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jie Ma



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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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      EP1.14-03 - Driver Genes as Predictive Indicators of Brain Metastasis in Patients with Advanced NSCLC: EGFR and ALK as Well as RET Gene Mutations (Now Available) (ID 2124)

      08:00 - 18:00  |  Author(s): jie Ma

      • Abstract
      • Slides

      Background

      Brain metastasis is a cause of disease progression and death in lung cancer patients, and is also one of the most common metastatic sites of lung cancer. Non-small lung cancer (NSCLC) accounts for about 80% of all lung cancer patients, and adenocarcinoma has become the main subtype of NSCLC in recent years. A retrospective analysis verified the role of gene mutations in brain metastasis in patients with non-small lung cancer (NSCLC).

      Method

      The clinicopathological data of 552 patients who received driver genes detection for lung cancer in the Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital from January 2015 to June 2017 were collected; NGS was used for gene detection. The driving genes for detection were EGFR, ALK, KRAS, ROS-1, BRAF, ERBB2, RET and c-MET, which were eight lung cancer driving genes recommended in NCCN guidelines. All the tests were carried out in the Center of Molecular Pathology in the Affiliated Tumor Hospital of Zhengzhou University.

      Result

      Of the 552 patients with advanced NSCLC, 153 (27.7%) had brain metastases. Univariate analysis showed that age (P = 0.008), gender (P = 0.016), smoking history (P = 0.010), lymph node metastasis (P = 0.003), and three driver genes: positive EGFR mutation (P = 0.001), positive ALK gene fusion (P = 0.021) and positive RET gene fusion (P = 0.003) were factors influencing the incidence of brain metastasis. Logistic multivariate regression analysis revealed that only positive EGFR mutation (P = 0.012), positive ALK gene fusion (P = 0.015), positive RET gene fusion (P = 0.003), pathological type (P = 0.009), lymph node N2–3 metastasis (P = 0.000) and a younger age (P = 0.000) were independent risk factors for brain metastasis. In addition, a ROC curve was plotted with the above factors with AUC=0.705 (P=0.000).

      Conclusion

      EGFR mutation, ALK gene fusion and RET gene fusion in advanced NSCLC patients play roles in brain metastasis as positive driver genes.

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    P2.14 - Targeted Therapy (ID 183)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.14-45 - EML4-ALK Fusion Subtype Is Associated with Therapeutic Efficacy in Advanced Non-Small Cell Lung Cancer (Now Available) (ID 2134)

      10:15 - 18:15  |  Author(s): jie Ma

      • Abstract
      • Slides

      Background

      The aim of this study was to investigate the molecular characteristics of each subtype of the EML4-ALK fusion gene and to evaluate the efficacy of first-line crizotinib or pemetrexed in combination with platinum in the treatment of patients with advanced NSL4-ALK fusion subtypes of advanced NSCLC.

      Method

      From August 2015 to September 2018, the clinicopathological data of patients who received driver genes detection for lung cancer in the Affiliated Cancer Hospital of Zhengzhou University were collected,NGS was used for gene detection.The EML4-ALK fusion gene was divided into E13: A20 subtype (variant 1, V1), E20: A20 subtype (variant 2, V2), E6: A20 subtype (variant 3, V3) and Other subtypes (V4) 4 groups. The primary study endpoint was progression-free survival.

      Result

      A total of 122 patients with ALK fusion gene-positive NSCLC were screened. Of the 122 patients, 41 (33.6%) had V1 variants, 14 (11.5%) had V2 variants, 35 (28.7%) had V3 variants, and 32 (26.2%) had other variants. There was no correlation between EML4-ALK gene mutation subtypes and distant metastasis (x2=0.570, P=0.903), brain metastasis (x2=4.447, P=0.217) and bone metastasis (x2=1.547, P=0.672). The median was 13.3 months (95% CI: 9.45-17.10) and 6.83 months (95% CI: 5.30-8.36),respectively, in patients receiving first line Crizotinib and chemotherapy, with statistically significant differences (P =0.001). In the first-line application of crizotinib, the ORR of V1, V2, V3 and V4 variants were 55.56% (10/18), 62.50% (5/8), 44.44% (4/9) and 43.75%, respectively. (7/16), median PFS were 11.96 months, 15.08 months, 12.88 months, and 7.62 months, respectively. There was no significant difference. The ORR of V1, V2, V3 and V4 variants in first-line patients treated with pemetrexe-platinum regimen was 41.18%(7/17), 37.50% (3/8), 36.36%(4/11)and 41.18% (7/17), respectively. The median PFS were 9.13 months, 3.22 months, 7.52 months, and 7.85 months, respectively. There was no statistically significant difference in PFS between V1: V3, V2: V3, and V1: V4. However, the PFS differences in the V1:V2 group (V1:V2=9.13 months: 3.22 months, P=0.007) and the V2:V4 group (V2:V4=3.22 months: 7.85 months, P=0.015) .

      Conclusion

      Among all ALK fusion subtypes, E13:A20 subtype (V1 variants) is the most common. Smoking history was a factor affecting crizotinib PFS.Compared with chemotherapy, patients with E20:A20 subtype (V2 variant) showed significant benefit with crizotinib.The median PFS of the pemetrexed combined with platinum regimen was lower than that of the E13:A20 subtype.

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