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Y. Lee



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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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      P1.11-001 - Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) related interstitial lung disease in Taiwanese patients with non-small cell lung cancer (ID 261)

      09:30 - 09:30  |  Author(s): Y. Lee

      • Abstract

      Background
      In the recent years, it has been shown that epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), gefitinib or erlotinib, can provide significant benefit to patients with advanced non-small cell lung cancer (NSCLC). A major concern during EGFR-TKI treatment is the development of interstitial lung disease (ILD). The incidence and clinical characteristics of ILD associated with EGFR-TKIs in Taiwanese patients are less well defined.

      Methods
      Patients with advanced NSCLC in the Taipei Veterans General Hospital were screened and patients who had received EGFR-TKIs were enrolled in this study. The clinical information including medical records and chest images were reviewed. The diagnosis of EGFR-TKI related ILD was confirmed by two pulmonologists according to previously published criteria. Association between ILD development and clinical factors was evaluated.

      Results
      From February 2008 to July 2012, a total of 1214 patients who received EGFR-TKI as single therapy for NSCLC were screened. Patients who developed severe ILD and needed hospitalization (grade 3-5) were included. Consequently, 9 of 1214 patients (0.7%) were diagnosed to have severe EGFR-TKI related ILD. The median age of the patients with ILD was 61.0 years and 6 were male (66.7%). The median time interval from EGFR-TKIs use to onest of ILD was 31 days (range: 10-75 days). The most common symptom of EGFR-TKIs related ILD was dyspnea (88.9%). The most common radiological manifestation was bilateral ground glass opacity (GGO), which was noted in 5 patients (55.6%). All patients discontinued EGFR-TKIs immediately when ILD was suspected and 8 patients (88.9%) received systemic steroids. Six of nine patients (67%) patients died from ILD.

      Conclusion
      EGFR-TKIs, both gefitinib and erlotinib may cause fatal ILD in Taiwanese NSCLC patients. Physicians should be aware of this rare but severe side effect of EGFR-TKI and monitor this pulmonary toxicity closely.

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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-049 - Lung and Bone Metastasis Are Associated With Different Response and Disease Control Rate of First-line Therapy in Patients With Adenocarcinoma of Lung. (ID 3164)

      09:30 - 09:30  |  Author(s): Y. Lee

      • Abstract

      Background
      Bone and lung are frequent metastatic sites for adenocarcinoma of lung. Chemotherapy and tyrosine-kinase inhibitor (TKI) are standard first-line therapies for stage IV adenocarcinoma of lung according to the epidermal growth factor receptor (EGFR) mutation status. This study aimed at evaluating the relationship between bone, lung metastasis, with or without classic EGFR mutation, response rate and disease control rate of first-line chemotherapy and TKI therapy.

      Methods
      We retrospectively reviewed 206 patients who were diagnosed of adenocarcinoma of lung at our hospital. The patients’ bone and lung metastatic status at diagnosis, with or without classic EGFR mutation, response and disease control status of first-line chemotherapy and TKI therapy were collected for chi-square analysis.

      Results
      Fifty-five (26.7%) patients had bone metastasis and 82 (39.8%) patients had lung metastasis. 107 (51.9%) patients had classic EGFR mutation. There was no significant difference between bone, lung metastatic status and with or without classic EGFR mutation (p=0.65 for bone, p=0.46 for lung). For the patients without classic EGFR mutation and received first-line chemotherapy, 33(57.9%) patients were without response (13, 20 patients were without, with bone metastasis, respectively), 24(42.1%) patients were with response (21, 3 patients were without, with bone metastasis, respectively), p<0.01; 21(36.8%) patients were not controlled (9, 12 patients were without, with bone metastasis, respectively),36 (63.2%) patients were controlled (25, 11 patients were without, with bone metastasis, respectively), p=0.048. For the patients with classic EGFR mutation and received first-line chemotherapy, 27(60%) patients were without response (14, 13 patients were without, with bone metastasis, respectively), 18(40%) patients were with response (16, 2 patients were without, with bone metastasis, respectively), p=0.01; 10(22.2%) patients were not controlled (4, 6 patients were without, with bone metastasis, respectively), 35(77.8%) patients were controlled (26, 9 patients were without, with bone metastasis, respectively), p=0.043. There were no significant difference between response status of TKI and lung metastatic status (p=0.469), control status of TKI and lung metastatic status(p=0.855), response status of TKI and bone metastatic status(p=0.673), control status of TKI and bone metastatic status(p=0.58), response status of chemotherapy and bone metastatic status(p=0.533), control status of chemotherapy and bone metastatic status(p=0.777) in patients without classic EGFR mutation. For patients with classic EGFR mutation, there were also no significant difference between response status of TKI and lung metastatic status(p=0.077), control status of TKI and lung metastatic status(p=0.332), response status of TKI and bone metastatic status(p=0.76), control status of TKI and bone metastatic status(p=0.05), response status of chemotherapy and bone metastatic status (p=0.143), except for control status of chemotherapy and bone metastatic status(p=0.017).

      Conclusion
      For patients with adenocarcinoma of lung, bone metastasis is associated with decreased disease control rate in those with classic EGFR mutation and received first-line chemotherapy, and lung metastasis is associated with decreased response and disease control rate in those received first-line TKI therapy no matter of with or without classic EGFR mutation.

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    P2.11 - Poster Session 2 - NSCLC Novel Therapies (ID 209)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 3
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      P2.11-028 - Erlotinib salvage therapy in pulmonary adenocarcinoma patients who had disease progressed after previous EGFR-TKI treatment and platinum-based chemotherapies (ID 2110)

      09:30 - 09:30  |  Author(s): Y. Lee

      • Abstract

      Background
      Erlotinib is an EGFR tyrosine kinase inhibitor with promising efficacy in treating lung adenocarcinoma. However, after the failure of two lines of EGFR-TKI and chemotherapy, the remaining treatment choices are few. The purpose of this study is to demonstrate the efficacy of erlotinib as ≥ third-line treatment in this kind of patients.

      Methods
      We retrospectively reviewed the chart records of our stage IV pulmonary adenocarcinoma patients who were diagnosed and treated in our hospital between July 2004 and June 2013. Clinical data, type of response to the treatment, time to disease progression, the duration between starting erlotinib treatment and end of first line EGFR-TKI treatment, and overall survival time were collected.

      Results
      Seventy-four patients were enrolled and they all had been treated with EGFR-TKI, either as a first-line therapy or following platinum-based chemotherapy. Thirty-nine patients had response to initial EGFR-TKI treatment and thirty-five of them did not. The median progression free survival (PFS) of front-line EGFR-TKI is 8.2 months. All received erlotinib as salvage treatment after they had disease progressed to both chemotherapy and front-line EGFR-TKI. The median PFS of erlotnib as salvage treatment for patients with and without response to front-line EGFR-TKI are 5.1 months and 4.9 months (p=0.768), respectively. Detailed data of subgroup analysis regarding EGFR mutation status and clinical characteristics will be presented in the meeting.

      Conclusion
      In pulmonary adenocarcinoma patients who were heavily treated, erlotinib is still a choice whether or not the patient was responsive to previous EGFR-TKI.

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      P2.11-031 - Radiofrequency ablation of liver metastases may prolong the survival of pulmonary adenocarcinoma patients with liver metastasis (ID 2249)

      09:30 - 09:30  |  Author(s): Y. Lee

      • Abstract

      Background
      In patients with non-small cell lung cancer (NSCLC), the development of liver metastasis (LM) is a poor prognostic factor that compromises survival time. Whether combine systemic treatment with local treatment for liver metastases has benefit for NSCLC patients with LM is unknown. How to select a suitable patient for receiving local treatment is also unclear.

      Methods
      We retrospectively reviewed 713 pulmonary adenocarcinoma patients and 85 patients that developed LM at any time point in the course of the disease were identified for analysis. We use radiofrequency ablation (RFA) for local treatment of liver metastases. The indication of RFA were liver metastases number less than three with maximal size less than 5cm. RFA was performed with real-time ultrasonography guidance. Dynamic computed tomography (CT) scan was done 1 month after RFA for evaluating local therapeutic efficacy. An SPSS version 19 statistical software package (SPSS INC, Chicago, IL, USA) was used for data analysis.

      Results
      The independent prognostic factors after LM were Performance status、epidermal growth factor receptor (EGFR) mutation and LM numbers. There were 47 patients (54.7%) have LM nodules number less than three. The median overall survival (OS) in patients with LM nodules number less than three was 7.9 months comparing with 2.9 months in patients with nodules number over three ( P < 0.001). The independent prognostic factors for LM nodules number less than three patients were performance status and presence of brain metastasis. There were total six patients received RFA. Patients who received RFA treatment had better median OS after LM than those not ( 19.1 v.s 6.0 months, P = 0.04)

      Conclusion
      We recommend patients with better performance status (ECOG <2) without brain metastasis can consider RFA for liver metastases.

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      P2.11-036 - Association Between Tumor EGFR Mutation and primary tumor location in Patients with Adenocarcinoma of the Lungs (ID 2547)

      09:30 - 09:30  |  Author(s): Y. Lee

      • Abstract

      Background
      Lung cancer is the leading cause of cancer death in the world, and the non-small cell lung cancer accounts for more than 80% of the lung cancer. Among patients with non-small cell lung cancer, tumor epidermal growth factor receptor (EGFR) activating mutations were mostly found in patients with adenocarcinoma and were associated with a better prognosis than EGFR wild-type tumors. The relationship between EGFR activating mutations and their primary tumor location in the lungs was not reported before.

      Methods
      We retrospectively reviewed the data of our pulmonary adenocarcinoma patients who had received complete staging and received tumor EGFR mutation analysis. The association between EGFR mutation status, patients smoking status, patient’s gender and primary tumor location were analyzed.

      Results
      205 cases were reviewed. There are 126 patients with tumor EGFR mutations, including 115 patients with classic EGFR mutations (exon 19 deletions or L858R), and 79 patients were without EGFR mutation. There are statistically significant association between tumor EGFR mutations and primary tumor location in right upper lobe (P=0.007); especially in RB1 segment (P=0.018), and primary tumor location of exon 19 deletions occurred more frequently in right upper lobe (P<0.001). There were no significant associations between patients smoking status and primary tumor location(P=0.659), nor was patients gender and primary tumor location (P=0.473).

      Conclusion
      There are statistically significant association between EGFR mutation and primary tumor location in right upper lobe of patients with adenocarcinoma of the lungs.

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.11-033 - Brain Metastasis Features and Association with Tumor EGFR mutation in Patients with Adenocarcinoma of the Lungs (ID 2516)

      09:30 - 09:30  |  Author(s): Y. Lee

      • Abstract

      Background
      More than half of pulmonary adenocarcinoma patients present with locally advanced or metastatic disease. Most patients with brain metastases suffered from poor quality of life and poor survival time. Epidermal growth factor receptor (EGFR) mutations were most frequently found in patients with pulmonary adenocarcinoma and were associated with a better prognosis than patients with EGFR wild-type tumors. However, the association between tumor EGFR mutation and whether or not more frequent brain metastasis is still unclear.

      Methods
      We retrospectively reviewed the data of our pulmonary adenocarcinoma patients who have brain metastasis, and record the characteristics of brain metastasis. The association between tumor EGFR mutation and clinical characteristics of brain metastasis were analyzed.

      Results
      374 cases were reviewed. There are 239 patients with EGFR mutations, 69 patients with initial diagnosis of brain metastasis, and 82 patients with brain metastasis after treatment. Older patients (more than 70 years old) had fewer brain metastasis than younger (less than 70 years old) patients (25.8% v.s 48%, P<0.001). Patients with higher N stage of TNM staging system had higher proportion of brain metastasis (P=0.006). Patients with exon 19 deletion had more chance to suffer from brain metastasis than those with EGFR wild type (48.1% v.s. 34.1%, P=0.021). Patients with exon 19 deletion didn’t have significantly higher chance to have initial diagnosis of brain metastasis (P=0.216). However, patients with exon 19 deletion had higher chance to suffered from brain metastasis after treatment than those with EGFR wild type (35.6% v.s. 21.2%, P=0.019). Patients with exon 19 deletion survived longer than those with EGFR wild type (1-yr survival rate 95.8% vs. 78.7%, P=0.003). Thus, longer survival time may lead to higher proportion of brain metastasis occurrence in patients with exon 19 deletion than those with EGFR wild type.

      Conclusion
      There is no significant difference in frequency of initial brain metastases in patients with EGFR mutation or wild type. However, there are statistically significant association between brain metastasis and EGFR mutations in pulmonary adenocarcinoma patients in their disease process.