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M. Yehia



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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
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      P2.03a-034 - RRM1 - A Prognostic Marker in Advanced NSCLC among Male Smokers Receiving Chemotherapy (ID 6218)

      14:30 - 14:30  |  Author(s): M. Yehia

      • Abstract
      • Slides

      Background:
      RRM1 is the regulatory subunit of ribonucleotide reductase. It has important role in DNA synthesis and damage repair as it is linked to G2 cell cycle arrest. Previous studies showed its prognostic significance in early stage NSCLC post-operatively (NEJM 356:800, 2007)

      Methods:
      We prospectively analyzed formalin fixed and paraffin-embedded (FFPE) tumor specimens to identify RRM1 mRNA expression (using Real-time quantitative PCR). Tumor cells isolated from male smoker with advanced NSCLC who will receive Cisplatin and Gemcitabin was measured in patients attending National Cancer Institute(NCI), Cairo between Jan2011-Jan2014

      Results:
      70 cases were involved, median age was 57years (35-76). 90% had ECOG-PS1 while 59(84.3%) had Stage IV and 55.7% had ≥4 chemotherapy cycles. 62.7% were responders(SD/PR), High RRM1 RNA was encountered in 33(37.1%) specimens. High RRM1 protein and IHC were encountered in 37(52.9%) and 33(47.1%) specimens respectively. RRM1 RNA was correlated and collinear with RRM1 protein and IHC (Kappa value 0.462 and 0.686, p<0.001 respectively) On Cox regression multivariate analysis (MVA) for predictors of overall survival; Advanced age (p=0.025, HR1.05, 95%CI:1.01-1.09), Non-responder(p=0.035, HR:1.95, 95%CI:1.05-3.63) and high RRM1.RNA(p=0.048, HR:1.93, 95%CI:1.01-3.70) adversely affect survival. Median OS in low RRM1.RNA was 11.6 vs 7.1 months in high group (Figure).Median PFS in low RRM1.RNA was 6.8 vs 5.1 months in high group. On logistic regression MVA for predictors of chemotherapy response; number of chemotherapy cycles was the only independent predictor (p<0.001).

      Conclusion:
      Low expression of RRM1 could be used to predict better survival in advanced NSCLC. The RRM1 could contribute to the future design of personalized cancer treatment in advanced NSCLC. Prospective multi-institutional clinical trials are warranted. Figure 1



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    P2.04 - Poster Session with Presenters Present (ID 466)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P2.04-031 - Predictors of Pathological Complete Response (TRG=1) among Esophageal Cancer Cases; NCI Pooled Data (ID 5396)

      14:30 - 14:30  |  Author(s): M. Yehia

      • Abstract

      Background:
      Commonly used chemotherapy regimens for esophageal cancer(EC) are EOX(Epirubicin/Oxaloplatin/Capecitabine) for adenocarcinoma and CF(Cisplatin and 5-Fluorouracil) for squamous carcinoma. In this study we aim to assess prevalence of pathological complete response(pCR) after current chemotherapeutic regimens among our EC cases and compare pCR cases to the remaining cohort

      Methods:
      We retrospectively reviewed Pathology Department database to retrieve EC patients treated in our National Cancer Institute(NCI),Cairo University during the past 5-years. Available variables were age, gender, operation, diagnosis, tumor size and grade, LN-size, presence of Barrett’s esophagus or in-situ/micro-invasive carcinoma, gross and microscopic pictures. MANDARD’s pathological response using tumor regression grade(TRG) was quantitated into five grades(1-5) with TRG=1 showing absence of residual cancer(Mandard_et al.,1994.Esophageal carcinoma regression after chemoradiotherapy,Cancer,73(11),2680-86).Logistic regression was used to identify pCR(TRG-1)predictors. Kaplan-Meier survival curves were used.

      Results:
      334 patients were encountered with males predominance;202(60.5%), Median age was64(Inter-quartile range;IQR;58-68), Pathology was SqCC in 227(68%), adenocarcinoma in 94(28.1%), undifferentiated ca in 9(2.7%)and others in 4(1.2%). pCR(TRG-1) was evident in 15 cases(4.5%). Among mentioned variables, only advanced age, non SqCC and high grade tumors adversely affect pathological response to induction treatment. On MVA, Advanced age (Odd Ratio(OR)=0.923,95%Confidence interval(CI)=0.86-0.99) p=0.025),moderate/high grade tumors(OR=0.03,p<0.001)adversely affect response while SqCC pathology has better response trend(OR4.39, p=0.086). 3-years overall survival (OS) was 100% in pCR(TRG-1) vs 82.3% in the remaining cohort(Figure). Among esophagectomy cases, surgery was done in 71.7% males vs28.3%females(p=0.093). Gastric pull up was performed in all surgical cases. R1 was present in 2.2%. Median tumor size was 4.3cm(IQR;3-5.6cm),least surgical margin was3(2-4)and max(LN)size was 1(1-2cm).Median +veLN, total LNnumber&LN-ratio was0(0-1),10(7-17)and 0(0-5%)respectively.30-days-perioperative mortality was6.5%. 3years OS among esophagectomy patients was 79.6%.

      Conclusion:
      Young EC patients and low grade tumor show better response to chemotherapy so aggressive treatment is warranted among this cohort. SqCC carries a good prediction to pathological response and hence better survival mandating aggressive chemo-radiation in this cohort aiming to cure. Figure 1