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H.P. Shashidhara
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P2.03a - Poster Session with Presenters Present (ID 464)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03a-016 - Weekly Paclitaxel with 4 Weekly Carboplatin as Salvage Treatment in Advanced Non-Small Cell Lung Cancer- HCG Centre Experience (ID 5074)
14:30 - 14:30 | Author(s): H.P. Shashidhara
- Abstract
Background:
Progress has been made in the treatment of non-small cell lung cancer (NSCLC) over past 40 years. Chemotherapy can prolong survival in the patients with advanced NSCLC with newer supportive care availability. Newer advances include Histology, targeted therapy with the help of next generation sequencing (NGS) and Immunotherapy. Immunotherapy is not feasible in most of our patients in India after failure to first two line chemotherapy; hence this study was conducted to evaluate the efficacy and toxicity of weekly paclitaxel and 4 weekly Carboplatin as salvage regimen.
Methods:
The NSCLC patients(42) failure to previous 2 lines of chemotherapy including targeted agents were treated with salvage regimen weekly Paclitaxel 70- 80 mg/m2 3 weeks / 1 week gap and 4 weekly Carboplatin- AUC 5 with Growth factor support at HCG, Bangalore from Jan 2014 to june 2015. The efficacy and toxicity of above regimen were analyzed
Results:
Of 42 patients male: Female ratio 2.5:1, median age-59, 66.6%, were Adenocarcinoma, 19% had EGFR mutations. Objective response: Partial Response (PR)) was seen in 14.28%, Stable disease (SD) in 28.57% and progressive disease (PD) in 57.14%. Median progression free survival (PFS) 3.5 months, mean overall Survival (OS) 9.5 months.
Hematological toxicity: anemia (38% grade 1-2), neutropenia (28.57% grade 1-2), Febrile neutropenia (9.5%), thrombocytopenia (31%-Gr-1-2). Nonhematological toxicity: peripheral neuropathy (38% grade 1-2), Alopecia 88%, Mucositis 23.8%(Gr 1-2), Nausea/vomiting 16.6%, Diarrhea 9.52% and discontinuation due to severe peripheral neuropathy -7.1%Prior therapy for NSCLC Prior EGFR inhibitor +1 line Chemo(N-8) Prior 2 lines of Chemo (n-27) Prior 3 lines of chemo (n-7) PR 37.5% 11.1% - SD 37.% 29.62% 14.2% PD 25% 59.25% 85.7% Median PFS in months 7 4 3 Median OS in months 15 10 8
Conclusion:
Weekly Paclitaxel with 4 weekly Carboplatin is feasible, active and tolerable salvage regimen in previously treated NSCLC.
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P2.03b - Poster Session with Presenters Present (ID 465)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03b-064 - Genomic Profiling in Non Small Cell Lung Cancer: New Hope for Personalized Medicine (ID 4174)
14:30 - 14:30 | Author(s): H.P. Shashidhara
- Abstract
Background:
Lung cancer is rich in molecular complexities and spurred by different molecular pathways. Personalized medicine has begun to bring new hope to people with lung cancer, especially non-small cell lung cancer (NSCLC). Personalized medicine involves looking at the cells obtained from a biopsy to see if there are any genetic mutations able to exploit these unique pathways to develop targeted therapies. Very few publications are there from India related to lung cancer and genomics by Next generation Sequencing (NGS).
Methods:
The patients with NSCLC with initially negative for EGFR by PCR and ALK by IHC or FISH method treated at HCG Hospital from Jan-2013 to April -2016 are subjected for Gene profiling. The patients were consented to be profiled by targeted deep sequencing for hotspot mutations in 48 cancer-related genes using Illumina’s TSCAP panel and MiSeq technology. The average coverage across 220 hot spots was greater than 1000X. Data was processed using Strand Avadis NGS™. Mutations identified in the tumor were assessed for ‘actionability’ i.e. response to therapy and impact on prognosis.
Results:
. A total of 65 patients were analyzed. Male: Female ratio- 2.6:1. In 11 patients NGS were rejected due to poor quality DNA tumor availability in paraffin blocks. In 19 patients didn’t find any actionable mutation. The pathogenic mutations were identified in remaining 35 patients. The following mutations were found. (table)
Out of 35positive patients, 13 had two mutations and 43.75% could offer targeted therapy. 38% of them responded to therapies who were treated with targeted drugs.Types of mutations Number of cases TP 53 18 EGFR 7 EGFR , T790M 3 PIK3CA 4 K-RAS 4 N-RAS 1 KDR 2 RET 2 PTEN 3 MPL 1 HER2 1 MET 1 CTNNB1 1 ATM 1
Conclusion:
There is a potential role for PIK3CA, EGFR +/- T790M, KDR, RET and PTEN as therapeutic targets as personalized therapy in NSCLC. Present study helps us in understanding the diversity of molecular drivers in lung cancer and its clinical management for these patients, along with understanding of prognosis.
