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W. Fang



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    MINI 05 - EGFR Mutant Lung Cancer 1 (ID 103)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      MINI05.01 - A Progression Free Survival Score for EGFR Mutant Non-Small Cell Lung Cancer Patients Treat with First Line EGFR Tyrosine Kinase Inhibitors (ID 493)

      16:45 - 16:50  |  Author(s): W. Fang

      • Abstract
      • Presentation
      • Slides

      Background:
      As epidermal growth factor receptor (EGFR) mutation a strong predictor of EGFR tyrosine kinase inhibitor (TKI) responsiveness, there are still around 10% TKI-naïve patients early refractory to first line TKIs. We aimed to find clinical predictors of TKIs responsiveness in EGFR-mutant non-small cell lung cancer (NSCLC) patients and create a scoring system as progression free survival (PFS) prediction.

      Methods:
      This retrospective study evaluated 262 patients harboring EGFR mutation received TKIs as first line therapy for NSCLC between January 2011 and December 2013. Patients were assigned to test (N=131) and validation (N=131) by time sequence. Patients with age ≤ 40, uncommon EGFR mutation, poor performance status, more sites of distal metastasis, and lymphocyte to monocyte ratio ≤3 were independently associated with poor progression free survival. These five factors were included in the scoring system and 3 predictive groups were formed by total score. Table. 1 Univariate and Cox regression analysis of progression free survival

      Univariate analysis Multivariate analysis
      PFS (M) P value P value
      Age >40 ≤40 11.6 3.3 0.001 0.002
      BMI >24 ≤24 14.9 9.1 0.027 0.928
      Gender Male Female 9.3 12.0 0.292
      DM YES NO 9.1 11.5 0.500
      Smoking Never Former / current 11.5 7.6 0.413
      Performance status ECOG 0-2 ECOG 3-4 11.5 2.7 0.009 0.012
      Mutation Common Uncommon 11.5 4.1 <0.001 <0.001
      Tumor type Adenocarcinoma Non-adenocarcinoma 11.1 9.8 0.789
      No. of distal metastasis 0 1-2 >2 21.4 11.3 6.1 <0.001 <0.001 0.015 <0.001
      Malignant effusion Yes No 9.1 11.6 0.031 0.946
      Lymphocyte to monocyte ratio >3 ≤3 13.4 7.4 <0.001 0.047


      Results:
      Progression free survival in the test group were 15.7 months(m) for 0-1 points, 9.3 m for 2 points, 4.0 m for 3-6 points (p <0.001). In the validation test, Progression free survival in there predictive groups each were 13.7 m, 9.5 m, 4.8 m (p <0.001). Between the test and validation groups, no significant differences were found in each one of the three predictive groups. Figure 1



      Conclusion:
      The score appears valid and reproducible. It can stratify NSCLC patients harboring EGFR mutation using first line EGFR-TKIs into long, intermediate and short PFS groups.

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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-018 - Baseline Lymphocyte-Monocyte Ratio Is a Prognostic Marker in EGFR Mutant NSCLC Patients Receiving First Line EGFR TKIs (ID 909)

      09:30 - 09:30  |  Author(s): W. Fang

      • Abstract
      • Slides

      Background:
      Patients with higher lymphocyte to monocyte ratio (LMR) has shown to have favorable prognostic in early stage lung cancer, non-metastatic renal cell carcinoma, gastric cancer, colon cancer, pancreatic cancer and breast cancer. However, prognostic significance of LMR in patients with advanced stage, epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer receiving first line EGFR tyrosine kinase inhibitors is not well known. We conducted a retrospective analysis to investigate the influence of baseline LMR on clinical outcomes including progression free survival (PFS) and overall survival (OS) in EGFR mutant NSCLC patients.

      Methods:
      This retrospective study evaluated 253 patients harboring EGFR mutation received TKIs as first line therapy for advanced NSCLC between January 2011 and October 2013. The cut- off value determined by Receiver operating characteristic (ROC) curves for LMR was 3.29. Patients were divided into high and low LMR ratio based on above cut-off level. Kaplan–Meier analysis was used for PFS and OS estimation; and the log-rank test was utilized to examine the significance of the differences of survival distributions between groups.

      Results:
      Among 253 patients mean age was 65.2 years, 41% were male, medium PFS was 10.3 months, medium OS was 22 months. Low baseline LMR patients had shorter PFS (low vs. high: 8.2 vs 11.6m, HR: 1.508, p=0.003), and OS (low vs. high: 14.3m vs. 32.1m HR: 2.23, p<0.001) Figure 1



      Conclusion:
      Our results suggest baseline LMR is a prognostic marker for EGFR mutant NSCLC patients receiving first line EGFR-TKIs.

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