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Shi Qiu



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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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      EP1.01-103 - Long-Term Response to Second-Line Afatinib for the Treatment of Advanced Lung Squamous Cell Carcinoma (Now Available) (ID 2962)

      08:00 - 18:00  |  Author(s): Shi Qiu

      • Abstract
      • Slides

      Background

      Lung squamous cell carcinoma (SqCC) with large heterogeneity and complex genetic map accounts for 25–30% of non-small-cell lung cancer (NSCLC) cases. SqCC is lack of defined molecular targets and often diagnosed at a advanced stage, which contribute to poor prognosis. Afatinib is an irreversible ErbB family inhibitor that is approved for the second-line treatment of patients with advanced SqCC who progressed after platinum-based chemotherapy based on the significant clinical benefits in Lux-Lung8.

      Method

      We presented a case of a 56-year-old male with a 30-year history of smoking was diagnosed as SqCC of the left lung (cT2N3M0, IIIB). After neoadjuvant chemotherapy +sugery + adjuvant chemotherapy, CT scans showed disease progressed with disease-free survival (DFS) of 12 months. Thus, continuous chemoradiotherapy was administered. Seven months later, chest CT suggested that the disease progresssed again. Subsequently, the patient was enrolled into LUX-Lung 8 study and began the second-line therapy of afatinib (40 mg/day).

      Result

      The patient remaining in stable disease (SD) after 8 weeks and achieving complete response(CR) after 12 weeks treatment.The patient is still alive and the disease has not progressed more than 5 years since initiation of treatment. There‘s no obvious side effects during the treatment.

      Conclusion

      We found that the patient had a favorable progosis with the overall survial of more than five years treated with afatinib. Long-term response to afatinib in this case provides an important reference for the treatment of patients with advanced SqCC.

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      EP1.01-106 - A Special Case of Synchronous Multiple Primary Lung Cancer with Mediastinal Lymph Node Metastases of Unknown Primary Origin (Now Available) (ID 2101)

      08:00 - 18:00  |  Author(s): Shi Qiu

      • Abstract
      • Slides

      Background

      Coexisting lung cancers that are independent of each other and have either different or the same histology type are designated synchronous multiple primary lung cancer (sMPLC). The incidence of sMPLC is 0.2%-8% and has been increasing due to the recent development of early detection technology. Cancer of unknown primary site (CUP) accounts for 3%-5% of cancers, it rarely occurs in mediastinal lymph nodes and accounts for only 1.0−1.5% of all CUP cases.

      Method

      We presented a 61-year-old man with a history of smoking and old tuberculosis. The image data showed a large mass (2.4 cm*2.3 cm*2.0 cm) in the left lower lobe, and the 5th group of mediastinum lymph nodes was enlarged, suggesting peripheral lung cancer with lymph node metastasis. Multiple GGNs had been found in both lungs and the tuberculosis in the upper lobes of both lungs was identified. No other distant metastases were detected from other image data. Left lower lobe resection and lymph node dissection were performed on the patient.

      Result

      Intraoperative pathology revealed squamous cell carcinoma with no driver mutations in the left lower lobe. Adenocarcinoma harbouring the EGFR gene exon 18 mutation (G719A/G719C) was diagnosed in the mediastinum lymph node dissection. Multiple gene sequencing showed that there’s no relationship was between two primary sites. The hypothesis of the primary origin of the metastatic mediastinal lymph nodes is scar cancer from tuberculosis or multiple GGNs. Chemotherapy consisting of four cycles of gemcitabine plus cisplatin were prescribed for this patient after the operation. The current status of the patient was evaluated as stable disease (SD) with a PFS of more than 12 months.

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      Conclusion

      We found a sMPLC patient with different pathological types between the lung and lymph node lesions. Lung scar cancer or GGNs is highly suspected to be the origin of the metastatic mediastinal lymph node.

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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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      EP1.14-50 - The Effectiveness of the Combined Therapy of Osimertinib and Vemurafenib in a Patient with Coexistance of EGFR and BRAF Mutation (Now Available) (ID 2501)

      08:00 - 18:00  |  Author(s): Shi Qiu

      • Abstract
      • Slides

      Background

      With the widely application of gene detection techonology in lung cancer, more rare genetic alterations are indentified, including the coexistance of double driver mutations. The coexistance of EGFR and BRAF mutations in lung cancer is rare and its treatment strategy has not been systemetically explored. Synergistic inhibition of the tumour cells by EGFR-TKI combied with BRAF inhibitor has been proved in a vitro trail. If there's clinical benefit of the combined tharepy targeting EGFR and BRAF pathways is unclear.

      Method

      We present an adenocarcinoma lung cancer patient harboring 19 exon deletion and T790M mutation of EGFR who progressed on osimertinib with an emergence of BRAF VE600 mutation. The treatment of single-agent vemurafenib is effective for the metastatic leision but make the primary leision progession. Given the progression of primary leision the was noted, osimertinib was added to vemurafenib for treatment.

      Result

      During the first week of combined therapy of osimertinib and vermurafenib with oral dose of 80 mg qd and 960mg bid respetively, the patient developed intolerable palpitation and fatigue (grade 3), which were related to drugs. Therefore, the dose of vemurafenib was reduced to 960mg qd, and osimertinib was taken with the original dose (80mg qd). Subsequently, aboved adverse events were obviously relieved (grade 1). After three months of combined therapy, the size of the priamry leision reduced significantly and the patient achieved a partial reponse, suggesting the the effectiveness of the combined therapy of osimertinib and vemurafenib. Currently, the follow-up of the patient is ongoing

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      Conclusion

      This case provides an example of the successful treatment of the combination of vemurafenib and osimertinib, and highlights the potential value of BRAF inhibitor combined EGFR-TKIs in the treatment of advanced lung cancer harboring BRAF mutation and EGFR mutation.

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