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W.H. Choi



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-024 - Metabolic activity on [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography and glucose transporter-1 expression may predict clinical outcomes in patients with limited disease of small cell lung cancer receiving concurrent chemoradiation (ID 1573)

      09:30 - 09:30  |  Author(s): W.H. Choi

      • Abstract

      Background
      Limited disease of small cell lung cancer (LD-SCLC) respond well to concurrent chemo-radiation (CCRT), but have high relapse rates and short relapse-free survival (RFS). We aimed to evaluate tumor metabolic activities measured by [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET) as a prognostic factor and analyze its relationships with markers of tumor biologic behavior.

      Methods
      Forty-one LD-SCLC patients receiving 4 cycles of EP (etoposide 120 mg/m[2], days 1–3; cisplatin 60 mg/m[2], day 1), 2 cycles of EP (etoposide 130 mg/m[2], days 1–3; cisplatin 30 mg/m[2], day 1) with concurrent mediastinal irradiation were enrolled. SUVmax of primary tumor was revised with the SUV of liver (SUVlivermax). Differences between pre- and post-treatment average SUV uptake of the primary tumor and intrathoracic lymph nodes were presented as ∆SUVliveravg. Thirty-one tumor biopsy specimens were immunostained for glucose transporter-1 (GLUT-1), Bcl-2, and hypoxia inducible factor-1α (HIF-1α).

      Results
      Objective response rates (ORRs) after CCRT were 92.7% and 87.8% on chest CT and FDG-PET, respectively. Median overall survival (OS) and RFS were 13.7 (range 4.4–54.1) months and 10.4 (range 0.97–54.1) months, respectively. In multivariate analysis, pretreatment lactate dehydrogenase (LDH) and ∆SUVliveravg correlated significantly with RFS (hazard ratio [HR] 2.8, P = 0.043 and HR 0.3, P = 0.004, respectively). Gender, pretreatment LDH, objective tumor metabolic response, and SUVlivermax correlated significantly with OS (HR 12.1, P = 0.006; HR 3.7, P = 0.037; HR 10.1, P = 0.008 and HR 0.2, P = 0.014, respectively). High GLUT-1-positivity (>75%) and pretreatment LDH levels (>400 U/L) correlated significantly with better ORR (P = 0.012) and HIF-1α immunoreactivity score (IRS, P = 0.029), respectively.

      Conclusion
      ∆SUVliveravg and GLUT-1, with respect to tumor glucose metabolism, might predict RFS and ORR, respectively, in definitive CCRT-treated LD-SCLC patients.

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    P3.10 - Poster Session 3 - Chemotherapy (ID 210)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.10-025 - Taxane-Platinum Induction Chemotherapy in Locoregionally Advanced Non-Small-Cell Lung Cancer: Outcomes and Prognostic Factors (ID 1546)

      09:30 - 09:30  |  Author(s): W.H. Choi

      • Abstract

      Background
      Induction chemotherapy (IC) in locoregionally advanced non-small-cell lung cancer (LA-NSCLC) has shown survival benefit. This retrospective study aimed to assess clinical outcomes and to identify prognostic factors in the LA-NSCLC patients who received taxane-platinum IC (TP-IC).

      Methods
      We reviewed medical charts, imaging studies, and pathologic reports in 51 LA-NSCLC pts who were treated with TP-IC between January 2003 and June 2012 at Seoul St. Mary’s Hospital and St. Vincent’s Hospital.

      Results
      Mean age at diagnosis was 63.1 years (range, 43-77). Forty-two pts (82.4%) were male. ECOG performance status was 0 in 17 pts (33.3%) and 1 in 34 (66.7%). Histology was squamous cell in 30 pts (58.8%), adenocarcinoma in 20 (39.2%), and large cell in 1. Thirty-four pts (66.7%) had stage IIIA disease, 13 (25.5%) IIIB and 4 (7.8%) IIB. All pts were treated with docetaxel 75 mg/m[2] or paclitaxel 175 mg/m[2], and cisplatin 75 mg/m[2] or carboplatin AUC 5 on day 1 every 3 weeks. Forty-four pts (86.3%) received docetaxel-cisplatin IC, 4 (7.8%) docetaxel-carboplatin, and 3 (15.7%) paclitaxel-cisplatin. The median number of IC cycles was 3 (range, 2-4). Mean relative dose intensity was 90.4% (±10.8) and RDI ≥90% was achieved in 31 pts (60.8%). During TP-IC, asthenia (88.1%), anorexia (89.1%), neutropenia (84.4%), alopecia (80.4%), nausea (71.7%) and myalgia (57.1%) were frequent. Most common grade 3/4 toxicity was neutropenia (80%) and febrile neutropenia occurred in 3 pts (5.9%). All toxicities were manageable with supportive care with no treatment-related death. Tumor response was assessed according to the RECIST and PERCIST criteria. According to RECIST, 3 pts (5.9%) achieved complete responses (CR), 32 (62.7%) partial responses (PR), 14 (27.5%) stable diseases (SD), and 2 (3.9%) progressive disease (PD). In addition, response evaluation by PERCIST was available in 38 pts, 5 pts (13.2%) achieved CR, 26 (68.4%) PR, 5 (13.2%) SD, and 2 (5.3%) PD. Thirty-one pts (60.8%) underwent surgery, 12 (23.5%) concurrent chemo-radiation (CCRT), 2 (4.3%) radiotherapy alone, 5 (9.8%) 2[nd] line chemotherapy or best supportive care and 1 lost follow-up. In 31 pts undergone surgical resection, 27 (87.1%) achieved R0 resection while 30-day postoperative death was reported in 2 pts. Median relapse-free survival (RFS) and overall survival (OS) were 10.7 months (95% CI, 8.1-13.2 months) and 25.5 months (95% CI, 20.4-30.6 months), respectively. The pts. with MD histology and objective metabolic response (CR+PR) by PERCIST showed significant longer RFS with HR of 6.27 (P=.002) and 3.23 (P=.04), respectively.

      Conclusion
      The TP-IC in LA-NSCLC showed remarkable tumor regression activity, leading to high R0 resection rate. MD histology and tumor response (CR+PR) by PET (PERCIST) were significant prognostic factors for RFS. Further study is ongoing to identify molecular markers affecting clinical outcomes.