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C. Salvador Coloma
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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): C. Salvador Coloma
- 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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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-010 - Early Radiographic Response to TKI in Non Small Cell Lung Cancer with EGFR Mutations (ID 429)
09:30 - 09:30 | Author(s): C. Salvador Coloma
- Abstract
Background:
EGFR mutations have become an important target to choose a treatment for non-small cell lung cancer (NSCLC) patients. The response to chemotherapy is evaluated after the patient completes the second-third course of treatment. The response to tyrosine Kinase Inhibitor (TKI) could be observed in few days, the time for response evaluation is not well-defined.
Methods:
From January 2009 to November 2014, EGFR mutation status was analysed in 360 NSCLC patients’ samples. 55 patients (15,3%) were EGFR mutation positive. Among the 55 patients, 40 patients who were stage IIIB-IV and had received treatment with either gefitinib 250 mg, erlotinib 150 mg or afatinib 40 mg once daily were included in this analysis. The principal aim was to correlate the early radiological response (ERR) to TKI by computed tomography (TC) with progression‑free survival (PFS) and overall survival (OS) in NSCLC patients with EGFR mutations and stage IIIB-IV disease. Secondary objectives were to correlate the TKI response with different EGFR mutations and to evaluate the safety and efficacy of TKI treatment. The PFS and OS were estimated by the Kaplan–Meier method with (SPSSv.19). The log‑rank test was used to assess significant differences between‑groups (p<0.05).
Results:
The clinic-pathologic characteristics of the 40 eligible patients are listed in table 1. The EGFR mutations identified were mainly exon 19 deletions (12 patients) and L858R point mutations (16 patients). Twenty‑six patients (65%) had ERR. Four patients with a partial response (PR) on early CT achieved a complete response (CR). The median follow‑up time was 17 months (range 2-66 months). Among the 26 patients with ERR the median PFS was 11.8 months. The median PFS for patients with stable disease (SD) and progressive disease (PD) was 7.5 months. The overall log‑rank test for PFS, when comparing the groups of patients (ERR vs SD and PD) showed a significant difference (p<0.034). For patients with ERR the median OS was 20.1 months. The median OS for patients with SD and PD was 11.9 months. The overall log‑rank test for OS, when comparing the groups showed a significant difference (p<0.017).Table 1: The clinic-pathologic characteristics
VARIABLES NUMBER % Patients 40 100 Gender Male Female 19 21 47.5 52.5 Age (years) Median (range) 62 (40-85) Race European Others 38 2 95 5 Smoking Yes No Former smokers 9 22 9 22.5 55 22.5 Packs-year Median (range) 35.5 (5-185) PS 0 1 >2 14 22 4 35 55 10 Pathology diagnosis Adenocarcinoma Squamous Others 37 2 1 82.5 5 2.5 Stage IIIB IV 2 38 5 95 Number of prior chemotherapies 0 1-2 >2 17 20 3 42.5 50 7.5 TKI Erlotinib Gefitinib Afatinib 30 8 2 75 20 5
Conclusion:
The ERR to TKI could be a predictive factor of PFS and OS in NSCLC with activating EGFR mutation. Patients with SD at the first evaluation should be followed closely because of the risk of early progression.
