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Carlos Garcia Giron
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FP12 - Tumor Biology and Systems Biology - Basic and Translational Science (ID 188)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Tumor Biology and Systems Biology - Basic and Translational Science
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP12.01 - Circulating Tumor DNA to the Identification of EGFR Positive NSCLC Long-Term Survivors (ID 3013)
00:00 - 00:00 | Author(s): Carlos Garcia Giron
- Abstract
Introduction
Survival data supports the use of first-line osimertinib as standard of care for EGFR positive non-small lung cancer (NSCLC). However, it remains unclear whether upfront osimertinib is superior to sequential first- or second-generation tyrosine kinase inhibitor (TKI) followed by osimertinib for all patients. The impossibility of predicting which patients are at high risk of progression constitutes a major limitation of the sequential TKI approach.
Methods
Seven hundred and forty-five plasma samples from 192 stage IV, EGFR positive NSCLC patients who were treated with first-line TKI were analysed by digital PCR.
Results
Patients with EGFR sensitizing mutations in plasma with mutant allele frequency (MAF) <7% before treatment initiation had median OS 37.9 months (25.3-NR), compared 17.5 (95%CI: 11.3-25.5) months for patients with MAF≥7% (adjusted HR=0.43; 95%CI: 0.25-0.76, respectively). OS was achieved with 53.1% of the patients treated with a 2nd line treatment other than osimertinib. In the multivariable analysis, undetectable levels of circulating tumour DNA (ctDNA) after 3 and 6 months of treatment were associated with improved PFS and OS (P<0.001 in all cases). Patients who became ctDNA negative after 3 or 6 months of treatment with MAF<7% at diagnosis had more than two-thirds lower risk of progression and death compare to the rest of patients (adjusted HR=0.28; 95%CI: 0.17-0.46 and HR=0.24; 95%CI: 0.12-0.48 for PFS and OS, respectively).
Conclusion
Pre-treatment ctDNA levels identify patients at low risk of progression and death who could benefit from sequential TKI treatment. Information regarding EGFR sensitizing mutation clearance could improve patient selection.
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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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P76.42 - OsimertinibTreatment in Non-Small Cell Lung Cancer (NSCLC) EGFR-T790M+. Activity in Patients with CNS Metastases. OSIREX (ID 1860)
00:00 - 00:00 | Author(s): Carlos Garcia Giron
- Abstract
Introduction
Based on the lack of real-life results the Spanish Lung Cancer Group (SLCG) proposed to organize a retrospective study in which we can describe the experience in efficacy and safety of osimertinib in p with NSCLC EGFRm T790M and central nervous system CNS) metastases.
Methods
Observational, non-interventional, multicentre, one-arm, non comparative, retrospective study in T790M positive NSCLC p with advanced or metastatic disease. A total of 155 p were included. The observation period was from August 2016 to December 2018 in 30 Spanish hospitals. This corresponds to a total period of 29 months.
Results
155 p were included (108 women (69.7%), median age: 67 (37-88), 64% (99/155) were non-smokers and 99 % (154/155) had adenocarcinoma. Most p had received at least one prior treatment (97.4%, 151/155): 76.8% previous EGFR-TKIs, and 20.6% had received prior cytotoxic chemotherapy. At data cutoff, median duration of follow-up was 11.7 months (0.4-32).
A total of 155 p were evaluable for response analysis, 87(56%) as 1st and 2nd line therapy and 68 as ≥3rd line. 45 patients (30%) had CNS metastases at baseline. PFS was inferior en patients with CNS metastases than in those without (median, 7.2 months (95% CI, 3.9 to 10.6) vs 10.3 months (95% CI, 7.8 to 12.8) HR: 1.54 (95% CI, 1.03 to 2.32).
Conclusion
This retrospective study to assess the real-world clinical impact of osimertinib in p with advanced NSCLC and CNS metastases. Osimertinib had demonstrated greater penetration of blood brain barrier than gefitinib or erlotinib and these results could recommend us to use in first line.
