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K.H. Min
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MINI 15 - Chemotherapy Developments for Lung Cancer (ID 128)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:L. Crinò, C.P. Belani
- Coordinates: 9/08/2015, 16:45 - 18:15, Mile High Ballroom 1a-1f
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MINI15.11 - Optimal Second Line Chemotherapy after 1st Line Pemetrexed and Cisplatin Treatment in EGFR Mutation Negative Advanced NSCLC Patients (ID 1356)
17:45 - 17:50 | Author(s): K.H. Min
- Abstract
- Presentation
Background:
Pemetrexed and cisplatin (P-C) has become the standard 1st line chemotherapy in NSCLC patients with wild-type EGFR. The recommended drugs in the 2nd line are docetaxel, docetaxel plus ramucirumab, gemcitabine or EGFR TKIs. Gemcitabine and vinorelbine have good clinical efficacies and low toxicity profiles, so this two drug combination therapy is challenged for their clinical efficacy as 2nd line treatment. The optimal 2nd line chemotherapy following failure of 1st line P-C treatment in advanced NSCLC patients with wild-type EGFR is not yet defined. Therefore, we evaluated the optimal 2nd line chemotherapy in P-C non-responders with advanced NSCLC.
Methods:
We conducted a retrospective analysis of patients with stage IIIB or IV NSCLC who had been treated with P-C as a first line treatment from February 2010 to May 2014. Patients who had EGFR mutation or were on pemetrexed maintenance therapy were excluded. We compared the progression free survival, overall response rate and adverse effects of each regimen.
Results:
Among 110 patients, 52 were eligible for the study. 28 received EGFR TKI (gefitinib or erlotinib); 13 received docetaxel monotherapy; 11 received gemcitabine-vinorelbine (G-V) combination therapy. Median age was 64.5, 61 and 63 years, respectively. All patients showed adenocarcinoma type histology except two in docetaxel and G-V group with large cell type histology. Best response rates were 15.4% in docetaxel group, 18.1% in G-V group and 11% in EGFR TKIs group. Median progression free survival time was 62 days(95% CI 54-70) in EGFR TKIs group, 63 days (95% CI 30-96) in docetaxel group, and 83 days (95% CI 55-111) in G-V group (P=0.17). In pairwise comparisons, p-value was 0.54 for EGFR TKI versus docetaxel group, 0.08 for TKI versus G-V group, and 0.23 for docetaxel versus G-V group. There were no difference in progression-free survival and response rate among the groups. There was a higher rate of grade 3/4 neutropenia in the Docetaxel group.
Conclusion:
Despite the absence of statistical significance, there was a trend that G-V combination therapy had longer progression-free survival outcome compared to EGFR TKI or Docetaxel groups. G-V as well showed better toxicity profiles compared to Docetaxel group. A larger study is required to confirm the efficacy of cytotoxic chemotherapy, especially G-V, as a second line treatment in EGFR mutation negative NSCLC patients.
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-027 - Pleural Fluid Reactive Oxygen Species Modulator 1 (Romo1) as a Diagnostic and Prognostic Marker in Lung Cancer Patients with Malignant Effusion (ID 800)
09:30 - 09:30 | Author(s): K.H. Min
- Abstract
Background:
Reactive oxygen species modulator 1 (Romo1) is a novel protein that is critical in mitochondrial reactive oxygen species (ROS) generation. It is increased in most cancer cell lines and is associated with resistance to chemotherapy in vitro. Recently, serum Romo1 has been suggested as a potential diagnostic marker for non-small cell lung cancer (NSCLC), and increased tissue Romo1 protein expression has been related with poor prognosis in patients following surgical resection for NSCLC. The clinical significance of pleural fluid Romo1 is unknown. We evaluated the clinical usefulness of pleural fluid Romo1 as a potential diagnostic and prognostic marker in patients with lung cancer-associated malignant effusion.
Methods:
Romo1 level was measured in pleural fluid using enzyme-linked immunosorbent assay in four groups: lung cancer-associated malignant effusion (n =24; 15 adenocarcinomas, 7 squamous cell carcinomas and 2 small cell lung cancers), tuberculous pleurisy (n = 14), parapneumonic effusion (n =15) and transudative effusion (n = 16). The discriminative power in lung cancer-associated malignant effusion and the association with survival of Romo1 was determined using receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis, respectively.
Results:
Pleural fluid Romo1 level was significantly higher in lung cancer-associated malignant effusion compared with other groups (all p < 0.001). In the ROC curve analysis, the optimal cutoff value for lung cancer-associated malignant effusion was 451.5 pg/mL with a sensitivity of 81.9% and specificity of 84.8%, with an area under the curve of 0.838 (95% confidence interval : 0.789 - 0892, p < 0.01). In addition, at the cutoff determined by median Romo1 level, high Romo1 expression was related with reduced overall survival in patients with NSCLC (p = 0.03). For all patients, pleural fluid Romo1 level was not related with age, gender, smoking status, tumor differentiation, histological type, glucose, protein, albumin and lactate dehydrogenase level.
Conclusion:
Romo1 discriminated lung cancer-associated malignant effusion from non-malignant effusions with considerable sensitivity and specificity. Also, high Romo1 level was associated with poor prognosis in lung cancer patients. Pleural fluid Romo1 could be a potential diagnostic and prognostic marker in patients with lung cancer-associated malignant effusion.
