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Yu Ding



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    FP04 - Locoregional and Oligometastatic Disease (ID 126)

    • Event: WCLC 2020
    • Type: Posters (Featured)
    • Track: Locoregional and Oligometastatic Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      FP04.03 - Dynamic Liquid Biopsy for Selecting Advanced NSCLC Patients for Primary Tumor Resection After Targeted Therapy (ID 1152)

      00:00 - 00:00  |  Author(s): Yu Ding

      • Abstract
      • Presentation
      • Slides

      Introduction

      Surgery can provide survival benefit for certain patients after targeted therapies of advanced non-small cell lung caner (NSCLC) with active mutations. However, there is currently no well-established criteria for selecting the potential beneficiaries. Dynamic liquid biopsy, which allows serial systemic assessments of both primary tumor and metastases, might be an option for this purpose.

      Methods

      We performed a retrospective analysis of 37 patients with stage IIIb to IVb NSCLC, who had at least one detectable gene mutation in blood and received targeted therapies for 1 to 20 months before intended resection of primary tumor during 2013 to 2017. All patients were tested for a baseline abundance of mutated genes using next-generation sequencing. Twenty of them were also dynamically monitored within 1 week before and after operation. An optimal cutoff value to categorize patients into low-risk and high-risk groups was determined by X-tile based on proportional change in genetic abundance. Progression-free (PFS) and overall survival (OS) were estimated and compared by Kaplan Meier and log-rank test in SPSS 19.

      Results

      The number of patients in low-risk, high-risk and untested groups was 14 (37.8%), 6 (16.2%) and 17 (46%), respectively, with individual clinicopathological features depicted by heat mapping (Figure 1A). All patients had a PS score of 0-1 and oligo-metastasis less than 5 tumors. With a median follow-up of 34 months, the estimated median OS (mOS) and postoperative PFS (post-mPFS) for the overall cohort were 30 months (95% CI, 23.6-36.4) and 14 months (95% CI, 5.5-22.5), respectively. Patients with unchanged or increased abundance of mutated genes after targeted therapy had a poorer prognosis (Figure 1B). Patients in low-risk group had significantly longer post-mPFS (18 vs. 2 months, p=0.004) and mOS (35 vs. 14 months, p=0.001) than patients in high-risk group (Figure 1C, 1D). Multivariate analysis using Cox proportional hazard model suggested that efficacy of targeted therapy and proportional change in genetic abundance were independent prognostic factors for overall survival.

      figure 1.jpg

      Conclusion

      Dynamic blood test of mutated gene abundance had a good prognostic predictability, which may serve as a “classifier” to select ideal patients with advanced NSCLC for surgical resection of primary tumors. Prospective controlled study is needed to further verify the results. Development of novel biomarkers and methods which have higher detecting sensitivity and more accurate quantification might further increase the efficacy of patient selection.

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