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Chi-Lu Chiang



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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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      EP1.14-35 - Squamous Cell Carcinoma Transformation After Acquired Resistance to Osimertinib  (Now Available) (ID 85)

      08:00 - 18:00  |  Presenting Author(s): Chi-Lu Chiang

      • Abstract
      • Slides

      Background

      Osimertinib is a third-generation epidermal growth factor receptor - tyrosine kinase inhibitor (EGFR-TKI) for the management of NSCLC carrying EGFR T790M mutation after acquired resistance to prior EGFR-TKI and is now the preferred therapy in the front-line. The resistance mechanism of osimertinib, including histologic transformation had been reported, mostly small cell carcinoma.

      Method

      Here we a patient with lung adenocarcinoma with uncommon EGFR H835L +L833V + T790M mutation who developed progressive lung atelectasis after acquired resistance to osimertinib. Bronchoscopic biopsy over the endobronchial tumor was done and the pathology report showed squamous cell carcinoma.

      Result

      Mutation analysis of the squamous cell carcinoma performed by next generation sequencing (FoundationOne® CDx) was performed and reveled complex genomic alteration including EGFR H835L, L833V and T790M mutation, TP53 mutation and mTOR amplification. Squamous cell transformation after acquired resistance to osimeritinib was diagnosed. Then the patient was treated with a mTOR inhibitor, everolimus (5mg /day) plus osimertinib. One month after treatment an initial tumor response was observed, however, a progression occurred after 3 months of treatment.

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      Conclusion

      Squamous cell transformation is a rare manifestation of osimertinib resistance, further research is need to investigate the underlying mechanism of this histologic change and discover the proper treatment strategy.

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    P1.17 - Treatment of Early Stage/Localized Disease (ID 188)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.17-16 - Neo-Adjuvant Targeted Therapy in Non-Small Cell Lung Cancer Patients: A 10-Year Experience in a Tertiary Medical Center (ID 1018)

      09:45 - 18:00  |  Author(s): Chi-Lu Chiang

      • Abstract
      • Slides

      Background

      Epidermal growth factor receptor (EGFR) Tyrosine kinase inhibitor (TKI) or anaplastic lymphoma kinase (ALK) inhibitor had can provide dramatic response in lung adenocarcinoma patients, and have been the first line treatment for stage IV patients with corresponding genes mutations. Recent clinical trials had demonstrated both safety and tolerability in neo-adjuvant settings. However, there are still limited clinical data regarding long-term outcome and additional adjuvant treatment options. Our purpose was to investigate the treatment response and image change of neoadjuvant target therapy in non-small cell lung (NSCLC) cancer patient patients.

      Method

      Taipei Veterans General Hospital Lung Cancer Database was used to search for stage I to stage III NSCL patients, who’s first line treatment was TKI. Their medical records and chest CT and PET images were reviewed.

      Result

      We identified 20 patients in a 10 year period (January 2007 - December 2017) receive neoadjuvant TKI. 2 failed to receive further surgery treatment. One of them was due to disease progression while the other remained non-operable despite tumor sized down. The overall response rate for neoadjuvant TKI was 86%. 17 patients were clinical stage IIIA(AJCC 8th edition), 1 was IIIB, 2B and 1b. One of them received ALK inhibitor while the others received EGFR TKI. The mean duration of neo-adjuvant therapy was 73 days. For 18 patients receiving surgical treatment, 12 experienced down-staging (one got pathological complete response). 13 patients received adjuvant therapy with great variety. 7 patients did not have recurrent disease after surgery, and they all had pathological down staging. The median recurrence-free survival and overall survival was 13.7 months and 6 years, respectively.

      Conclusion

      As long-term survival was potentially achievable in such patient group, and with the diverse treatment options, results from randomized clinical trials are needed to give solid conclusion.

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