Author of

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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
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P3.11-045 - EGFR-TKI after disease progression with central nervous system metastasis in advanced non-small cell lung cancer with EGFR mutations (ID 3044)

    09:30 - 09:30  |  Author(s): A. Sakai
    • Abstract

    Background
    Several retrospective studies have reported that continued treatment with EGFR-TKI after developing progressive disease (PD) by RECIST improved survival compared to TKI-free treatment in NSCLC patients with EGFR mutations. However, it is unclear which patients would benefit from EGFR-TKI after PD. We hypothesized that patients with CNS progression only, without systemic deterioration, would show a good prognosis with EGFR-TKI after PD.Several retrospective studies have reported that continued treatment with EGFR-TKI after developing progressive disease (PD) by RECIST improved survival compared to TKI-free treatment in NSCLC patients with EGFR mutations. However, it is unclear which patients would benefit from EGFR-TKI after PD. We hypothesized that patients with CNS progression only, without systemic deterioration, would show a good prognosis with EGFR-TKI after PD.

    Methods
    In order to clarify the survival benefits in patients treated by EGFR-TKI after developing PD, particularly patients with CNS metastasis alone, NSCLC patients with EGFR mutations who were treated with EGFR-TKI and showed progression were analyzed retrospectively. The patients were categorized into two groups: patients continuing with EGFR-TKI treatment after progression (continuation group) and patients switched to chemotherapy or BSC (discontinuation group). Patients were also classified into two groups by site of progression: patients who showed deterioration involving only CNS metastasis (CNS progression group) and patients who showed progression of the primary lesion, lymph nodes, bone, liver, adrenal glands, CNS, or other sites (systemic progression group). Differences in post-EGFR-TKI progression survival (PPS) and overall survival were compared between the groups.

    Results
    A total of 160 patients, including 107 women, 116 light or never smokers, 156 patients with adenocarcinomas, and 130 patients with good performance status, were analyzed. There were 78 patients with deletions in exon 19, 69 patients with L858R, and 13 with minor mutations. At the time of the analysis, 111 patients showed disease progression by RECIST. No significant difference in the PPS was observed between the CNS progression group (n=29) and systemic progression group (n=82) (10.6 m vs. 11.2 m, p=0.90). Although it was not significant, the continuation group (n=43) showed longer PPS than the discontinuation group (n=68) (13.0 m vs. 9.7 m, p=0.06). The analysis of Cox hazards model including five variables (sex, smoking status, PS, continuation of EGFR-TKI, CNS progression or systemic progression) showed that the continuation of EGFR TKI beyond PD was the factor associated with longer PPS (HR=0.55, 0.31-0.92).

    Conclusion
    In this retrospective analysis, continued treatment with EGFR-TKI after PD resulted in longer PPS. A prospective study of continuation EGFR-TKI beyond REIST PD is needed.