of radiation to onset. 74 (69%) patients met the PACIFIC criteria and were considered to be eligible for durvalumab. The overall response rate was 64% and the progression free survival was 10.3 (95% CI, 8.4–12.2) months. The OS was 41.8 (95%CI, 20.1-63.5) months and 2-year OS were 63%. Of the 82 patients who relapsed after CRT, 18 patients received ICI treatment (14 nivolumab, 3 pembrolizumab, 1 atezolizumab) in the course of treatment. Patients who received ICI after relapse had significantly better survival than those who did not receive ICI (2-year OS, 87% vs. 41%; p=0.001).

      Conclusion

      Concurrent CRT using platinum-based regimen was considered effective treatment with acceptable toxicity for LA-NSCLC patients. The efficacy of ICI treatment has been shown in patients with relapse after concurrent CRT in LA-NSCLC, and indication with durvalumab maintenance therapy is expected to further improve the prognosis in patients with LA-NSCLC. The optimal use timing of ICI treatment for patients with LA-NSCLC should be considered.

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