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Takashi Kasai
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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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EP1.01-83 - Efficacy and Safety of EGFR-TKI Rechallenge Treatment in Elderly Patients with Advanced NSCLC Harboring Sensitive EGFR Mutations (Now Available) (ID 81)
08:00 - 18:00 | Author(s): Takashi Kasai
- Abstract
Background
Epidermal growth factor receptor–tyrosine kinase inhibitor (EGFR–TKI) is effective as first-line chemotherapy for patients with advanced non-small-cell lung cancer (NSCLC) harboring sensitive EGFR mutations. However, whether the efficacy of second-line EGFR–TKI treatment after first-line EGFR–TKI treatment was poorly studied in elderly patients aged ≥ 75 years harboring sensitive EGFR mutations. Therefore, we aimed to investigate the efficacy and safety of EGFR-TKI re-administration after first-line EGFR–TKI treatment in elderly patients with NSCLC harboring sensitive EGFR mutations.
Method
Between October 2002 and December 2015, 22 elderly patients with advanced NSCLC harboring sensitive EGFR mutations who were initiated on EGFR–TKI Rechallenge at four Japanese institutions were included in this study.
The eligibility criteria were histologically or cytologically confirmed NSCLC, unresectable stage III/IV disease, and a drug-sensitive EGFR mutation (exon 19 deletion or exon 21 L858R).
All patients were initially treated with gefitinib (250 mg/day) or erlotinib (150 mg/day) and after recurrence, re-administration of EGFR-TKIs (gefitinib, erlotinib, afatinib) was performed as a secondary chemotherapy
Result
Ultimately, 22 cases of this study were studied. The median age was 77.5 years (range 75-87 years).
Although it was a retrospective analysis, even with re-administration of EGFR-TKI rechallenge, the response rate was 23%, PFS 5.26 months, OS (after EGFR-TKI rechallenge) 14.4 months (the administration lines were 2, 3 and 4 lines ).
Conclusion
Until now it was said that EGFR-TKI rechallenge does not contribute to OS in LUX-LUNG 1 and so on.
On the other hand, there are also reports on the usefulness of EGFR-TKI rechallenge.
From the results of this study it can be said that it can be one of the options among the limited treatment options for elderly EGFR positive lung cancer.
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P1.04 - Immuno-oncology (ID 164)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.04-34 - Efficacy and Safety of First-Line Pembrolizumab Monotherapy in Elderly Patients (Aged ≥ 75 years) with Non-Small Cell Lung Cancer (ID 265)
09:45 - 18:00 | Author(s): Takashi Kasai
- Abstract
Background
Pembrolizumab is effective as first-line treatment for advanced non-small cell lung cancer (NSCLC) patients expressing high programmed death-ligand 1 (PD-L1). However, it is unclear whether the efficacy of first-line pembrolizumab treatment in elderly patients (aged ≥75 years) is similar to that in non-elderly patients expressing high PD-L1. Therefore, we aimed to investigate the efficacy and safety of first-line pembrolizumab monotherapy in elderly patients with NSCLC expressing high PD-L1.
Method
Between February 2017 and February 2018, 128 patients (comprising 47 elderly) with advanced NSCLC expressing high PD-L1 received first-line pembrolizumab monotherapy at 10 Japanese institutions. Baseline characteristics, efficacy of pembrolizumab treatment, and adverse events were recorded.
Result
Overall, 47 patients (40 men and 7 women) (median age, 79 [range, 75–88] years) were included in our analysis. In these patients who received first-line pembrolizumab monotherapy, the overall response, disease control rates, median progression-free survival (PFS), and overall survival (OS) were 53.1%, 74.4%, 7.0 months, and not reached, respectively. Common adverse events included anorexia, fatigue, skin rash, and hypothyroidism. Two treatment-related deaths due to pneumonitis and infection were noted. First-line pembrolizumab monotherapy with non-progressive disease (PD) was associated with better PFS. Pembrolizumab monotherapy with good performance status and non-PD was also linked to better OS.
Conclusion
First-line pembrolizumab monotherapy among elderly patients with NSCLC expressing high PD-L1 was effective and safe and showed outcomes equivalent to those in non-elderly patients. First-line pembrolizumab monotherapy without PD, and with good performance status and non-PD, might be associated with better PFS and OS, respectively.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-95 - Updated Data of KRSG 1302 Study: Nedaplatin and Nab-Paclitaxel for Patients with Previously Untreated Advanced Squamous Cell Lung Cancer (Now Available) (ID 136)
10:15 - 18:15 | Author(s): Takashi Kasai
- Abstract
Background
Background: Nedaplatin (N) and nab-paclitaxel (nab-P) are efficacious for the treatment of non-small cell lung cancer, especially advanced squamous cell lung cancer. Although a combination of N and nab-P is expected to result in the treatment of squamous cell lung cancer, no sufficient and reliable data have been reported yet.
Method
Patients and methods: The inclusion criteria were no prior chemotherapy; stage IIIB or stage IV squamous cell lung cancer; a performance status (PS) of 0–1; 75 > patients’ age > 20 years; and adequate major organ function. Patients received escalating doses of nab-P under a fixed dose of N (100 mg/m2, 1st day) every 3 weeks in phase I. The initial dose of nab-P was 100 mg/m2 on the 1st and 8th day (level 1), and the next dose was 100 mg/m2 on the 1st, 8th, and 15th day (level 2). In phase II, the patients received the recommended dose of N/nab-P. The primary endpoint was tumor response, which was measured according to the revised version of response evaluation criteria in solid tumors.
Result
Results: In this study, 5 patients were enrolled in the phase I. Three patients in level 1 experienced no dose-limiting toxicities (DLTs); whereas, 2 patients in level 2 experienced DLTs. Therefore, level 1 was named the recommended dose. In addition, 23 patients were enrolled in phase II. Three and 23 patients in level 1 and phase II were evaluated, respectively. However, among them, 2 of 26 patients were not assessed due to pneumonia, and 1 of 26 patients was excluded from analysis due to patients’ refusal. Partial response, stable disease, and progressive disease were noted in 21, 0, and 2 patients, respectively, yielding a response rate of 91.3% [95% confidence interval (CI): 72.0–98.9]. The median progression-free survival (PFS) was 223 days (95%CI: 144–330), and the median overall survival (OS) was 358 days (95% CI: 255–950). The 1- and 2-year PFS rate were 17.8% and 12.0%. The 1- and 2-year OS rate were 50.0% and 43.8%, respectively. The grade 3 and grade 4 toxicities were manageable and there was no treatment-related death. These data were published in 2018 ESMO. We will report updated efficacy and safety of N/nab-P in KRSG 1302 study.
Conclusion
Conclusions: A combination of N (100 mg/m2, 1st day) with nab-P (100 mg/m2, 1st and 8th day) every 3 weeks demonstrated an effective therapeutic approach. Therefore, N/nab-P administration is to be safe and efficacious for patients with advanced squamous cell lung cancer.
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P2.08 - Oligometastatic NSCLC (ID 172)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.08-05 - The Role of Surgical Treatment for Patients with NSCLC Demonstrating Limited Pleural Dissemination (ID 701)
10:15 - 18:15 | Author(s): Takashi Kasai
- Abstract
Background
Pleural dissemination or malignant pleural effusion confirmed during surgery generally indicates incurable disease and is a contraindication for lung resection. However, recent studies suggested that complete removal of the disseminated nodule in combination with lung resection is associated with long-term survival when dissemination is limited.
This study investigated whether there is a curable subgroup of patients with NSCLC exhibiting limited malignant pleural disease (MPD).
Method
Among 1966 patients who underwent lung surgery for primary lung cancer at our institution between 1986 and 2015, 61 patients were diagnosed with MPD during the operation. Excluding 3 patients who had other active malignancies and 2 patients who were lost to follow-up, we analyzed 59 patients, including 33 who had signs of MPD on preoperative CT. The type of surgery was biopsy only for 26, extrapleural pneumonectomy (EPP) for 17, lobectomy for 13, and wedge resection for 3. Macroscopic complete resection (MCR) was carried out for 24 patients. All but one patient were followed until December 2018 or death, and the follow-up period for surviving patients ranged from 48 to 361 months (median 158 months).
Result
Overall and progression-free survival Patients group Type of surgery Number of patients 5yOS/PFS(%) 10yOS/PFS(%) 15yOS/PFS(%) All patients 59 28.1/10.1 18.1/6.7 13.8/6.7 MCR 24 37.5/25.0 25.0/16.7 20.8/16.7 EPP 17 41.2/29.4 35.3/23.5 29.4/23.5 No sigh of MPD preoperatively 26 34.6/15.4 19.8/11.5 19.8/11.5 MCR 11 45.5/36.4 27.3/27.3 27.3/27.3 EPP 5 60/60 60/60 60/60 Any sign of MPD preoperatively 33 23.1/6.0 13.2/3.0 9.9/3.0 MCR 13 30.8/15.3 23.1/7.6 15.4/7.6 EPP 12 33.0/16.6 25.0/8.3 16.7/8.3 Among the 59 patients, 4 patients survived without recurrence for more than 10 years. Furthermore, 3 out of the 4 patients were still alive at 361 months, 300 months, and 211 months, respectively. Among the 4 patients, 3 patients did not exhibit signs of malignant pleural disease preoperatively, and all 4 patients underwent EPP. The overall and progression-free survival rates at 5, 10, and 15 years for all 59 patients, the 26 not exhibiting signs of MPD preoperatively, and the 33 patients with signs of MPD according to the type of surgery are presented in the Table. Prognostic factors significantly associated with longer progression-free survival were early clinical stage, adenocarcinoma histology, absence of pathological mediastinal nodal metastasis, MCR, and EPP.
Conclusion
A curable subgroup may exist among patients diagnosed with malignant pleural disease during surgery, especially among those without signs of pleural disease preoperatively treated by EPP.
