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Chung-Shien Lee
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.27 - Descriptive Review of Breast Cancer Patients With Subsequent Lung Cancer (ID 1058)
00:00 - 00:00 | Author(s): Chung-Shien Lee
- Abstract
Introduction
Breast cancer (BC) is the most common cancer in women. With advances in treatments and early detection, survival rates have significantly improved. However, survivors are at risk for developing secondary primary malignancies due to radiation and chemotherapy exposure. Lung cancer (LC) has been shown to be one of the largest secondary cancers among breast cancer survivors. Radiotherapy, race, age and tumor type have been associated with this relationship. We look to evaluate the association of breast cancer and secondary lung cancer at our health system.
Methods
An IRB approved, retrospective chart review was conducted using outpatient records at Northwell Health from 2010 to 2017. This review was limited to females who were diagnosed with either primary breast or lung cancer, which progressed into a secondary malignancy. Patient information analyzed included radiation treatment history, chemotherapy treatment history, family history, smoking history and presence of any germline or somatic mutations.
Results
During the timeframe of the study, 19,150 patients seen at our institution had a history of BC, 8,367 patients a history of LC and 303 patients had had both. Ninety-seven patients were excluded due to inadequate medical records leaving 206 patients for analysis. Majority of the patients who had history of both cancers had breast cancer as first diagnosis (n=177, 86%) and this was the group that we focused for this study. More than half of these patients (58%) had a family history of cancer and 58% had a smoking history (median = 30 pack years). The median time for developing a secondary LC was 8 years (range, 0.1 to 42.7). Fifty-five percent of patients (96/175) received radiation treatment, 94% (164/175) surgery and 27% (48/175) intravenous chemotherapy. Majority of these patients had hormone positive BC (92/108, 85%) and 20% (18/87) HER2 positive BC. Fourteen patients received genetic counseling. Out of those nine patients tested positive for germline pathogenic variant in BRCA1 only (2), BRCA 2 only (1) or both (6). Ninety-four percent of patients (157/167) developed non-small cell LC and 10 developed small cell LC.
Conclusion
Even though prognosis for early stage BC is excellent, patients may develop secondary malignancies. Risk factors for developing secondary LC after primary BC have not been clearly identified. Radiotherapy has been described previously as a potential risk factor, although studies are conflicting. Genetic backgrounds and hormonal characteristics of BC may also play a role and have not been well defined. Further studies are needed to better define risk factors for developing secondary LC after primary BC.
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P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)
- Event: WCLC 2020
- Type: Posters
- Track: Targeted Therapy - Clinically Focused
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P76.09 - A Comparison of Sequential EGFR-TKI Therapy Versus First-Line Osimertinib in NSCLC: A Multi-Center, Retrospective Study (ID 1010)
00:00 - 00:00 | Presenting Author(s): Chung-Shien Lee
- Abstract
Introduction
Lung cancer remains the deadliest form of cancer. Several driver mutations have been identified of which targeted tyrosine kinase inhibitors (TKIs) have shown favorable response. Epidermal growth factor receptor (EGFR) is the most common driver mutation and is present in approximately 15% of adenocarcinomas. There are currently several TKIs approved for the use of EGFR mutated lung cancer. The FLAURA trial showed a progression free survival (PFS) and overall survival (OS) benefit with osimertinib compared to first generation EGFR TKIs. There is a paucity of data to support using a first or second generation EGFR TKI after progression on osimertinib. In this study, we aim to assess the outcomes of EGFR mutated lung cancer patients being treated with a first or second generation EGFR TKI compared to osimertinib.
Methods
An IRB approved, multi-center, retrospective review of lung cancer patients receiving EGFR TKIs between 2014 and 2019 was conducted. Patients were included in this review if they had received an EGFR TKI for metastatic lung cancer in the front line setting. Patients were excluded if they had an active concomitant cancer, de novo T790M mutation, no EGFR mutations, or who were treated with chemotherapy as first line therapy. EGFR TKI was dichotomized as osimertinib vs all other EGFR TKIs. PFS and OS was estimated using the Kaplan-Meier product-limit method and first line EGFR TKI was compared using the log-rank test. A Cox proportional hazards model was used to examine the association between PFS and OS and EGFR TKI and various patient factors.
Results
A total of 172 were included in the analysis, 52 (30.2%) received osimertinib and 120 (69.8%) received another EGFR TKI (afatinib=25, gefitinib=1, erlotinib=94) as first line treatment. All but three of these patients (98%) were never or former smokers and 35% of patients had baseline brain metastasis. Sixty percent of patients had an exon 19 deletion, 33% exon 21 mutation and 7% had another EGFR mutation. The PFS rates at 12 and 18 months were 79.5% and 69.8% in the osimertinib group and 64.2% and 39.3% in the other EGFR TKI groups, respectively (p<0.0036). The adjusted Hazard Ratio (HR) for PFS (reference: osimertinib) was 2.59 (95% CI: 1.31 to 5.11) p<0.0064. Estimated OS at 12 and 18 months were 94.2% and 80.2% in the osimertinib group and 93.9% and 84.1% in the other EGFR TKI groups, respectively (p<0.6382). The adjusted HR for OS was 0.95 (95% CI, 0.37 to 2.44) p<0.9128.
Conclusion
In this single institution retrospective review, osimertinib demonstrated a greater PFS compared to other EGFR TKIs at 12 and 18 months. Estimated OS were no different between the two groups. Additional follow up is needed to solidify the real world OS benefit of osimertinib to other EGFR TKIs.
