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Ara Vaporciyan
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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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FP04.04 - EGFR Mutations Predict Superior Survival of NSCLC Patients with Oligometastatic Disease Treated with Local Consolidative Therapy (ID 2994)
00:00 - 00:00 | Author(s): Ara Vaporciyan
- Abstract
Introduction
Local consolidative therapy (LCT) following systemic therapy for selected patients with oligometastatic non-small cell lung cancer (NSCLC) is an evolving treatment strategy. We sought to identify predictive genomic markers for overall survival (OS) and progression free survival (PFS) in patients presenting with synchronous oligometastatic NSCLC at diagnosis.
Methods
Patients presenting to a single institution (2000-2017) with stage IV NSCLC and ≤3 synchronous metastatic lesions were identified. Of 194 patients who met our inclusion criteria, 121 received comprehensive local consolidative therapy (LCT) to all sites of disease with either surgery or radiation. Intrathoracic nodal disease was counted as one site. Univariable and multivariable Cox regressions were performed to identify factors associated with OS. A ninety-day landmark analysis was performed to limit survivorship bias. Mutational status was obtained via an institutional database, when available.
Results
Of 194 patients who met our inclusion criteria and had genomic data available, TP53 mutations were identified in 40 of 55 (72%), KRAS in 30 of 65 (46%), EGFR in 22 of 90 (24%), ALK in 4 of 81 (5%), ROS1 in 2 of 63 (3%), and BRAF in 1 of 32 (3%) patients. The median age was 62 years. After a median follow-up of 52.3 months, median OS and PFS for this cohort was 26.5 (CI 23.0-30.0) months and 11.1 (95%, 9.1-13.0) months, respectively. Among all patients, comprehensive LCT to all sites of disease (N=121) was associated with improved OS (HR 0.67, CI 0.47-0.96, p=0.03) consistent with our previous study. Among all patients, on univariable analysis, patients with EGFR mutations had improved median OS (95.5 vs 37.2 months, p=0.03) compared to EGFR WT patients. Conversely, TP53, and KRAS mutations did not predict for OS. Among patients who received comprehensive LCT with known EGFR mutational status (N=57), EGFR mutations continued to predict for improved median OS (97.5 vs 29.8 months, p=0.02) (Figure 1).
Conclusion
Aggressive consolidative therapy to the primary lesion and all metastatic sites was associated with improved OS in a large cohort of oligometastatic patients, supporting results of recent prospective trials. EGFR mutations, but not KRAS or TP53 mutations, predicted for improved OS among oligometastatic patients who are treated with comprehensive LCT in addition to systemic therapy. These data support ongoing prospective trials evaluating the benefit of local therapy in oligometastatic EGFR mutant NSCLC.
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FP05 - Mesothelioma, Thymoma and Other Thoracic Malignancies (ID 135)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP05.03 - Association between Baseline Tumor Thickness and Response to Neoadjuvant Chemotherapy in Malignant Pleural Mesothelioma (ID 3052)
00:00 - 00:00 | Author(s): Ara Vaporciyan
- Abstract
- Presentation
Introduction
Tumor thickness in malignant pleural mesothelioma has been reported to be prognostic for survival and disease recurrence, but the relationship of tumor thickness and response to chemotherapy has not been explored. We sought to investigate the utility of baseline tumor thickness as a predictor of response to neoadjuvant chemotherapy (NAC).
Methods
Patients who underwent NAC followed by cytoreductive surgery were reviewed from 2000-2019. Chest CT performed before and after completion of NAC were measured for tumor thickness using the modified RECIST 1.1 criteria. Total tumor thickness consisted of three mediastinal and three chest wall mesurements. Radiologic response to NAC were categorized into partial response (PR≥30% decrease), progressive disease (PD, ≥20% increase) or stable disease (SD, -29% to +19% change) based on the change in total tumor thickness. Mean and median tumor thickness for each tumor response category was evaluated for total and percent change in tumor thickness after NAC. Overall survival (OS) was defined from time of diagnosis and compared between PD and PR. Multivariable logistic regression was performed for PD after neoadjuvant chemotherapy.
Results
143 patients were reviewed. Median age was 65 years, most patients were male (112, 78%), and white (123, 86%). Histology was comprised of 111(78%) epithelioid, 28(20%) biphasic, and 4(3%) sarcomatoid. All patients were pathologic stage I-III, NAC consisted of 108(76%) platinum/pemetrexed, 19(13%) dasatinib, and 16(11%) other. There were 36(25%) patients with PD, 54(38%) SD, and 53(37%) PR. Analysis for OS showed PR with improved survival compared to PD (27 vs. 13 months, p=0.007). There was a positive correlation between baseline tumors thickness and radiological response to NAC (r=0.537, p<0.001); this pattern was consistent for platinum/pemetrexed, dasatinib, and other therapies. The median baseline thickness for PD was 36 mm, which was thinner than SD (63mm, p<0.001) and PR (63mm, p<0.001). In tumors <36mm,10% of patients achieved PR, and 61% of patients achieved PD, compared to 45% PR (p<0.001) and 15% PD (p<0.001) in tumors above 36mm. Tumors <36mm was associated with PD (OR: 5.48; 95% CI: 1.82-17.26; p=0.003) in a multivariable model.
Table. Multivariable Logistic Regression for Progressive Disease Variable Odds Ratio (95% Confidence interval) p-value Female sex 0.94 (0.25 - 3.06) 0.927 Zubrod Performance Status 1.66 (0.71 - 3.90) 0.234 Clinical N+ 0.74 (0.18 - 2.55) 0.652 Epithelioid Histology 1.25 (0.39 - 4.46) 0.709 Platinum/Pemetrexed 0.40 (0.13 - 1.29) 0.119 Tumor<36mm 5.48 (1.82 - 17.26) 0.003 Baseline SUVmax (Gray) 1.08 (0.98 - 1.17) 0.128
Conclusion
Responders to NAC portends longer survival. There seems to be a correlation between baseline tumor thickness and response to neoadjuvant chemotherapy. While these results will need further validation, it generates a hypothesis of differential tumor environment and response to neoadjuvant therapy in thinner and thicker tumors. Further studies should focus on defining the mesothelioma microenvironment based on radiographic tumor thickness.
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