Author of

• 12648

  +

  P3.11 - Poster Session 3 - NSCLC Novel Therapies (ID 211)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12698

    +

    P3.11-050 - Sunitinib for the treatment of RET-translocated NSCLC: A case report (ID 693)

    09:30 - 09:30  |  Author(s): G. Pall
    • Abstract

    Background
    RET-translocations have recently been identified as oncogenic drivers in a subset of non-small cell lung cancer (NSCLC). Up to now, there is limited information on the therapeutic value of RET-inhibitors in treating patients with RET-translocated NSCLC. Here we report on the clinical course of a patient with RET-translocated NSCLC treated with sunitinib, a multitarget tyrosinkinase-inhibitor with activity against RET.

    Methods
    A 65 year old woman with a non smoking history was diagnosed with adenocarcinoma of the left upper lobe in october 2009. Staging by CT and PET revealed stage II. Therefore the patient was referred to lobectomy plus lymphnode dissection. Pathologic work up in the following led to an upstaging to stage IIIA (pT1N2M0L1V0R0,GIII). The patient refused to get adjuvant chemotherapy but postoperative radiotherapy was applied. In may 2012 the patient developed left-sided pleural carcinomatosis and a thoracoscopic biopsy confirmed recurrence of the bronchial adenocarcinoma. Molecular workup of the available tissue showed EGFRwt and no evidence for ALK-translocation. As a platinum-based chemotherapy was not acceptable for the patient she was treated with pemetrexed monotherapy for 3 cycles leading to disease stabilization. At that timepoint the patient opted for a treatment holiday. In december 2012 CT-restaging showed progressive disease with increasing pleural tumor deposits. As the patient denied further cytostatic therapy, additional analyses for potential driver mutations were initiated and the existence of a KIF5B/RET-translocation was detected by FISH-analysis. As, at that timepoint, sunitinib was the only available RET-inhibitor at our site the patient was offered sunitinib treatment.

    Results
    Sunitinib was initiated in january 2013 (50mg qd, 4 weeks on/2 weeks off) with the patient at that timepoint not suffering from any symptoms (WHO 0). Due to severe toxicities (mucositis, fatigue, diarrhea) a dose reduction had to be performed allready during the first treatment cycle (37,5mg, 4/2 weeks). CT-restaging after 2 cycles showed stable disease. Treatment was continued, but, due to ongoing toxicities, the dose of sunitinib had to be further reduced (25mg qd, continously). In may 2013, with the patient free from tumor-associated symptoms, another CT-scan still revealed disease stabilization. At that timepoint the patient refused further treatment with sunitinib, due to subjectively inacceptable side effects (diarrhea, fatigue).

    Conclusion
    In this case of a patient with recurrent RET-translocated NSCLC treatment with sunitinib showed signs of clinical activity by inducing disease-stabilization for at least 4 months despite substantial dose reductions due to toxicities. As the patient withdrew further treatment, no further conclusions on the potential long term effects of such treatment can be drawn. Based on the preclinical evidence and the published case reports so far, testing of RET-inhibitors for the treatment of patients with RET-translocated NSCLC within prospective clinical trials is strongly recommended.