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A. Joshi



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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-037 - Addition of bevacizumab to standard palliative chemotherapy in advanced non squamous cell lung carcinoma: Tata Memorial Hospital experience. (ID 2743)

      09:30 - 09:30  |  Author(s): A. Joshi

      • Abstract

      Background
      Outcome of advanced NSCLC is poor. Platinum based chemotherapy is standard of care. Addition of antiangiogenic agent such as bevacizumab improves the results.

      Methods
      Prospectively collected data of patients received bevacizumab, platin and pemetrexed as initial therapy for 6 cycle followed by maintenance pemetrexede and bevacizumab till disease progression or unacceptable toxicity.

      Results
      We had 18 patients, 14 were males and 4 were females. The age of the patients ranged from 45 to 68 years with a median age of 54 years. About one third of the patients were smokers and most of the patients were of good performance status (ECOG-0/1-94%). The most common symptoms of presentation were, cough in 61% of patients followed by dyspnea in 39% of patients. The chest pain and neck swelling were present in 11% of patients whereas bony pains were present in 39% of patients. Co-morbidities of diabetes and hypertension each were present in 17% of patients. Most of the patients were stage IV(94%). The patients received chemotherapy which comprised of pemetrexed, platin and bevacizumab for 6 cycle followed by pemetrexed and bevacizumab maintenance till progression in responding patients after six cycle. Number of cycle’s received ranged from 2 to 21 with a median of 10 cycles. Response rates achieved were stable disease in 72%, partial remission in 22% with disease stabilization rate of 95%. Grade 3 and 4 toxicities observed were neutropenia 11%,proteinuria 11%, anemia and Hyponatremia were present in 17%.One patient each developed pulmonary thromboembolism and hypertension. Bevacizumab was stopped because of toxicitty in one patint who developed pulmonary throboembolism. Median progression free survival was 7 month and median overall survival for whole group is not reached.

      Conclusion
      Addition of bevacizumab to standard platin based therapy in both initial and maintenance phase is feasible with acceptable toxicities. Some patients have long term disease control.

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-056 - A Tertiary cancer experience in use of TKI in metastatic lung cancer (ID 3351)

      09:30 - 09:30  |  Author(s): A. Joshi

      • Abstract

      Background
      Use of tyrosine kinase inhibitors is a attractive option due to its predicatble profile of side effects & it been a oral tablet. Its efficacy and toxicities have been well described in both east asian and western population. However not much literature is available on its use from India. The aim of this paper was to audit the population which received TKI (Erlotinib or Gefinib) in a tertiary cancer center in India.

      Methods
      All patients who received TKI in lung cancer were identified from our OPD database. There case records, electronic medical records & our OPD databases were utilized. The demographic profile, the staging details , details of EGFR mutations, the RECIST response rates, the toxicities, progression free survival (PFS) & overall survival (OS). SPSS 16 was used for statistical analysis.

      Results
      Total of 105 patients were identified with a median age of 58 years (35-77 years). There were 56 females (52.8%). The 15.2 % (16) of patients were smokers & 22.3 % (18) were tobacco chewers. The median duration of smoking & tobacco chewing was 25 & 15 years respectively. All patients had stage IV disease. There were 2 cases of squamous cell carcinoma (1.9%)& rest all were adenocarcinomas. (98.1%) Extrathoracic disease was present in 42 patients (39.6 %) The EGFR mutation invoved exon 19 , 21 & 18 in 25, 72 & 8 patients respectively. The ECOF PS was 0 & 1 in 14 (13.2%) & 51 (48.1%) patients respectively.The incidence of any grade skin and mucosal toxicites were 53% & 38% respectively. The median PFS & OS overall were 11.1 & 21 months respectively. The PFS & OS were not affected by the performnce status, comorbidities & sites of metastasis

      Conclusion
      Use of TKI in Indian population had similar toxicity & efficacy as reported in literature.

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    P3.02 - Poster Session 3 - Novel Cancer Genes and Pathways (ID 149)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.02-018 - EGFR mutation and its subtypes in Indian population: a study from single academic centre- Tata Memorial Centre (ID 2965)

      09:30 - 09:30  |  Author(s): A. Joshi

      • Abstract

      Background
      Tyrosine Kinase (TK) domains are central regulators of signaling pathways that control differentiation, transcription, cell cycle progression, apoptosis, motility and invasion. EGFR TK mutations represent bona fide somatic mutations in NSCLC. Patients with specific mutations respond better to targeted therapy.Mutation analysis is known to be evaluated by several methods. Real time PCR using allele specific TaqMan primer probes is a simple, robust, highly sensitive, and selective method that is compatible with standard processes used for known gene expression analysis. The main objective of our study was to detect EGFR mutations in NSCLC patients registered in Tata Memorial Hospital (TMH) by using rapid and sensitive technique of RQ-PCR with In-house TaqMan primer probes. There is limited data regarding EGFR mutation in Indian population with variable mutation rate reported. This is an attempt to get actual mutation rate in our population, correlate the frequency of EGFR mutation and their subtypes and analyze across different variables of age, gender, habits and histology with different ethnicity groups.

      Methods
      1018 patients of NSCLC were referred for EFGR testing as a routine service over a 1.5-year period. Extracted DNA from FFPE blocks was amplified for the exons 18, 19, 20 and 21 using the specific TaqMan primer probes with the End point genotyping method on LC-480 II platform. Chi-square test was performed to reveal any significant correlation between the mutation status and age, gender and habits of the patient and tumor histology.

      Results
      Overall Mutation Rate (MR) was 25.0% with a higher mutation rate in females than males (34 vs.21) with a p value of 0.002. Within the age group, MR was high in > 60 yrs group as compared to <60 years (47.6 % vs. 31%). Total population of smoker vs. never-smoker was 37.5% vs. 58.6 %. (p value <0.001). MR was significantly higher in Never Smoker (NS) as compared to Smoker (S) (31.5 % vs.16 %), MR in Adenocarcinoma (ADC) was significantly higher than squamous (27.7 %vs. 5.6%) with a p value of <0.001. MR is higher in ADC NS female as compared to ADC NS male (37.2 %vs.29 %). MR of Exon 19 , 21, 18, & 20 was 53%, 38 %, 5.8 % & 2.4 % respectively. In the cohort of ADC NS gender, Exon 19 positivity was predominantly higher in male than female (61.8% vs.34 %) , whereas Exon 21 was marginally higher in ADC NS female than male (39 % vs 34 %). Exon 20 expressed 2.4%.

      Conclusion
      There is a heterogenous EGFR MR in diferent geographical population. We are in close association with East Asian countries than Western countries. In our data though the MR is high in NS, 16 % of EGFR MR in smokers is also startling reality. Another possibility of variation in EGFR mutation rate could be due to application of different technologies. Each technique differs in their sensitivity and specifictiy. EGFR tyrosine kinase domain define a new molecular marker for lung carcinoma.