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S. Smojver-Jezek
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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-009 - Brain Metastasis and Epidermal Growth Factor Receptor Mutations in Croatian Caucasians with Lung Adenocarcinoma (ID 5182)
14:30 - 14:30 | Author(s): S. Smojver-Jezek
- Abstract
Background:
The brain is a common site of metastasis in non-small cell lung cancer (NSCLC). The aim of this study was two-fold: 1) to determine the incidence of brain metastasis (BM) in Caucasian lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations and 2) to evaluate the frequencies and potential relationship of the different EGFR mutations with BM.
Methods:
A retrospective cohort study was conducted at a Croatian tertiary hospital (Clinic for Respiratory Diseases “Jordanovac”) using data collected from medical records. Caucasian patients with primary NSCLC who were tested for EGFR mutation status between January 2014 and October 2015 were included.
Results:
Of 1040 NSCLC samples tested, 122 (11.7%) patients with lung adenocarcinoma harboured EGFR mutations; six EGFR positive (+) patients (four with BM) had repeat EGFR testing. The majority of EGFR mutants were females (n= 90, 77.6%), non-smokers (including never-smokers and former-smokers; n= 95, 92.2%), diagnosed with advanced disease (stage IIIB/IV) at first presentation (n= 75, 68.8%), and median age at initial diagnosis of primary lung cancer was 65 years (35 - 90). Twenty-three (19.8%) of 116 EGFR+ patients were diagnosed with BM; for six EGFR+ patients, data about BM was missing. Most were 64 years of age or younger (n= 15, 65.2%) at diagnosis of BM (median age: 62 years, 48 - 72). Synchronous BM disease at initial diagnosis of lung cancer was found in 43.5% of EGFR+ patients with BM (n= 10). There were more EGFR+ women with BM (n= 20, 87%) than men. Single exon 19 deletion and exon 21 L858R mutations were the most common subtypes in both EGFR+ patients without BM (n= 44, 47.3% and n= 27, 27.8%, respectively) and with BM (n= 13, 56.5% and n= 5, 21.7%, respectively). One BM patient (4.3%) had a double mutation (exon 19 and 21), while six non-BM patients (6.2%) had simultaneous pairings, most commonly between exon 19 and 20 (n=3, 3.1%). Although exon 18 mutations were seen in six patients without BM (6.2%), none were found in BM+EGFR+ patients. Exon 20 T790M mutation occurred in 17.4% of BM patients (n= 4) versus 15.3% of non-BM patients (n= 15). Rare EGFR double mutations (exon 18 and 20) were found in two non-BM patients (2.2%).
Conclusion:
Larger long-term prospective studies to explore and confirm these results in BM+EGFR+ patients are warranted. In the era of precision oncology, molecular testing of EGFR mutations may further clarify the pathogenesis of lung cancer-associated BM.
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P3.02b - Poster Session with Presenters Present (ID 494)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.02b-114 - Second Line Treatment of EGFR Positive Lung Adenocarcinoma - Our Experience (ID 6064)
14:30 - 14:30 | Author(s): S. Smojver-Jezek
- Abstract
Background:
EGFR testing and specific targeted therapy of lung adenocarcinoma is a standard worldwide. In Croatia, tirosin-kinase inhibitors (TKI)are allowed as a second-line therapy for EGFR positive (+) patients. We analysed the median overall survival (mOS) differences between TKI- and.conventional chemotherapy-treated patients as a second-line therapy.
Methods:
Medical records of patients diagnosed with lung adenocarcinoma and tested for specific mutations in Clinical hospital center Zagreb, Department for respiratory diseases Jordanovac, during the year 2013 and 2014, were retrospectively collected and reviewed. Median overall survival (mOS) was measured and analyzed using routine statistic tests.
Results:
A total of 334 patients were tested for EGFR mutations, 47 of whom came positive and 287 negative. There was signifficant difference between the two subgroups regarding some demographic categories: the majority (78,7%) of the EGFR + patients were female, as opposed to the EGFR - group. Also, the EGFR+ patients were older on average ath time of diagnosis.(66,04 vs 63,04 years). After recieving first line platinum based chemotherapy a total of 20 positive EGFR patients recieved second-line therapy. 15 were treated with TKI and 5 recieved pemetrexed. In the EGFR negative group, 100 patients received second-line therapy, 85 of whom recieved pemetrexed and the other 15 were treated with platinum- or gemcitabine- based chemotherapy. If analysing mOS of all the patients, there was statistically significant difference between the TKI-treated patients (mOS not met) compared to the other ones (mOS=20 months) (chi-square= 6,07; p=0,014). Also, if analysing only the EGFR positive patients, the mOS difference reached statistical significance, comparing the TKI-treated patients (mOS =24,3months) with those treated with pemetrexed. (mOS=15,7 months) (chi-square= 7,99; p=0,005)
Conclusion:
Our results showed the significance of molecular testing and specific TKI treatment of patients with EGFR positive lung adenocarcinoma, as they had a significatly better overall survival compared to patients treated with pemetrexed. The results are conclusive with the general experience and treatment recommendations, and should be implemented in every day praxis, i.e. enabling molecular testing and specific treatment for all EGFR+ patients, at least as a second-line therapy option, should be an imperative.
