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N. Blais



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    P1.18 - Poster Session 1 - Pathology (ID 175)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P1.18-021 - Retrospective analysis of the prevalence of NSCLC driver mutations in unselected samples. (ID 3365)

      09:30 - 09:30  |  Author(s): N. Blais

      • Abstract

      Background
      Much of the recent improvement in lung cancer outcomes owes to the advent of the Lung Cancer Mutation Consortium. We aimed to assess thequality of the pathologic specimens and to study the prevalence of each of the most clinically relevant driver mutations in a non-referred population with non-squamous, non-small cell lung cancer (NS-NSCLC) treated in a tertiary center in the province of Quebec characterized by a high prevalence of smokers (25% of adult population).

      Methods
      Consecutive patients with pathologically proven NS-NSCLC diagnosed or treated in our institution between January 2006 and June 2009 inclusively were accrued. Patients whose diagnosis is based uniquely on a positive cytology or whose diagnostic material was not available were excluded. Specimens were tested for ALK translocations (by IHC and FISH), for EGFR mutations in exons 19 and 21 by PCR (fragment analysis and qPCR) and for mutations in KRAS codons 12 and 13 by PCR-RFLP. ALK-FISH and ALK-IHC results were analyzed in a blinded manner.

      Results
      A total of 1017 consecutive patients were screened. We excluded 209 patients who had only cytologic material, 55 patients who had no residual material and 197 patients who had insufficient tissue. Analysis was possible on 556 patients. The median age of the analyzed population was 64 years and male gender frequency was 45.5%. Compared to our entire cohort, metastatic cases were significantly under-represented in the analyzed population 27.3% vs. 79.1% for local disease (p<0.0001). The distribution according to stage and year of diagnosis along with that related to overall eligible population as well as the percentage of each of the 3 driver mutations status in the specimens analyzed so far are shown in the table below:

      Local disease analyzable / overall Loco-regional analyzable / overall Metastatic analyzable / overall Total analyzable / overall
      2006 - 2007 188/227 (82.8%) 66/147 (44.9 %) 55/207 (26.6 %) 311/583 (53.3 %)
      2008 - Mid 2009 161/214 (75.2%) 50/96 (52.1 %) 36/126 (28.6 %) 247/436 (56.7 %)
      Total 349/441 (79.1%) 116/243 (47.7%) 91/333 (27.3 %) 556/1017 (54.7 %)
      Mutation results: Local disease positive/total analyzed Loco-regional positive/total analyzed Metastatic positive/total analyzed Total positive/total analyzed
      KRAS codon 12 76/216 (35.2%) 20/55 (36.4%) 17/54 (31.5%) 113/325 (34.8%)
      KRAS codon 13 7/216 (3.2%) 2/55 (3.6%) 2/54 (3.7%) 11/325 (3.1%)
      KRAS mutated 83/216 (38.4%) 22/55 (40%) 19/54 (35.2%) 124/325 (37.9%)
      EGFR exon 19 11/128 (8.6%) 2/42 (4.8%) 4/39 (10.3%) 17/209 (8.1%)
      EGFR exon 21 6/128 (4.7%) 3/42 (7.1%) 1/39 (2.6%) 10/209 (4.8%)
      EGFR mutated 17/128 (13.3%) 5/42 (11.9%) 5/39 (12.8%) 27/209 (12.9%)
      ALK-FISH 2/264 (0.8%) 0/90 (0%) 1/69 (1.4%) 3/423 (0.7%)
      ALK – IHC* 1/277 (0.4%) 0/97 (0%) 1/75 (1.3%) 2/453 (0.4%)
      *One ALK-FISH positive case was IHC negative on repeated testing.

      Conclusion
      Our study shows that adequate tumor sampling is a challenge when performing retrospective molecular biology studies, creating a bias of adequate tissue availability in favor of more localized stages of disease. Nonetheless, our study shows a lower percentage of EGFR/ALK mutations and a higher percentage of KRAS mutations than that reported by the LCMC and other groups. This may be related to the non-selected, regional distribution and smoking habits of our study population. Prospective studies on the molecular diagnosis of NS-NSCLC will refine epidemiologic features of the different genetic subtypes of this disease.

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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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      P3.11-027 - A randomised, open-label phase II trial of volasertib as monotherapy and in combination with standard dose pemetrexed compared with pemetrexed monotherapy in second-line non-small cell lung cancer (NSCLC) (ID 2307)

      09:30 - 09:30  |  Author(s): N. Blais

      • Abstract

      Background
      Polo-like kinases (Plks) are overexpressed in many cancers including NSCLC. Volasertib (BI 6727; an investigational drug) is a selective and potent Plk inhibitor, which induces mitotic arrest and apoptosis. This 3-arm trial compared the efficacy, safety and pharmacokinetics of volasertib monotherapy, volasertib combined with pemetrexed and single-agent pemetrexed as second-line therapy in patients with advanced/metastatic NSCLC (NCT00824408).

      Methods
      An initial run-in phase was conducted to determine the tolerability and dose of volasertib combined with pemetrexed 500mg/m[2]. Subsequent patients were randomised to one of three arms: (A) volasertib 300mg, (B) volasertib 300mg plus pemetrexed 500mg/m[2], or (C) pemetrexed 500mg/m[2]. Both drugs were administered on Day 1 every 21 days. Eligible patients had advanced/metastatic NSCLC, ECOG PS 0–2, adequate organ function and prior platinum-based chemotherapy. The primary endpoint was progression-free survival (PFS) evaluated using a stratified one-sided log-rank test (Arms B versus C); an exploratory analysis was performed for Arms A versus C. Secondary endpoints included objective response rate (ORR), overall survival (OS), safety and pharmacokinetics.

      Results
      Twelve patients were included in the run-in phase; the volasertib dose selected for the randomised phase was 300mg. 131 patients were then randomised to the three arms (A: n=37, B: n=47, C: n=47). Arm A recruitment was stopped early due to an increased rate of early progression. Demographic data were balanced between the arms. One patient per arm did not receive treatment. The median number (range) of treatment cycles in Arms A, B and C was 2 (1–49), 4 (1–36) and 5.5 (1–38), respectively. Median PFS (Arms A/B/C) was 1.4/3.3/5.3 months (HR B versus C =1.141 [95% CI: 0.735–1.771; p=0.2804]; HR A versus C =2.045 [95% CI: 1.271–3.292; two-sided p=0.0030]). ORR (Arms A/B/C) was 8%/21%/9%; no complete responses were observed. Disease control rates (Arms A/B/C) were 27%/66%/68%. Median OS (Arms A/B/C) was 22.9/17.1/17.4 months. Median relative dose intensity was 100% for both volasertib and pemetrexed in all arms with a range of 80.6–111.1% in Arm A and 83.3–100.0% in Arm B for volasertib, and 87.5–100% in Arm B and 81.3–100% in Arm C for pemetrexed. The most common all-grade adverse events (AEs) were (Arms A/B/C): fatigue (56%/74%/70%), nausea (14%/48%/54%), decreased appetite (8%/44%/41%), constipation (17%/37%/22%), dyspnoea (17%/28%/30%) and vomiting (19%/33%/24%). Most common grade 3/4 AEs (>5%) were (Arms A/B/C): fatigue (8%/13%/17%), neutropenia (14%/11%/4%) and dyspnoea (3%/9% /13%). Grade 3/4 febrile neutropenia was seen in 2 (4%) patients in Arm B and 1 (2%) patient in Arm C. One fatal AE of septic shock (Arm B) was considered drug-related; 22%/22%/26% of patients experienced a serious AE. Pharmacokinetic analysis of volasertib in Arms A and B, together with historical pharmacokinetic data for pemetrexed, did not reveal any evidence of pharmacokinetic interactions between volasertib and pemetrexed.

      Conclusion
      Volasertib and pemetrexed could be combined at full single-agent doses, with generally acceptable toxicities, and demonstrated modest antitumour activity. However, the addition of volasertib did not improve PFS compared to single-agent pemetrexed in patients with relapsed or refractory NSCLC after platinum-based first-line therapy.