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Gang Wu



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    EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.16-14 - Efficacy of First-Line Continuous Maintenance of Pemetrexed Therapy for Lung Adenocarcinoma When Administered at Routine or Extended Intervals (Now Available) (ID 1822)

      08:00 - 18:00  |  Author(s): Gang Wu

      • Abstract
      • Slides

      Background

      Background: Lung cancer is the most common cancer and the leading cause of death due to cancer worldwide , The benefit of maintenance therapy with pemetrexed with or without antiangiogenesis inhibitors has been observed in previous studies. However, continuous maintenance therapy with the pemetrexed-antiangiogenesis combination has rarely been evaluated in the real world setting. In real life, patients may not receive maintenance therapy or may receive delayed maintenance therapy (stopping interval of >21 days) owing to many factors. The purpose of this study was to obtain real-world data on the maintenance of local progressive and metastatic non-squamous non-small cell lung cancer (NSCLC) in first-line patients treated with or without pemetrexed antiangiogenesis, and to evaluate the effect of extended interention on clinical outcomes.

      Method

      Methods: 168 patients with stage IIIB or IV lung adenocarcinoma who had not been treated previously received pemetreplatin-induced chemotherapy with or without anti-angiogenesis inhibitors (bevacizumab or rh-endostatin) every 3 weeks for a course of 4-6 weeks.The efficacy and safety of 112 patients without progression after induction chemotherapy were analyzed.

      Result

      Results: 70 of the 112 patients received continuous maintenance therapy, with or without an anti-angiogenesis inhibitor, until the disease progressed.42 patients did not receive continuous maintenance therapy.The median duration of maintenance therapy was 4(range 1-26);The median interval of each maintenance treatment cycle was 40 days (ranged from 21 to 77 days).The optimal objective efficiency of maintenance group and non-maintenance group was 48.6% and 33.3%, respectively.At an average follow-up of 14.6 months, the median progression-free survival was 11.5 months (95% CI: 9.8 -13.2 months) and 6.8 months (95% CI :5.4-8.2 months,p < 0.001), and the median overall survival was 40.1 months (22.5 - 57.7 months) and 18.0 months (10.4-25.6 months,p = 0.001) in the maintenance and non-maintenance groups, respectively.The most common grade 3-4 adverse event in both groups was neutropenia (18.6% vs. 19.0%).

      Conclusion

      Conclusion: prolongation of maintenance time is feasible, and for patients without progression after first-line induction therapy for lung adenocarcinoma, continuous maintenance therapy with or without combination of pemetrexed with anti-angiogenesis is essential for survival benefits.

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-44 - The Role of Microbiota on the Development of Non-Small-Cell Lung Cancer (Now Available) (ID 2055)

      09:45 - 18:00  |  Author(s): Gang Wu

      • Abstract
      • Slides

      Background

      The functional role of microbiota on the development of cancer has attracted an accumulating attention recently. However, the impact of fecal and sputum microbiome in the formation and development of Non-small-cell lung cancer (NSCLC) are mostly unknown. Our study aimed to characterize and compare fecal and sputum microbiome of NSCLC patients with healthy control subjects, and analysis the fecal microbiome of NSCLC patients with or without brain metastasis (BM).

      Method

      We collected 102 fecal and 71 sputum samples from Wuhan Union Hospital. The Illumine Miseq sequencing platform was used to analyze 16S rRNA variable regions V3 and V4 in these samples. C57/BJ mice were treated with an antibiotic cocktail to postnatally deplete the microbiota. The effect of antibiotic was subsequently investigated both in xenograft model and brain metastases model.

      Result

      Clinical characteristics of the participants including age, gender and body mass index were matched between the compared groups. (1) The sputum microbial diversity of healthy control group (n=18) was higher than NSCLC group (n=53, P < 0.05). Genus Actinomyces was significantly more abundant in sputum samples of NSCLC patients than the healthy controls (P < 0.05), while Neisseria was more abundant in the controls. The area under the curve of genus Actinomyces used to predict lung cancer was 0.71 (95% CI: 0.69 - 0.91). (2) However, no difference in alpha diversity was showed between the fecal microbial of healthy control group (n=22) and NSCLC group (n=80). Genus Haemophilus was significantly more abundant in fecal sample of NSCLC patients than the healthy controls (P < 0.05). The area under the curve of genus Actinomyces used to predict lung cancer was 0.75 (95% CI: 0.65 - 0.84). (3) The alpha diversity of fecal microbial was similar between patients with brain metastasis group (BM+, n=18) and patients without BM group (BM-, n=32). But there were some differences in the microflora structure between the 2 groups. (4) An impaired microbiota of mouse, antibiotic treatment, promoted tumorigenesis in subcutaneous xenograft, but inhibited tumorigenesis in brain metastasis. Impaired microbiota at least partially influenced the progression of Lewis cell line through acute and chronic inflammation of the intestine.

      Conclusion

      The genus Actinomyces in sputum samples and Haemophilus in fecal samples were abundant in NCSLC group and exhibited moderate classification potential. The microflora structure of BM(-) and BM(+) group was significantly different. Antibiotic treatment at least partially influenced Lewis progression through acute and chronic inflammation of the intestine.

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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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      P2.01-34 - Endostar Combined with Whole Brain Radiotherapy in Patients with NSCLC Brain Metastases (Now Available) (ID 1956)

      10:15 - 18:15  |  Author(s): Gang Wu

      • Abstract
      • Slides

      Background

      Brain metastasis (BM) is the leading cause of poor prognosis, recurrence, and death in non-small-cell lung cancer (NSCLC) patients. The effectiveness of whole-brain radiotherapy is unsatisfactory. Endostar was reported as an anti-angiogenic agent, which could promote vascular normalization in tumor. This study is to investigate the influence of endostar combined with cranial radiation to survival, cerebral blood flow, immune status and quality of life of the patients.

      Method

      28 NSCLC patients with multiple brain metastasis(more than four)were randomly divided into two groups. The experimental group (n = 14) received WBRT (30Gy/10F) combined with Endostar (15mg/m2, 7days), and the control group (n=14) received WBRT (30Gy/10F) alone. Tumor progression and survival of the patients were established by certified oncologists based on whole brain MRI scan. Magnetic resonance perfusion imaging was carried out pre- and one month post-radiation to detect regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), mean transit time (MTT) and transit time to peak (TTP) of the contrast medium. The changes of blood T lymphocyte subpopulation, the cognitive function and overall healthy level were evaluated pre- and post- radiation every two months against the MMSE, MoCA and EORTC QLQ-C30 scales.

      Result

      The median progression free survival (mPFS) was 211 days vs. 84 days (P=0.2204), while the median intracranial PFS (miPFS) was 333 days vs. 192 days (P=0.1882) and the median extracranial PFS (mePFS) was 311 days vs. 84 days (P=0.0873) between the Endostar group vs. the control group, but neither with significant difference, may for the limit of sample size. Moreover, compared with the control group, rCBF of the lesion in the Endostar group decreased more evidently (-69.0286±87.4532 vs. -25.3444±233.4, P=0.6158), rCBV decreased slightly (-13.1286±389 vs. -510.8±800.1, P=0.1545), MTT increased (69.0571±1190.7 vs. -483.3±1885.1, P=0.5108) and TTP increased (156.6±1232.8 vs. 102.1±864.1, P=0.9185), indicating that endostar group had a better control of the cerebral perfusion and the tumor. The T lymphocyte subpopulation increased in the Endostar group, especially the CD3+CD8+ T lymphocyte but without significant difference compared with the control group(P=0.1447). At the same time, after cranial radiation, the cognitive function, physical, role, social and emotional functions improved in the endostar group, while a small fluctuation in the control group with significant difference(P<0.05).

      Conclusion

      Our study showed that endostar could improve survival of the patients, adjust cerebral perfusion and promote control of lesions, ameliorate the immune status, while improve cognitive function and quality of life of the patients at the same time.

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