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Masato Kato
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EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-03 - New Approach to Complete Video-Assisted Thoracoscopic Lobectomy in T2 and T3 Non-Small Cell Lung Cancer (Now Available) (ID 874)
08:00 - 18:00 | Presenting Author(s): Masato Kato
- Abstract
Background
The advantages of complete video assisted thoracoscopic surgery(c-VATS) include less postoperative pain and early cosmetic benefit because of the small incision recured. If large tumors can be successfully removed without need for a long thoracic incision or extensive costal rib resection, c-VATS may be performed in patients with stage II or III NSCLC. We herein repot our experience with a novel c-VATS technique that involves removal of resected lung tissu from an abdominal incision in patinets with T2 and T3 NSCLC.
Method
Fifteen patients with T2 and T3 NSCLC who underwent surgical treatment . Five patients underwent c-VATS lobectomy, and 10 patients under went hybrid VATS(h-VATS), which is performed mainly by direct visualization using video assistance. The tumour large perpendicular was 60 to 140mm in the c-VATS group and 52mm to 82mm in the h-VATSgroup.
Result
Surgical procedure. For lobectomy, the ports were placed in the 3rd, 5fh, and 7th intercostal spaces on the anterior axillary line for the operator and camera pole and in the 6th and 8th intercostal spaces on the infrascapular line for the assistant. An abdominal skin incision of <5cm was then created just below the xiphoid in Fig1. A forceps was inserted through this incision into the intrapleural cavity through the preperitoneal space to remove the resected lung tissu by grabbing the endocatch bag. the resected lung tissue was remoed with the forceps through this route.
Comparison between c-VATS and h-VATS groups. Significantly fewer patients in the c-VATS than h-VATS group developed severe pain in Table1.Fig.1
table1
Conclusion
The present study suggests that the indications for c-VATS lobectomy in patients with T2 and T3 NSCLC can be expanded by implementation of our approach, which involves removal of the free lobe through an abdoninal incision.
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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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P1.01-47 - Prospective Study for Usefulness of Plasma DNA on Prediction of Third Generation EGFR Tyrosine Kinase Inhibitors (S-PLAT Study) (Now Available) (ID 1112)
09:45 - 18:00 | Author(s): Masato Kato
- Abstract
Background
The AURA and FLAURA studies have shown that EGFR T790M mutation detected in cfDNA is correlated with efficacy of osimertinib as measured via overall response rate (ORR), and progression-free survival (PFS). However, the following clinical-related questions have been raised: Can other different assay systems confirm the results mentioned above? Does T790M level affect osimertinib treatment efficacy? Do mutations at loci other than EGFR influence treatment efficacy?
Method
This is a prospective observational study, joining 27 Japanese hospitals. Plasma samples from patients with non-small cell lung cancer (NSCLC) who acquired resistance to EGFR-TKI (gefitinib, erlotinib, afatinib) were collected between Feb 2017 and Jan 2019. We tested T790M by MBP-QP method which has been newly developed using cfDNA and investigated the concordance with the result by cobas EGFR mutation Test v.2 (tissue and/or plasma) which is commercially available. We also checked the allele frequency (AF) of T790M in cfDNA by ddPCR and the mutational status of cancer related actionable genes by cfDNA specific NGS (Guardant360). The major objectives were ORR, disease control rate (DCR) to osimertinib and PFS in patients with T790M positive by MBP-QP method.
Result
Among 145 NSCLC patients who acquired resistance to 1st or 2nd EGFR-TKI, T790M was detected in 57 patients by cobas (tissue and/or plasma), and these patients received osimertinib (80mg daily). T790M was detected by cobas in 16 patients from plasma, 44 patients from tissue, 3 patients from both samples. Among assessable patients, ORR, DCR and PFS in patients with T790M positive by cobas from plasma were 66.7%, 86.7%, 194 days, those of tissue were 53.5%, 97.7%, 186 days, respectively. In these 57 patients, MBP-QP also could detect T790M from 10 patients from plasma, and ORR, DCR and PFS in patients with T790M positive by MBP-QP from plasma were 75.0%, 87.5%, 184 days, respectively. These results suggest that T790M detection from cfDNA not only by cobas but also MBP-QP is correlated with RR of osimertinib. Now, using ddPCR and Guardant360, we have been investigating about the relationship between T790M AF and RR to osimertinib, and the influence of mutations at loci other on efficacy of osimertinib.
Conclusion
cfDNA analysis can be predictive for osimertinib efficacy, just as re-biopsy. Whether comprehensive approach including AF and coexistence of other actionable genes is more precisely informative for drug efficacy has been continuously analyzed.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-28 - Examination of the Indication and Validity of Segmental Resection as Intentional and Palliative Limited Resection for Lung Cancer (Now Available) (ID 2482)
10:15 - 18:15 | Author(s): Masato Kato
- Abstract
Background
Segmental resection with lymph node dissection as intentional limited resection is now regarded as the effective surgical procedure for early lung cancer from the view point of curability and preservation of respiratory function. But the curability of this procedure for more advanced cancer is not well known. We may show it by investigating the detailed results of all segmental resection cases as intentional and palliative limited resection.
Method
We targeted 167 cases who passed more than five years after operation among 240 lung cancer cases on whom we have performed segmental resection with lymph node dissection between January in 2003 and March in 2019. It was decided that the indication of segmental resection as intentional limited resection was cStage 0, IA1 and IA2 (UICC 8th) with meeting the SUVmax value of FDG-PET was 1.5 or less (=group A). Segmental resection as palliative limited resection was performed on cStage IB or less patients who had difficulty in lobectomy because of poor respiratory function, multiple lung cancer or presence of serious other disease, etc, (=group B). We investigated prognosis and pathological recurrent factors in both groups, and we considered each indication of segmental resection as intentional or palliative limited resection again.
Result
Group A contains 102 cases and 5-year survival rate was 97% (All death cases died of other disease). In group A, local recurrence occurred in 1 case (pStage IA1, surgical margin insufficient) but distant metastasis did not occur. Group B contains 65 cases and 5-year survival rate was 71% (The original death from lung cancer was 5 cases among 17 death cases). In group B, local recurrence occurred in 4 cases (pStage IA2: 1(surgical margin insufficient), pStage IB: 2, pStage IIIA: 1), distant metastasis occurred in 6 cases (pStage IA3: 1, pStage IB: 1, pStage IIIA: 3, pStage IIIB: 1) and 3 cases on which postoperative adjuvant chemotherapy had been performed had no recurrence (pStage IB: 1, pStage IIB: 2). Recurrence of pStage IA3 was only 1 case (10% in all pStage IA3 cases, Sm, distant metastasis). The multivariable analysis of pathological recurrent factors (pStage, p, v, ly) in group B (except for 3cases on which postoperative adjuvant chemotherapy was performed) showed that lymphatic involvement had a significant influence on recurrence (p-value / Hazard ratio: lymphatic involvement: 0.03 / 6.49, more than pStage II: 0.37 / 2.50).
Conclusion
We are convinced that the current indication of our intentional limited resection to be almost proper but we have thought that we should include a part of Stage IA3 depending on a condition. In palliative limited resection cases, postoperative adjuvant chemotherapy should be considered if possible when pathological result show lymphatic involvement or more than pStage II.
