Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11011

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    P1.24-010 - Successful rechalenge of erlotinib in patient with non-small cell lung cancer - regain of tyrosine kinase sensitivity. Case report (ID 877)

    09:30 - 09:30  |  Author(s): E. Chmielowska
    • Abstract

    Background
    Activating mutation in EGFR gene is a predictive marker for treatment response for tyrosine kinase inhibitors (TKI), such as gefitinib and erlotinib. These drugs are approved for treatment in any line of advanced stage EGFR-mutated non-small cell lung cancer. The TK domain EGFR mutations are more frequently found in Asian population than Caucasian, and are more prevalent in women than in men. There is scarce data regarding reintroduction of TKI after developing drug resistance during previous treatment.

    Methods
    We report on the case of 56-years old Caucasian, non-smoking woman diagnosed with cancer of the right lung. In 2004 patient underwent lobectomy of lower right lobe with mediastinal lymph nodes sampling – histopathology showed a grade 2 lung adenocarcinoma, pathological stage was pT2N1; no distant metastases were found. Adjuvant chemotherapy has been applied – patient received 4 cycles of PG regimen (Cisplatin with Gemcitabine); radiotherapy was not used. In March 2008, three and a half years after completion of primary treatment regional recurrence was documented by thoracic CT scan – mediastinal lymph nodes and parietal pleura were involved. Sequential chemoradiotherapy was used – patient received 4 courses of pemetrexed and radiotherapy (RTH) 44 Gy in 22 fractions – partial remission was obtained. Six month after RTH completion, in April 2009, the CT scan demonstrated the progression – large lytic lesion on sternum appeared and mediastinal nodes increased in size.

    Results
    Because primary tumor was positive for mutation in EGFR exon 19 by polymerase chain reaction, erlotinib treatment in dose 150 mg/d was initiated. The dose has been reduced to 100 mg after 4 courses due to toxicity – persistent and recurrent genitourinary infection. After dose reduction no adverse events were reported. Erlotinib treatment was continued for 18 months until disease progressed in November 2010 - lytic lesion in sternum increased and became symptomatic. Palliative radiotherapy on sternum was applied and third line of systemic treatment was introduced – six cycles of paclitaxel and carboplatin. Result of treatment was stabilization by RECIST 1.0 criteria and bone pain was gone. For the next 12 months CT scans were performed every 12 weeks – during that period there was no need for anticancer treatment. On February 2012 progression was confirmed – dissemination to both lungs. Because of reports in literature suggesting that EGFR-TKI drug resistance may be result of non-mutational, reversible mechanism that can be overcome by temporarily withholding TKI usage (so called “chemotherapy holidays”), decision was made to restart treatment with erlotinib. Treatment with reduced dose of 100 mg/d was initiated in March 2012 and is continued 15 months later. Every three months CT scans are performed – after initial shrinkage there is a tendency to increase tumor size, but progression criteria by RECIST are not met. 60 months after disease recurrence patient is in good condition, fully active and no adverse events were noticed.

    Conclusion
    Conclusions The intermittent therapy of TKI inhibitors may be beneficial for some patients with lung cancer, given they have reversible TKI-resistance.

• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11956

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    P2.24-010 - Advanced non small lung cancer long term survivors - clinical data analysis. Single center experience (ID 876)

    09:30 - 09:30  |  Author(s): E. Chmielowska
    • Abstract

    Background
    Patients with advanced non-small cell lung cancer are qualified to chemotherapy treatment with palliative intentions. Median survival time of those patients is 10 months and 24% live longer than 12 months. Current treatment modalities with targeted drugs and maintenance treatment extend survival time in limited group of patients beyond 24 months.The aim of the paper is to analyze selected patient-related factors, tumor factors and treatment regimens among patients who survived more than 24 months.

    Methods
    47 patients selected among 390 patients with advanced non-small cell lung cancer whose data were previously presented on WCLC 2011, not qualified to radical chemoradiotherapy treatment, who survived more than 24 months. Patients were treated with various platinum-based chemotherapy regimens – CDDP+Navelibine, CDDP+Gemcitabine, CDDP+Pemetrexed, Paclitaxel+Carboplatin and targeted drugs like erlotinib, gefitinib and bevacizumab. Usage of specific treatment regimen depended on clinical situation. Retrospective analysis of selected host factors, tumor factors and treatment regimen.

    Results
    Host-dependent factors: sex – 30 women, 17 men, age – range 39-67, median age 58 yrs, stage – IIIB – 15 patients, IV – 21 pts, reccurence after radical treatment – 9 pts; active smokers – 11 pts, former smokers – 32, non-smokers – 4; ECOG performance status – 0 – 32 pts, 1 – 15pts. Tumor-related factors: NSLC subtypes – not-otherwise specified – 28 pts, adenocarcinoma – 14, squamous cell carcinoma – 5 pts. Number of metastatic sites – 1- 30 pts, 2 – 17 pts; Metastatic locations – bone – 17 pts, lymph nodes – 20 pts, liver – 21 pts, brain – 0 pts. Treatment related factors – antyEGFR treatment – 6 patients, monoclonal anti body maintenance- 2 pts, premetreksed maintence-7 pts, taxenes maintenance- 8 pts. Patients recieved from 1 up to 4 lines of treatment. Median survival time was 34 months.

    Conclusion
    Survival time depends on various factors including usage of targeted drug therapies and maintenance treatment. Good performance status during treatment initialization still is one of the most important prognostic factors.