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Anthony G F Thottian
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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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EP1.14-32 - Pattern of EGFR Mutations and Response to First Generation EGFR TKIs in Patients of Metastatic Lung Cancer at a Tertiary Care Centre in India (Now Available) (ID 2497)
08:00 - 18:00 | Author(s): Anthony G F Thottian
- Abstract
Background
EGFR gene mutations, ALK and ROS1 gene rearrangements represent the most common targetable lesions in
Method
the era of TKIs for treatment of metastatic lung cancer. Use of TKIs improves overall survival compared to
cytotoxic chemotherapy in these patients. The objective of the study was to identify the prevalence and pattern
of EGFR mutations and their response to TKIs in Indian patients.
Histopathologically confirmed cases of metastatic lung adenocarcinoma diagnosed between 2016 to 2018 at
Result
Kidwai Cancer Institute, Bangalore were reviewed for their EGFR mutation, ALK and ROS1 gene rearrangement
status. DNA was extracted from formalin fixed paraffin embedded tissue and tested for EGFR hotspot
mutations (Exon 19 deletions, exon 20 insertions and substitution mutations G719X, S768I, T790M, L858R and
L861Q in exons 18, 20 and 21 of the EGFR gene) using ARMS real-time PCR. ALK and ROS1 rearrangement was
tested using IHC with primary antibody ALK D5F3 and ROS1 D4D6 respectively.
Complex EGFR mutations PATIENT ID EGFR MUTATION TREATMENT PFS ( MTHS) 51 EXON 19 DEL + T790M Chemotherapy 6 1626 EXON 19 DEL + L858R Gefitinib 6 164 S768I + L858R Gefitinib 2 208 L858R + T790M Chemotherapy 3 229 EXON 19 DEL + T790M Chemotherapy 4 A total of 240 patients underwent testing. EGFR mutations were detected in 31.6% (n =76) and ALK and ROS1
Conclusion
rearrangement in 7% (n=17) and 1.25% (n=3) of the patients. The most common EGFR mutation was exon 19
deletions (e19 del) (n=44; 57.9%) followed by L858R mutation in exon 21 (n=23; 30.3%). Double EGFR
mutations was seen in 5 patients (6.6%) and 3 patients had L861Q mutation. One patient had upfront T790M
mutation. Median age was 54 years (range 35 -78 years). Male to female ratio was 0.9. 43.45% (n=33) were
never smokers. Gefitinib was advised in 50 patients (65.8%), Erlotinib in 21 patients (27.6%) and rest were
treated with chemotherapy. Median PFS in patients with e19 del, L858R and other mutations was 11, 12 and 4
months respectively.
The prevalence of EGFR mutations in our studies are similar to those reported from other parts of India, lower
than that from other Asian countries and higher than that from Western countries. E19 del and L858R
mutations respond favourably to TKIs, but complex mutations do so poorly. Use of TKIs other than Gefitinib
and Erlotinib need to be explored in these cases to improve outcomes.
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EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.16-37 - Correlation of Serum Albumin and CRP Levels with Chemotherapy Toxicity in Patients of Metastatic Lung<br /> Cancer (Now Available) (ID 2548)
08:00 - 18:00 | Author(s): Anthony G F Thottian
- Abstract
Background
significant proportion of patients of lung cancer present with metastatic disease. Chemotherapy is often
Method
offered as first line treatment if patients does not have driver mutations in a specific targetable oncologic
pathway and is fit to receive systemic therapy. Systemic inflammation associated with advanced cancer is often
regarded as one of the factors for poor prognosis in lung cancer patients. High level of CRP and low levels of
albumin are regarded as markers of systemic inflammation and prior studies have shown poor survival in such
patients. It has also been shown that systemic inflammation alters the metabolism of chemotherapeutic agents
resulting in either treatment failure or increased toxicity, both of which can lead to poor outcomes. This study
aims to identify if increased systemic inflammatory response leads to enhanced toxicity with chemotherapeutic
agents used in palliative setting in patients of metastatic lung cancer, and in turn poorer survival.
Trial design
Result
Objectives
Primary objective – Correlating chemotherapy toxicity with patients’ baseline albumin and CRP levels
Secondary objective - Correlating CRP and Albumin levels with PFS and OS
Materials and Methods
Study Design - Patients with a tissue diagnosis of lung cancer will be prospectively enrolled in the study after
informed consent. All clinically relevant details will be entered in a clinical proforma.
Site and duration of study - Kidwai Cancer Institute; June 2018 to Dec 2019
Sample size – All patients meeting the inclusion criteria between the study time period will be included
Inclusion Criteria
Patients of Metastatic Biopsy Proven Lung Cancer
Age 18 – 80
Planned for chemotherapy with a platin Doublet
Albumin > 2.0
Exclusion Criteria
Presence of targettable driver mutations
Any other Synchronous / Metachronous cancer
Any other uncontrolled medical comorbidities
Statistical Analysis
Conclusion
The Mann-Whitney U test and the χ2 test will be used to determine statistically significant differences
1/10/2019 #337: Correlation of Serum Albumin and CRP Levels with Chemotherapy Toxicity in Patients of Metastatic...
https://cpaper.ctimeetingtech.com/elcc2019/submission/preview/print?publication_id=337 2/2
Kaplan-Meier method will be used to assess survival curves; Log-rank test to evaluate the statistical
significance of differences and Cox proportional hazards model for multivariate analysis of the effect of
clinicopathological factors on survival.
This study aims to identify if increased systemic inflammatory response leads to enhanced toxicity with chemotherapeutic
agents used in palliative setting in patients of metastatic lung cancer, and in turn poorer survival.
