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Y. Miyata



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    P2.09 - Poster Session 2 - Combined Modality (ID 213)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P2.09-016 - A feasibility study of neoadjuvant chemotherapy with cisplatin, pemetrexed and bevacizumab followed by surgery for nonsquamous non-small cell lung cancer (ID 2956)

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

      • Abstract

      Background
      Bevacizumab and pemetrexed/cisplatin improves the response and survival in patients with advanced or metastatic non-small cell lung cancer (NSCLC); however, the role of these medications in the setting of induction therapy for NSCLC is not well defined. The purpose of this study was to evaluate the feasibility of induction combination therapy with cisplatin, pemetrexed and bevacizumab followed by surgery in patients with clinical stage II/IIIA nonsquamous NSCLC.

      Methods
      Patients with clinical stage II/IIIA nonsquamous NSCLC were enrolled. The induction chemotherapy consisted of three cycles of cisplatin (75 mg/m[2]), pemetrexed (500 mg/m[2]) and bevacizumab (15 mg/kg) on Day 1, administered every 21 days. At least six weeks after the last administration of bevacizumab, the patients underwent surgical resection. The primary endpoint was the complete resection rate after the completion of three cycles of induction chemotherapy. The sample size was set at 30. The feasibility of the treatment was considered to be confirmed if the complete resection rate was 80% (24/30) or more.

      Results
      A total of six institutions in Japan participated in this trial. The study was initiated in June 2010, and patient enrollment was completed in November 2012. Thirty-one patients were recruited, 30 of which were eligible. The median age was 64 years (range: 54-71), and the male/female ratio was 17/13. The PS0/PS1 ratio was 29/1, the adenocarcinoma/large cell carcinoma ratio was 30/0 and the clinical stage IIA/IIB/IIIA ratio was 5/3/22. Grade 3 toxicities included neutropenia (7%), nausea (7%), appetite loss (13%), hypertension (23%) and pulmonary embolism (3%). There were no grade 4 events, and 27 (90%) patients completed three cycles at the full dose of chemotherapy. All but one patient exhibited radiologic tumor reduction based on the RECIST criteria. The objective responses to chemotherapy was CR in 0% of the patients, PR in 37%, SD in 50% and PD in 10% (due to new lesions). The disease control rate (CR+PR+SD) was 87%. Five patients dropped out from the study before surgery due to the patient’s decision in one patient, adverse events in three and disease progression in one. The complete resection rate after the completion of three cycles of induction chemotherapy was 83% (25/80). Therefore, the results met our criterion for feasibility.

      Conclusion
      Induction chemotherapy using a combination of cisplatin, pemetrexed and bevacizumab in patients with resectable clinical stage II/IIIA nonsquamous NSCLC is therefore considered to be a feasible treatment modality. Figure 1

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    P3.18 - Poster Session 3 - Pathology (ID 177)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P3.18-002 - Predicting stratification for recurrence of early lung adenocarcinoma based on 7th TNM classification and IASLC/ATS/ERS classification (ID 1146)

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

      • Abstract

      Background
      Seventh TNM classification for lung cancer and IASLC/ATS/ERS classification for pathological subtype of lung adenocarcinoma have been released independently. They have especially changed classification of small sized (≤ 3.0cm) and nodal negative adenocarcinomas. However, when utilizing them simultaneously, it is not clear which factors of each classification are useful to predict malignant potential of tumor.

      Methods
      We reviewed 154 pT1a-1bN0M0 adenocarcinoma cases resected between 1990 and 2011. Cases with adjuvant chemotherapy were excluded. 154 cases were subdivided into T1a or T1b cases according to 7th TNM classification. On the other hand, according to IASLC/ATS/ERS classification, reviewed cases were also subdivided into adenocarcinoma in situ/minimally invasive adenocarcinoma (AIS/MIA) or invasive adenocarcinoma (invasive Ad). Survival outcomes were evaluated based on these subclassfication methods.

      Results
      There were 84 AIS/MIA cases and 75 invasive Ad cases. T1a included 77 cases of AIS/MIA and 50 cases of invasive Ad. T1b included 7 cases of AIS/MIA and 25 cases of invasive Ad. T1a included significantly more AIS/MIA cases compared with T1b (p<0.001). The significance was confirmed about disease free survival (DFS) between T1a and T1b (96.7% vs 72.7, p<0.001). Pathological subtype also reached significance in DFS between AIS/MIA and invasive Ad (97.4% vs 85.7%, p<0.001). When combining these classifications, DFS of T1a-1b AIS/MIA (N=84), T1a invasive Ad (N=50), T1b invasive Ad (N=20) were 97.4%, 95.6% and 69.2%, respectively. The difference of DFS between T1a-1b AIS/MIA and T1b invasive Ad were more notable in comparison to single classification method. Relapse-free probability of T1a-1b AIS/MIA was 100%.

      Conclusion
      Combination of 7th TNM classification and IASLC/ATS/ERS classification were more useful compared with single method classification to predict T1a-1bN0M0 lung adenocarcinoma recurrence. T1b invasive Ad cases were identified as worsen subtypes than T1a-1b AIS/MIA. AIS and MIS might be handled equally regardless of tumor size.