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T. Inoue



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    ORAL 01 - Chemotherapy Developments for Lung Cancer (ID 88)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      ORAL01.01 - Randomized Phase III Study of Nedaplatin plus Docetaxel versus Cisplatin plus Docetaxel for Advanced Squamous Cell Lung Cancer (WJOG5208L) (ID 621)

      10:45 - 10:56  |  Author(s): T. Inoue

      • Abstract
      • Presentation
      • Slides

      Background:
      Nedaplatin (N) is a second-generation platinum compound with lower nausea/vomiting and nephrotoxicity than cisplatin (C). Nedaplatin plus docetaxel (ND) showed a promising efficacy with acceptable toxicity for advanced squamous cell lung cancer (SqLC) in the previous phase II study.

      Methods:
      Eligible patients (pts) were those with pathologically proven SqLC with stage IIIB/IV or postoperative recurrence, aged 20-74 years and ECOG PS 0-1. Pts were randomized 1:1 to ND (N 100 mg/m[2] and docetaxel (D) 60mg/m[2] iv, q3w, up to 6 cycles) or C plus D (CD) (C 80 mg/m[2] and D 60mg/m[2] iv, q3w, up to 6 cycles) according to stage, gender and institution. The primary endpoint was overall survival (OS), and secondary endpoints included progression-free survival (PFS), response rate (RR) and adverse events (AEs). Target sample size of 350 provided 90% statistical power to detect a hazard ratio of 0.71 with one-sided type I error of 0.05.

      Results:
      Between July 2009 and July 2012, 355 pts were randomized. Of 349 for efficacy analysis (ND 177; CD 172), baseline characteristics were well-balanced between two arms. ND had a significantly longer OS (p=0.037, one-sided stratified log-rank test). The OS HR was 0.81 (90%CI, 0.67-0.98) with a median OS of 13.6 months [m] for ND and 11.4 for CD. ND had a longer PFS (p=0.050) with a HR of 0.83 (0.69-1.00) and a median PFS of 4.9 m in ND and 4.5 in CD. RR was 54.5% in ND vs 52.9% in CD (p=0.829). Grade 3 or higher AEs of nausea (4.0% vs 14.3%), fatigue (3.4% vs 10.9%), hyponatremia (13.6% vs 30.3%) and hypokalemia (2.3% vs 8.6%) are more frequent in CD. Grade 3 or higher AEs of neutrophils (82.5% vs 70.3%) and platelets (9.0% vs 0.0%) are more frequent in ND, but there was no difference in grade 3 or higher febrile neutropenia (13.6% vs 15.4%). Treatment related deaths occurred in 4 and 3 pts in ND and CD, respectively.

      Conclusion:
      ND showed a significantly longer OS as compared to CD with different toxicity profile. ND will be considered as a new standard treatment for advanced or relapsed SqLC. Clinical trial information: UMIN000002015.

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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-014 - EGFR Tyrosine Kinase Inhibitor and Chemotherapy in EGFR Mutation-Positive Non-Small Cell Lung Cancer (ID 2378)

      09:30 - 09:30  |  Author(s): T. Inoue

      • Abstract
      • Slides

      Background:
      Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are recommended in the first-line setting for patients with EGFR mutation-positive non-small cell lung cancer (NSCLC). However, it remains unclear whether frontline EGFR TKIs are better strategy than first-line chemotherapy in EGFR-mutant patients. Generally, EGFR-TKIs had no significant benefits in overall survival (OS) compared with chemotherapy in both first-line and second-line setting. This retrospective study compared survival benefits in patients treated with post-TKI chemotherapy and first-line chemotherapy controls.

      Methods:
      This retrospective study included 442 EGFR-mutant patients in our institute. We examined EGFR gene status from 2007 to 2015. The patients treated from 1999 to 2015. The study group contained 173 patients treated with first-line EGFR-TKI and the control group contained 109 patients who received EGFR-TKI after first-line chemotherapy. The overall survival (OS) was assessed.

      Results:
      There was no significant difference between first-line chemotherapy and EGFR-TKI in OS for patients with mutation-positive NSCLC (median OS; 43 vs. 38 months, P = 1.645). There was substantial difference in OS between patients with postoperative recurrence and those with III/IV stage disease. Among patients with III/IV stage NSCLC, median OS was 40.8 months in first-line chemotherapy group, 30.5 months in chemotherapy after frontline EGFR-TKI group and 21.1 months in only EGFR-TKI group.

      Conclusion:
      In EGFR-mutant patients, both EGFR-TKI and chemotherapy improve the survival. Among patients with advanced NSCLC, EGFR-TKI after first-line chemotherapy may improve survival than frontline EGFR-TKI. These findings need to be validated in further randomized trials.

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