Virtual Library

 x 
My Library Virtual Library FAQ

Start Your Search

J. Whang-Peng



Author of

  • +

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
    • +

      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): J. Whang-Peng

      • 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.

  • +

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 2
    • +

      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): J. Whang-Peng

      • 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.

    • +

      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): J. Whang-Peng

      • 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.

  • +

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 2
    • +

      P3.11-004 - A Prospective Study of the Use of Circulating Markers as Predictors for Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Treatment in Pulmonary Adenocarcinoma (ID 726)

      09:30 - 09:30  |  Author(s): J. Whang-Peng

      • Abstract

      Background
      The use of liquid tissue, such as circulating cells or free DNA, to predict treatment response is attracting more attention.

      Methods
      Patients with stage IV adenocarcinoma of the lungs who were going to receive gefitinib or erlotinib treatment were included. Both tumor tissue and plasma specimens were prospectively collected before treatment and analyzed using the ARMS-Scorpions method for EGFR mutation status analysis. The numbers of circulating CD146+/CD3- cells (as circulating endothelial cells, CECs), CD34+/CD45- cells (as endothelial progenitor cells, EPCs), and CD133+ cells (as circulating cancer stem cells, CSCs) were measured with flow cytometry. From June 2010 to July 2012, 112 consecutive patients were enrolled.

      Results
      Eighty of the 112 patients had tissue EGFR (tEGFR) activating mutations. Plasma EGFR (pEGFR) activating mutations were detected in 24 of 80 patients with tEGFR activating mutations. There were lower CEC, EPC, and CSC counts in tEGFR mutated patients than in wild-type patients (p=0.001, 0.012, and 0.001, respectively). Progression-free survival (PFS) was best in those with only tEGFR mutations (n=56, median 16.8 months), followed by those with both tEGFR and pEGFR mutations (n=24, median 7.9 months), and worst in EGFR wild-type patients (n=32, median 2.1 months) (p<0.0001). PFS was significantly longer in patients with low CEC and low CSC counts than in those with high cell counts (p=0.0023 and 0.0053, respectively). Multivariate analysis showed that the presence of pEGFR was a poor prognostic factor, but not the presence of other markers.

      Conclusion
      The presence of pEGFR mutation is a poor prognostic factor for patients with tEGFR mutations when they receive EGFR-TKI treatment. EGFR wild-type patients had higher counts of CECs, EPCs, and CSCs. These circulating markers are useful in predicting EGFR-TKI treatment efficacy, but less useful than pEGFR detection.

    • +

      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): J. Whang-Peng

      • 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.