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Julian Pinsolle
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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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EP1.14-01 - Major Therapeutic Response to T-DM1 in Metastatic Lung Adenocarcinoma with HER2 Mutation (Now Available) (ID 1105)
08:00 - 18:00 | Author(s): Julian Pinsolle
- Abstract
Background
The HER2 exon 20 mutation is described in 1-5% of patients with Non-small cell Lung cancer, and at the moment no targeted agents are approved in Europe. However, the use of conjugated antibodies such as trastuzumab and ado-trastuzumab emtansine (T-DM1) has shown promising results.
Method
We describe the case of a major response to T-DM1 in fourth line treatment in a patient with metastatic adenocarcinoma and HER2 mutation.
Result
A 60-year-old male, former smoker (3 packs/year), presented to the emergency room in 2016 for dyspnoea. A bilateral pleural and compressive pericardial effusion with tamponade requiring pericardial drainage were discovered. A lung adenocarcinoma with HER2 mutations was diagnosed. He benefited from two successive treatment lines between September 2016 and September 2017 (carboplatin- paclitaxel and bevacizumab followed by bevacizumab maintenance until progression, then pemetrexed for two cycles). At this time, he developed a new disease progression as a recurrence of tamponade requiring surgical drainage and a third line with docetaxel and trastuzumab was started for twelve cycles. After eight months, he presented an acute respiratory failure due to the recurrence of pericardial and pleural effusions, requiring a pleural drainage (Fig.1A). After discussion at the multidisciplinary meeting, a fourth line of treatment with T-DM1 in compassionate has been proposed. After three cycles, we observed an excellent clinical response, with disappearance of dyspnoea, resumption of normal daily activity. The radiological evolution was also very favourable (Fig.1B). The patient benefited from other six months of treatment before getting a new progression.
Conclusion
In this case T-DM1 showed a major clinical and radiological benefit despite its use in fourth line. Other clinical reports and phase II trials confirmed promising results with targeted agents already used in breast cancer. Several studies are exploring the efficacy of these agents, opening up new hopes.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-10 - Importance of the Multidisciplinary Tumor Board in the Treatment Strategy of Stage III Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 1107)
10:15 - 18:15 | Author(s): Julian Pinsolle
- Abstract
Background
Stage III Non-Small Cell Lung Cancer (NSCLC) represents a heterogeneous population with different treatment strategies, often in combination. The PACIFIC trial is changing practices. It is therefore necessary to evaluate our current practices in order to identify the patients that should most likely receive this treatment after chemoradiotherapy
Method
A database constructed from our weekly multidisciplinary thoracic oncology meetings was retrospectively screened from 01/2010 to 01/2017. Consecutive patients with stages III NSCLC were included. We aimed to describe proposed treatment strategies and those really performed
Result
Of the 411 patients studied, 249 had a stage IIIA NSCLC and 162 a stage IIIB NSCLC. Median age was 65 years [IQR 25%-75%, 58-72], 309 (75%) patients were male. The majority of the patients (n=270, 69%, 20 missing data) had an ECOG-Performance status of 0 or 1. Regarding histology, 199 (48%) patients had an adenocarcinoma and 199 (48%) a squamous cell carcinoma. Treatment strategies are described in Table 1. Sixty-nine (17%) patients received exclusive chemoradiotherapy, and 60 (15%) were planned for neoadjuvant chemotherapy for subsequent surgery. Among these 60 patients, after the first cycles of the initial chemotherapy, only 37 (62%) received surgery in accordance with the multidisciplinary meeting decision; 6 (10%) received concurrent chemoradiotherapy and 6 (10%) sequential chemoradiotherapy.
Conclusion
In our cohort, 8% (32/411) of the stage III patients benefited from a chemoradiotherapy upfront. According to the PACIFIC study, these patients could receive adjuvant immunotherapy. We could ask if the patients planned for surgery after neoadjuvant chemotherapy should not be initially proposed for a concurrent chemoradiotherapy to give them the opportunity to receive adjuvant immunotherapy. Survival analyses according to treatment strategy are ongoing
