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J. Garcia Sanchez
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MINI 17 - WT EGFR, Angiogenesis and OMD (ID 131)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:R. Feld, R. Dziadziuszko
- Coordinates: 9/08/2015, 16:45 - 18:15, Mile High Ballroom 4a-4f
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MINI17.10 - Oligometastatic Non-Small-Cell Lung Cancer and Unresectable Primary Tumor: Safety and Efficacy of Radical Treatment (ID 2669)
17:40 - 17:45 | Author(s): J. Garcia Sanchez
- Abstract
- Presentation
Background:
Metastatic non-small cell lung cáncer (NSCLC) is associated with a poor prognosis, and palliative chemotherapy is the mainstay of treatment. However, long-time survival has been observed in oligometastatic patients treated with locally ablative therapies to all sites of tumoral disease. Oligometastatic NSCLC with unresectable primary tumor at diagnosis represents a therapeutic challenge, and nowadays there is limited evidence about the benefit of the treatment with radical intention of both primary tumor and metastases.
Methods:
Retrospective study of patients with oligometastatic (3 or less lesions, in a unique location) and unresectable NSCLC treated with radical chemo-radiotherapy at primary tumor and with surgery or stereotactic radiation therapy to the metastases. We have done a systematic review of clinical histories from NSCLC advanced patients diagnosed between October 2011 and March 2015. The aim of our study is to analyze the safety and efficacy of this treatment strategy in terms of response rate, progression free survival (PFS) and overall survival (OS).
Results:
Twenty-three patients met inclusion criteria. Median age 57 year, eighteen male (78,3%) and ECOG (0-1) 95,7%. Histology: 15 adenocarcinoma (65,2%), 5 squamous carcinoma (5%), and 3 (13%) others. All patients had unresectable mediastinal lymph nodes infiltration. Location of metastases included the brain (n=12, 52.2%), lung metastases (n=6, 26,1%), bone metastases (n= 3, 13%), adrenal (n=1, 4,3%) and lymph node (n=1, 4,3%). Chemotherapy: 9 CDDP-Pemetrexed (39,1%), 9 CDDP-Vinorelbina (39,1%), 3 Carboplatin-paclitaxel, 1 CDDP-Gemcitabina (4.3%), 1 CDDP-Docetaxel (4.3%). Ten patients (43.5%) received sequential thoracic radiotherapy and 12 (52.2%) concomitant. Metastases treatment: 12 stererotactic radiation (52.2%), 7 external radiotherapy (30, 4%), 3 surgery (13%), 1 radiofrequency (4.3%). Toxicity: four patients (17,39%) developed G3 toxicity (2 hematological, 1 pneumonitis, 1 esophagitis). Median follow up was 15 months, median OS 18 m, median PFS 11 months. The 1-year OS were 73.9%, 2-year OS 21,7% and 3-year OS 8.7%.
Conclusion:
Radical treatment of oligometastatic and unresectable NSCLC patients is a safe therapeutic strategy. Despite the limited data and the small numbers of our study, it could be contemplated as an effective therapeutic alternative for selected patients.
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-006 - Prognostic and Predictive Role of KRAS-Mutations in Patients with Advanced Non-Squmous Non-Small-Cell Lung Cancer (NS-NSCLC) (ID 2548)
09:30 - 09:30 | Author(s): J. Garcia Sanchez
- Abstract
Background:
KRAS is the most frequently mutated oncogene in lung adenocarcinoma patients. The prognostic rolo of mutatn-KRAS in lung adenocarcinoma is controversial, especially in non-asian populations. Studies also suggest the potencial predictive role of mutant-KRAS in the context of chemosensitivity of NSCLC. The aim of our study is to analyze the role of KRAS mutations as prognostic factor in advanced NSCLC, and their value as predictive biomarker of chemotherapy efficacy
Methods:
Retrospective study of patients with advanced NS-NSCLC in our institution between january-2013 and december-2014. Mutation analysis for KRAS was performed an the relation with overall survival was assessed. Secondary endpoints were its relation with progression-free survival and response to chemotherapy.
Results:
A total of 42 patients met inclusion criteria. Median age was 61.5 years. Thirty-three male (78.6%), 27 ECOG-PS 0-1 (64.3%), and 40 (95.2%) adenocarcinoma. Twenty-six patients (61.9%) received chemotherapy as first line treatment, 4 (9.5%) anti-EGFR treatment and 12 supportive care. Nine patients (21.4%) harboured KRAS mutations, all of them at exon 12. There were no differences in age, performance status or smoking history between patients with KRAS mutants vs those with wild-type tumours; instead KRASmut patients presented a higher rate of brain metastases (55.5 vs 20%; p=0.05) and higher number of methastatic locations at diagnosis (77.7 vs 41.3% of patients with more than one site of metastases). Median Overall Survival was superior for patients with wild type tumours (19 vs 10 months, p =0.22). There were no differences in response rate in patients treated with platinum doblet chemotherapy (Wild-type vs KRAS mut: 44.4 vs 33.3%, p=0.5), but progression free survival and overall survival were superior for wild-type tumour patients (PFS: 3 vs 15 months, p=0.001; OS: 10 vs NR, p=0.06)
Conclusion:
With the limitation of small numbers, our data suggest that KRASmut patients are a subgroup with poorer prognostic. Moreover, they seem to benefit less from standard chemotherapy based in platinum doublets.
