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M. Plana



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    P1.11 - Poster Session 1 - NSCLC Novel Therapies (ID 208)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.11-040 - Treatment strategies after failure to reversible Tyrosine Kinase Inhibitors (rTKI) in EGFR mutant (mut) Non-Small Cell Lung Cancer (NSCLC) patients (p). A retrospective analysis of 59 Spanish Patients (ID 2853)

      09:30 - 09:30  |  Author(s): M. Plana

      • Abstract

      Background
      Different therapeutic approaches have been used in the clinical setting in NSCLC p harbouring EGFR mutations progressing to rTKI, although the standard of care in this situation is still not well established.

      Methods
      A multinstitutional database from five different centers in Spain was review to identify EGFR mut p with acquired resistance to rTKI in order to evaluate the therapeutic strategies after rTKI failure and the effect on the post-progression survival (PPS) of these treatments.

      Results
      59 p with acquired resistance to rTKI were identified: 61% female; median (m) age 63 ±11 yrs; 96.6% Caucasian; del19 73.7%, never or light former smokers 98.3%; 93.2% adenocarcinomas; 59.4 % received TKI as first line therapy; 87% were initial stage IV. mPFS for the rTKI was 9,9 months (mo) and mOS was 32.8 mo for the entire population. P were treated with a median of 2 therapeutic strategies after the rTKI failure. 6 therapeutic strategies have been identified. As immediate approach, 31p were switched to chemotherapy (CT) with a mPPS of 5,6 mo. 10 p were switched to an irreversible TKI obtaining a mPPS of 4 mo. rTKI plus other drug was maintained in 12 p: rTKI plus CT in 9 p with a mPPS of 5,8 mo and rTKI plus other drug different to CT in 3 with a mPPS of 2 mo. Despite the progression, rTKI was maintained in 3 p, considered slow progressors obtaining a mPPS of 1,4 mo with an OS of 9mo. Furthermore, 3p with oligometastatic progressive disease local therapy was added to rTKI, obtaining mPPS of 1,4mo, but an OS of 17 mo. 4 p were treated sequentially with ≥5 strategies. These p attained a mOS of 45mo.

      Conclusion
      The combination of different strategies when treating EGFR mut p after rTKI failure may impact the survival especially when p are candidates to receive some of this treatments sequentially. These strategies may reflect different subsets of EGFR mut disease.

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    P2.08 - Poster Session 2 - Radiotherapy (ID 198)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P2.08-010 - Outcome of Epidermal Growth Factor Receptor mutated (EGFRm) non-small cell lung cancer (NSCLC) patients (p) with Brain metastases (BM) in a single institution: Value of the lung-GPA classification (ID 1309)

      09:30 - 09:30  |  Author(s): M. Plana

      • Abstract

      Background
      In February 2012 a specific GPA scale for assessing the prognosis of BM in NSCLC was published (JCO, 2012; 30(4): 419-426). Retrospective series have showed longer survival for patients with cerebral metastases and EGFR sensitizing mutations (m) compared with those without them.

      Methods
      Charts from EGFRm NSCLC p with BM were reviewed. We classified p with the lung-GPA prognosis scale at the time of diagnosis of BM and compared the expected GPA overall survival (GPA-OS) with the Observed OS (OS) for each group.

      Results
      24p were diagnosed from January 2007 to December 2012. 15 p were treated with whole-brain radiotherapy (WBRT), total dose 30Gy (2p GPA 0-1; 10p GPA 1.5-2; 3p GPA 2.5-3), 1 p with stereotactic radiosurgery (SRS), mean dose 18Gy (GPA 3.5-4), 1p with SRS and WBRT (GPA 2.5-3) and 2p with surgery (S) and WBRT (1p GPA 2.5-3; 1p GPA 3.5-4). 5p receive no treatment (3p GPA 0-1; 2p GPA 1.5-2). Outcomes were [Expected median (m) GPA-OS vs Observed m OS]:

      GPA Expected m GPA-OS(months) Observed m OS (months) Number of p
      0-1 3.4 <1 5
      1.5-2 4.7 6 12
      2.5-3 8.8 34 5
      3.5-4 14.8 Not reached (100% OS at 40 months) 2
      Two p did not receive any EGFR tyrosine kinase inhibitor (TKI). 5p were receiving an EGFR TKI when they were diagnosed with BM and 12p were treated with EGFR TKI after the diagnosis of BM. Sixteen p have died. Further details of p characteristics and treatment received will be presented at the meeting.

      Conclusion
      Observed m OS of p with EGFR m-NSCLC and brain mets was much longer than expected by GPA-OS. The GPA subsets might predict prognosis in patients with mutated tumors as well.