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Chunhong Hu
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FP01 - Early Stage/Localized Disease (ID 111)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP01.02 - The Efficacy of Postoperative Radiotherapy in IIIA-N2 Non-Squamous NSCLC with Different EGFR Mutation Status: A Retrospective Analysis (ID 3680)
00:00 - 00:00 | Author(s): Chunhong Hu
- Abstract
- Presentation
Introduction
The effect of postoperative radiotherapy (PORT) on completely resected IIIA-N2 non-squamous non-small cell lung cancer (NSCLC) remains controversial. Growing postoperative therapies for epidermal growth factor receptor (EGFR)-mutant patients make the role of PORT ambiguous. Previous in-vitro studies have indicated that the status of EGFR mutation status can influence the radio-sensitivity of lung cancer, which needs more clinical investigation to verify. In this retrospective study, we aim to assess the efficacy of PORT in IIIA-N2 non-squamous NSCLC with different EGFR mutation status.
Methods
We enrolled patients who were diagnosed with completely resected stage IIIA-N2 non-squamous NSCLC, receiving postoperative radiotherapy or not, between April 2011 and May 2017 from the Second Xiangya Hospital and Hunan Cancer Hospital. And we analyzed the influence of PORT on disease-free survival (DFS) and overall survival (OS) in NSCLC patients with different EGFR mutation status.
Results
In total, 124 patients were eligible. The median follow-up time was 43.2 months (range 6-103 months). In multivariate analysis, age (＞60 years old), cycles of chemotherapy (＜4) and multiple-station N2 metastasis were correlated with shorter DFS. Multiple-station N2 metastasis，wild-type EGFR and no PORT were independent risk factors for OS. PORT significantly improved OS (46.40 months vs. 34.17 months, P = 0.021) but not DFS (19.02 months vs. 17.23 months, P = 0.266). In the EGFR wild-type group, PORT prolong OS (43.20 months vs. 28.67 months, P = 0.007), especially in EGFR wild-type group with multiple-station N2 metastasis (39.73 months vs. 24.9 months, P = 0.006) rather than DFS (18.43 months vs. 17.77 months, P = 0.775). There was a trend that PORT improved OS (69.30 months vs. 49.97 months, P = 0.057) and DFS (21.17 months vs. 17.17 months, P = 0.075) in the EGFR-mutant group, although there was no significant difference. In EGFR-mutant patients with multiple-station N2 metastasis, the DFS was significantly prolonged (23.13 months vs. 14.10 months, P = 0.021) in the PORT group. Nevertheless, the OS (72.5 months vs. 60.63 months, P = 0.189) and DFS (13.7 months vs. 24.33 months, P = 0.664) were not improved in EGFR-mutant patients with single-station N2 metastasis(Figure 1).
Comparison of overall survivall (A,C,E) and disease-free survival (B,D,F) between the PORT and the non-PORT group. PORT=postoperative radiotherapy.
Conclusion
It is necessary for stage IIIA-N2 non-squamous NSCLC patients to receive PORT，especially for EGFR wild-type patients. Meanwhile, PORT can reduce local recurrence and metastasis in EGFR-mutant group, particularly in EGFR-mutant patients with multiple-station N2 metastasis. More prospective studies are needed to clarify the role of PORT in the EGFR-mutant IIIA-N2 non-squamous NSCLC patients.
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MA01 - Novel Systemic Treatment in NSCLC (ID 102)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Antibody Drug Conjugates, Novel Therapeutics and Cytotoxics
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA01.04 - A Randomized Study Comparing Cisplatin/Paclitaxel Liposome vs Cisplatin/Gemcitabine in Chemonaive, Advanced Squamous NSCLC (ID 1225)
11:45 - 12:45 | Author(s): Chunhong Hu
- Abstract
- Presentation
Introduction
Platinum-based chemotherapy is still the backbone of advanced squamous non–small-cell lung cancer (NSCLC). Paclitaxel (PTX) liposome is the only PTX liposomal formulation on the market for the treatment of lung, ovarian and breast cancer since 2006 in China. The purpose of this study was to compare the clinical efficacy and safety between PTX liposome/cisplatin and gemcitabine/cisplatin as first-line treatment of patients with staged IIIB/IV squamous NSCLC.
Methods
Eligible patients with chemo naive, advanced, squamous NSCLC were randomized to receive PTX liposome (175 mg/m2, on day 1) and cisplatin (75 mg/m2 on day 1, LP group) or gemcitabine (1,000 mg//m2, on day 1 and 8) and cisplatin (75 mg/m2 on day 1, GP group) intravenously, every 3 weeks for 4-6 cycles. Primary end point of the study was progression-free survival(PFS).
Results
A total of 540 patients from 34 centers of China were enrolled. Median age: 64.5 years; male/ female: 497(93.1%)/37(/6.9%); stage IIIB/IV: 177(33.1%)/357(66.9%) and ECOG PS 0/1: 87(16.3%)/447(83.7%). After a median follow-up of 15.4 months, PFS and overall survival were not different between LP and GP groups (median PFS 5.2 vs. 5.5 months, hazard ratio [HR] 1.03, P=0.5762; median OS 14.6 vs 12.5 months, HR 0.83, P=0.2147). Overall response rate was comparable between the 2 groups, 41.8% in LP group vs 45.9% in GP group. The most common adverse events (AEs) in the both groups were anemia, neutropenia, leukopenia and thrombocytopenia. AEs of grade 3 or higher occurred in 68.3% of the patients in the LP group and in 66.5% of the patients in the GP group. Grade 3 or higher anemia (31.2%, 84/269 vs. 14.3%, 38/265, P<0.0001) and thrombocytopenia (14.1%, 38/269 vs. 1.5%, 4/265, P<0.0001) were more frequent in the GP group, whereas grade 3 or higher neutropenia (35.5%, 94/265 vs. 28.3%, 76/269, P=0.0781) and leukopenia (23.4%, 62/265 vs. 19.0%, 51/269, P=0.2438) were more frequent in the LP group. Discontinuation of treatment due to AEs was more frequent in the GP group than in LP group (26.4% vs. 10.9%, P<0.0001).
Conclusion
The chemo-regimens, LP and GP produce comparable efficacy in terms of ORR, PFS and OS as 1st line therapy of advanced squamous NSCLC. But, LP is well tolerated and results in less frequent of anemia and thrombocytopenia and lower discontinuation of treatment in Chinese patients. So, LP is one of standard 1st line chemotherapy for advanced squamous NSCLC patients. (ClinicalTrials.gov number, NCT02996214)
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P30 - Palliative and Supportive Care (ID 163)
- Event: WCLC 2020
- Type: Posters
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P30.12 - The Impact of Pacemaker and Methylprednisolone Pulse Therapy on Immune-Related Myocarditis With Complete Atrioventricular Block (ID 2775)
00:00 - 00:00 | Author(s): Chunhong Hu
- Abstract
Introduction
With the extensive application of immunotherapy, immune-associated myocarditis is increasing and may be life-threatening. Complete atrioventricular block (AVB) is associated with high fatality. The study aims to evaluate the value of pacemakers and methylprednisolone pulse therapy (MPPT; 500-1000mg/d for 3-5 days) to patients with immune-associated myocarditis concomitant with complete AVB.
Methods
Medical records of 3 patients with immune-associated myocarditis concomitant with complete AVB were reviewed. To create a pooled analysis, we searched reported cases with immune-associated myocarditis in the PubMed database and screened patients accompanied by complete AVB. Clinical characteristics, management, and outcomes were summarized.
Results
Our three patients with lung cancers developed immune-associated myocarditis concomitant with complete AVB about two weeks after receiving pembrolizumab, but were successfully treated with pacemaker implantation and high-dose steroids (two received MPPT; Figure 1). In the pooled analysis, twenty-one cases were included with the overall fatality rate of 52% (Table 1). The median age was 66 years and males accounted for 62%. Fourteen (67%) patients suffered from melanoma or lung cancer, and nineteen (90%) received only 1 to 2 cycles of immunotherapy at the time of onset with nonspecific myocarditis symptoms. The fatality rate of patients with pacemaker was 38%, significantly lower than that of patients without it (38% [6 of 16] vs. 100% [5 of 5]; p=0.035) particularly in the MPPT subgroup (25% vs. 100%; p=0.019). Nevertheless, all five patients without pacemaker died regardless of whether they received MPPT. Among sixteen patients with a pacemaker, MPPT patients tended to have a lower fatality rate compared with non-MPPT patients despite no significance.
Conclusion
Timely pacemaker implantation played a crucial role in improving outcomes of patients with immune-related myocarditis concomitant with complete AVB. Additionally, patients receiving MPPT appeared to have a better prognosis.
