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Chun-Ming Tsai
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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
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.14-06 - Clinical Application of an Appropriate Size NGS Panel in Advanced Non-Small Cell Lung Cancer Management: Personal Experience (ID 684)
08:00 - 18:00 | Author(s): Chun-Ming Tsai
- Abstract
Background
Precision medicine plays an important role in patients with advanced non-small cell lung cancer (NSCLC). The targeted genes, EGFR, BRAF, ALK, and ROS1, have become as a standard genetic test in NSCLC. Using multi-gene next-generation sequencing (NGS) technology is an efficient approach compared with the conventional genetic test that can identify hundreds of genetic information simultaneously. In this study, we share our clinical experience of using an appropriate size NGS test in Taiwan NSCLC patients.
Method
The formalin-fixed, paraffin-embedded (FFPE) were collected from 100 patients with advanced NSCLC. 94 patients had received at least one treatment and six patients were treatment-naïve. The FFPE samples were profiled using a medium size NGS panel on the Ion Torrent system. The single nucleotide variants (SNV) and small InDels were detected in 35 or 40 genes, as well as copy number variations (CNVs) in 14 or 22 genes. The gene fusion status was evaluated by an RNA fusion test in 4 genes.
Result
In total, the alternation of FDA-approved biomarkers was identified in 70.0% (70/100) patients. Other genetic alterations, including suggested biomarkers in NCCN guideline (ERBB2 mutations and CNVs, MET exon 14 alterations and RET fusions), and other potential actionable mutations (EGFR exon 20 insertions and CNVs, BRAF rare mutations, KRAS mutations and CNVs, ALK CNVs, MET CNVs, mTOR pathway, and cell cycle pathway alternation) were detected in 60.0% (60/100) patients. The co-occurred potential genomic alterations were discovered in 60.7% (37/61) of patients who had EGFR mutations at diagnosis. 78.3% (18/23) patients with post third generation EGFR TKI therapy had at least a co-occurring potential actionable alterations with EGFR mutation. In patients with wild type EGFR and ALK or unknown-status at diagnosis, the targeted alternation was detected in 51.4% (19/37), and 21.6% (8/37) were FDA-approved biomarkers. Furthermore, we report two cases who responding to the targeted drugs followed the NGS testing results. One case had a potentially actionable alteration co-occurred with EGFR mutation and the other had a rare BRAF mutation.
Conclusion
The data reported here suggest that using genetic test by an appropriate size and cost-effective NGS panel for NSCLC patients at disease diagnosis or disease progression could identify more mutations other than FDA-approved biomarkers for targeted drug selection.
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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): Chun-Ming Tsai
- Abstract
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.
