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K. Minato
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-007 - Evaluation of Gefitinib Efficacy According to Body Surface Area, Body Weight, and Body Mass Index in Patients with NSCLC Harboring EGFR Mutations (ID 1681)
09:30 - 09:30 | Author(s): K. Minato
- Abstract
Background:
Gefitinib is effective as first-line chemotherapy for advanced non-small cell lung cancer (NSCLC) patients harboring sensitive epidermal growth factor receptor (EGFR) mutations. Exon 19 deletions and the L858R point mutation are the most commonly encountered sensitive EGFR mutations in NSCLC, and have been shown to predict greater efficacy of gefitinib therapy. The objective of this study was to evaluate whether body surface area (BSA), body weight (BW), and body mass index (BMI) affect the efficacy of gefitinib in patients with NSCLC harboring sensitive EGFR mutations.
Methods:
We reviewed the medical charts of consecutive patients with advanced NSCLC harboring sensitive EGFR mutations who received gefitinib. The median values were used as the cutoffs to evaluate the impact of BSA and BW on the efficacy of gefitinib. BMI was categorized as underweight (BMI < 18.5 kg/m[2]), normal weight (BMI 18.5 to < 25 kg/m[2]), and overweight (BMI ≥ 25 kg/m[2]).
Results:
The median BSA and BW of the 138 NSCLC patients harboring sensitive EGFR mutations were 1.48 m[2] and 53 kg, respectively. The overall response rate, progression-free survival (PFS), and overall survival (OS) were 65.2%, 12.2 months, and 24.2 months, respectively. There were no significant differences in clinical outcomes between the high-BSA (BSA ≥ 1.43 m[2]) and low-BSA groups (BSA < 1.43 m[2]), with response rates of 68.5% and 72.0% (p = 0.92), median PFS of 12.2 and 11.5 months (p = 0.73), and median OS of 25.0 and 21.9 months, respectively (p = 0.28). Moreover, there were no significant differences in clinical outcomes between the high-BW (BW ≥ 53 kg) and low-BW groups (BW < 53 kg), with response rates of 63.3% and 67.1% (p = 0.72), median PFS of 12.2 and 10.8 months (p = 0.46), and median OS of 28.9 and 21.9 months, respectively (p = 0.22). For BMI, the median PFS and OS estimated among underweight, normal weight, and overweight patients were 10.6 and 19.2 months, 12.0 and 23.3 months, and 13.1 and 33.1 months, respectively. There were no statistically significant differences in PFS and OS among underweight, normal weight, and overweight patients (p = 0.52 and p = 0.30, respectively). Finally, to substantiate possible differences in the efficacy in patients who are young (<75 years) vs. elderly (≥ 75 years) and who have exon 19 deletions vs. L858R, we also evaluated these subgroups separately regarding BSA, BW, and BMI. However, there were no significant differences in the PFS and OS between these groups.
Conclusion:
The efficacy of gefitinib in patients with NSCLC harboring sensitive EGFR mutations does not differ according to their BSA, BW, and BMI.
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-101 - Expression of the Endoplasmic Reticulum Stress Sensor BiP/GRP78 in Lung Adenocarcinoma: Correlations and Prognostic Significance (ID 2271)
09:30 - 09:30 | Author(s): K. Minato
- Abstract
Background:
Endoplasmic Reticulum (ER) Stress Sensor, BiP/glucose-related protein 78 (GRP78) is an important member of the heat shock protein family 70 (HSPs70) that plays an essential role in the tumor growth and progression. It is localized to the endoplasmic reticulum. Although GRP78/BiP is highly expressed in various cancer cells, the clinicopathological significance of its expression in non-small cell lung cancer (NSCLC) remains unclear. The aim of the present study was to investigate the expression of the GRP78/BiP in patients with lung adenocarcinoma.
Methods:
Two hundred and twenty patients with surgically resected lung adenocarcinoma were evaluated as one institutional cohort. Tumor sections were stained by immunohistochemistry for GRP78/BiP, PERK, Ki-67, p-mTOR, and CD34 to assess the microvessel density. The correlation between GRP78/BiP and the other factors was assessed using the Spearman correlation analysis.
Results:
GRP78/BiP was highly expressed in 41% of patients, and was significantly associated with pleural invasion, lymphatic permeation, vascular invasion, cell proliferation, and p-mTOR phosphorylation. Multivaritate analysis confirmed that GRP78/BiP expression was an independent factor for predicting poor progression-free survival and overall survival in patients with stage I disease.
Conclusion:
The increased GRP78/BiP expression is an independent prognostic factor for early stage lung adenocarcinoma patients. Our study suggests that the expression of GRP78/BiP as ER stress marker plays a crucial role in the pathogenesis and development of lung adenocarcinoma.
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P3.07 - Poster Session/ Small Cell Lung Cancer (ID 223)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.07-004 - Clinical Impact of Post-Progression Survival for Overall Survival in Patients with Sensitive Relapse of Small Cell Lung Cancer (ID 1021)
09:30 - 09:30 | Author(s): K. Minato
- Abstract
Background:
The effect of second-line chemotherapy on overall survival (OS) might be confounded by subsequent therapies in patients with sensitive relapse of small cell lung cancer (SCLC). But there is no research in this viewpoint. Therefore, we aimed to determine the relationships between progression-free survival (PFS), post-progression survival (PPS) and OS after second-line chemotherapy in this population.
Methods:
Between January 1999 and November 2013, seventy-seven patients with sensitive relapse of SCLC who had received second-line chemotherapy following first-line platinum doublet chemotherapy were analyzed. We retrospectively collected individual data at Gunma Prefectural Cancer Center and National Hospital Organization Nishigunma National Hospital from medical records, and evaluated patient characteristics, treatment data, tumor shrinkage, PFS, PPS and OS.
Results:
The median follow-up time was 13.1 months (range 2.3-80.8 months). The response rate, the disease control rate, median PFS and median OS were 58.4%, 93.5%, 5.1 months and 13.7 months, respectively. The relationships of PFS, PPS and tumor shrinkage with OS were analyzed at the individual level. Spearman rank correlation analysis and linear regression analysis showed that PPS was strongly correlated with OS (r = 0.91, p < 0.01, R [2]= 0.96), PFS was moderately correlated with OS (r = 0.58, p < 0.01, R[2 ]= 0.28), and tumor shrinkage was weakly correlated with OS (r = 0.34, p < 0.01, R[2 ]= 0.12). Using multivariate Cox proportional hazards model with a stepwise regression procedure to explore prognostic factors for PPS, the number of regimens after progression beyond second-line chemotherapy and performance status (PS) at the beginning of third-line treatment were both significantly associated with PPS (p < 0.01).
Conclusion:
PPS has more impact for OS than PFS in patients with sensitive relapse of SCLC. Moreover, this study suggests that subsequent treatment and PS after disease progression following second-line chemotherapy may be important factors that influence OS.
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P3.07-015 - Final Report of Phase I/II Study of Induction Carboplatin and Irinotecan Followed by TRT for Elderly Patients with LD-SCLC: TORG 0604 (ID 3232)
09:30 - 09:30 | Author(s): K. Minato
- Abstract
Background:
In elderly patients with LD-SCLC, the role of irinotecan has been unclear and the timing of TRT combined with chemo-therapy has not been fully evaluated. Furthermore, no standard treatment has been established for them. We report a phase I/II trial of induction chemotherapy of carboplatin and irinotecan followed by sequential TRT in this population.
Methods:
Patients with untreated, measurable LD-SCLC >70 years with performance status (PS) 0 to 2 and adequate organ function were eligible. Treatment consisted of induction with carboplatin on day 1 and irinotecan on days 1 and 8 every 21 days for four cycles. TRT of 54Gy in 27 fractions was then administered sequentially. Carboplatin dose was escalated from AUC of 4 to 5 (Levels 1 and 2, respectively) with a fixed dose of irinotecan at 50 mg/m[2]. The primary objective of the phase II portion was evaluation of efficacy.
Results:
A total of 41 patients were enrolled [median age 75 years, range 70-86 years; 31 male, 10 female; PS 0/1/2: 22/18/1]. At Level 1 (n=6), one patient experienced dose-limiting toxicity (DLT) as Grade 3 hypertension. At Level 2 (n=6), two patients experienced DLT as Grade 4 thrombocytopenia. Therefore, level 1 was chosen as the recommended dose. The phase II trial was then expanded by 35 patients in the level 1 based on the Simon minimax design. In all cohorts, the median chemotherapy cycle was 4 (1/2/3/4 courses administered as 4/2/2/33); median radiation dose was 54Gy (range 36-60). Toxicities were generally mild, as expected. Gr 3/4 leukopenia and thrombocytopenia were both observed in six (15%) patients. No Gr 3/4 diarrhea or esophagitis was noted. Although Gr 3 febrile neutropenia and Gr 3 pneumonitis were seen in two patients each, no treatment-related deaths occurred. There were five complete responses and 32 partial responses, for a response rate of 90%. With median follow-up of 80.4 months (n=41), median progression-free and overall survival times were 11.2 and 27.1 months, respectively.
Conclusion:
Induction chemotherapy with carboplatin plus irinotecan followed by sequential TRT was well tolerated and highly effective in elderly patients with LD-SCLC. Further confirmatory studies are warranted.
