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Yu Feng
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P47 - Small Cell Lung Cancer/NET - Biology / Translational (ID 234)
- Event: WCLC 2020
- Type: Posters
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P47.08 - Blood-Based Tumor Mutation Burden as a Predictive Biomarker for Clinical Benefit of Immunotherapy in Small-Cell Lung Cancer (ID 1697)
00:00 - 00:00 | Author(s): Yu Feng
- Abstract
Introduction
An exploratory analysis from the Checkmate-032 trial showed that the efficacy of nivolumab ± ipilimumab was enhanced in small-cell lung cancer (SCLC) patients (pts) with high tissue-based tumor mutational burden (tTMB). However, the availability of adequate tissue for genetic testing sometimes may be challenging. In this study, we aim to evaluate the reliability of blood-based TMB (bTMB) as a predictor for clinical benefit of immunotherapy in SCLC.
Methods
Pts with treatment-naïve, histologically or cytologically confirmed, limited- or extensive-stage SCLC were enrolled. Tumor tissue-derived DNA and plasma-derived ctDNA were obtained from these pts to perform a paired tumor-normal next-generation sequencing of 1021 cancer-related genes. TMB was determined as the number of somatic non-synonymous SNVs and Indels per Mb in the coding region (with variant allele fraction ≥0.03 for tTMB, and ≥0.005 for bTMB).
Results
Between Nov 2018 and Jan 2020, 30 pts with SCLC were enrolled. The median age at diagnosis was 61.5 years (range 43-69); 22 pts were male; 13 pts with extensive-stage SCLC, 16 pts with limited-stage SCLC, and one patient with unspecified pathology. Median tTMB was 9.6 muts/Mb (range 0-25.92), and median bTMB was 11.04 muts/Mb (range 0.96-21.12). No significant difference was observed in tTMB for pts with limited- and extensive-stage disease (median tTMB was 12.48 muts/Mb and 9.6 muts/Mb, respectively; p=0.3558). Pairwise comparison of tTMB and bTMB was shown in the Figure. A positive correlation between tTMB and bTMB was observed (Spearman rank correlation=0.7089, 95% confidence interval [CI]: 0.4594-0.8597, p<0.0001). TMB was categorized as high vs. low according to the upper quartile of two cohorts (cutoff: 14.4 muts/Mb for tTMB, and 13.33 muts/Mb for bTMB). The positive percentage agreement of bTMB was 87.5% (95% CI: 57.94%-117.06%), while the negative percentage agreement was 95.45% (95% CI: 86.00%-104.91%).
Conclusion
Our study suggested a strong correlation between bTMB and tTMB. Therefore, bTMB may be used as an attractive alternative to predict response to immunotherapy in pts with limited- or extensive-stage SCLC whose tumor tissue is not available.
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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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P76.50 - Analysis of Efficacy and Safety of First Generation EGFR-TKI plus Apatinib in Treating Advanced NSCLC after EGFR-TKI Treatment Failure (ID 2642)
00:00 - 00:00 | Presenting Author(s): Yu Feng
- Abstract
Introduction
To investigate the efficacy, safety and survival of first generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) plus Apatinib in treating advanced lung adenocarcinoma with EGFR mutation after EGFR-TKI treatment failure.
Methods
This retrospective study comprised 31 patients with EGFR-sensitive mutated advanced lung adenocarcinoma who had progressed after first or second-line treatment of first generation EGFR-TKI. When the disease progressed, they received the original EGFR-TKI plus Apatinib until disease progression or unacceptable toxicity. The efficacy、safety and survival would be investigated. The Kaplan-Meier method was used to plot survival curve, and Log-rank test was applied for inter-group comparison. PFS1 was defined as the progression free survival of patients treated with single EGFR-TKI; PFS2 was defined as the progression free survival of patients treated with EGFR-TKI plus Apatinib.
Results
During monotherapy of EGFR-TKI, of the 31 patients, no one had complete response(CR), whereas 15 patients achieved partial response(PR),14 patients were with stable disease(SD),and 2 patients were with progressive disease(PD), representing an objective response rate(ORR) of 48.4%（15/31）,and a disease control rate (DCR) of 93.5%（28/31）.The median PFS1 was 10.6（95%CI：7.15~14.05）months. During the treatment of EGFR-TKI plus Apatinib, one patient did not undergo mid-term evaluation, of the remaining 30 patients, no one had CR, whereas 1 patient achieved PR, 26 patients were with SD, 2 patients were with PD, representing an ORR of 3.3%（1/30），and a DCR of 90%（27/30）. The median PFS2 was 6.6（95%CI：3.57-9.63）months. Log-rank test indicated that, EGFR-TKI as first-line treatment had a significant benefit of PFS1 than as second-line treatment (15.6 months VS 7.4 months, p = 0.02); EGFR-TKI plus Apatinib as second-line treatment had a significant benefit of PFS2 than as third-line treatment (7.6 months vs 3.0 months, p<0.001). The median PFS1 was significantly associated with the presence or absence of brain metastases prior to receiving EGFR-TKI monotherapy, patients without brain metastasis had better survival benefits (13.0 months vs 7.4 months, p=0.03). The median PFS2 was not significantly different from the presence or absence of brain metastases before treatment with EGFR-TKI plus Apatinib (7.6 months vs 4.4 months, p=0.19). Grade 4-5 adverse reactions did not occur during the treatment of EGFR-TKI plus Apatinib, 10 cases of grade 3 adverse reactions occurred, including 6 cases of hypertension, 2 cases of fatigue, and 1 case of diarrhea and hand-foot skin reactions respectively.
Conclusion
The first generation EGFR-TKI plus Apatinib is efficacious in treating patients with advanced lung adenocarcinoma with EGFR-sensitive mutations after EGFR-TKI treatment failure, PFS2 is extended and with acceptable toxic effects. Brain metastasis is one of the factors with poor prognosis in patients with advanced lung adenocarcinoma.
