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Z. Zheng
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P3.02b - Poster Session with Presenters Present (ID 494)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.02b-002 - Treatment Outcome Comparison between Exon 19 and 21 EGFR Mutations after Second-Line TKIs in Advanced NSCLC Patients (ID 5113)
14:30 - 14:30 | Author(s): Z. Zheng
- Abstract
Background:
Although superior clinical benefits of first-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the treatment of advanced non-small-cell lung cancer (NSCLC) had been reported with different sensitivity. The sensitivity of second-line TKIs in NSCLC patients with different EFGR mutations was unknown. the purpose of this study is to investigate the clinical outcome of NSCLC patients with and without brain and/or bone metastases in different EGFR tumor genotypes receiving EGFR-TKIs as a second-line treatment.
Methods:
The treatment outcomes of 166 NSCLC patients harboring either the exon 19 deletion or the L858R point mutation of EGFR treated by second-line TKIs were retrospectively reviewed.
Results:
The disease control rate (DCR) and objective response rate (ORR) of enrolled NSCLC patients were 77.7% and 11.4%, respectively. The exon 19 deletion group had a significantly longer median progression-free survival (PFS) (6.7 vs. 4.5 months, P=0.002) and overall survival (OS) (13.7 vs. 11.7 months, P=0.02) compared with the L858R mutation group for NSCLC patients, as well for patients with brain metastasis [PFS: (6.7 vs. 3.9 months, p<0.001), OS: (13.7 vs. 7.9 months, p=0.006)]. The median PFS and OS for NSCLC patients with bone metastasis were 4.8 months (95% Cl, 4.0-5.6 months) and 12.9 months (95% Cl, 8.7-17.1 months), respectively. No significant difference was observed for patients with bone metastasis for different mutations. EGFR genotype and ECOG PS were independent predictors of PFS for both NSCLC patients with and without brain metastasis. Never smoking (P=0.001), exon 19 deletion (P=0.03), EGOC PS (0-1) (P<0.001) and no brain metastasis (p=0.01) were correlated with longer OS for all NSCLC patients. For patients with brain metastasis, age at disease progression (p=0.009), genotype (p=0.02) and EGOC PS (p<0.001) were independent predictors of OS. For patients with bone metastasis, EGOC PS (p<0.001) was an independent predictor for both PFS and OS. Female (P=0.01), never smoking (P=0.005), number of bone metastases (P=0.03) and EGOC PS (0-1) (P=0.002) were related to a longer PFS. EGOC PS (0-1) (P<0.001) was associated with a longer OS. Rash, fatigue, and anorexia were the three most frequent side effects observed No significant side effects difference between exon 19 and 21 mutation groups were observed.
Conclusion:
NSCLC patients harboring exon 19 deletion achieved better PFS and OS than those with L858R mutation, indicating that EGFR mutations are significant prognostic factors for advanced NSCLC patients with and without brain metastasis receiving second-line EGFR-TKIs treatment.
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P3.02b-089 - Treatment of NSCLC Patients with Malignant Pleural Effusion Harboring Exon 19 and 21 EGFR Mutations after First-Line and Second-Line TKIs (ID 5114)
14:30 - 14:30 | Author(s): Z. Zheng
- Abstract
Background:
Recent studies demonstrated a significantly increased frequency of epidermal growth factor receptor (EGFR) gene mutations in non-small cell lung cancer (NSCLC) patients with malignant pleural effusions (MPEs). However, the sensitivity of tyrosine kinase inhibitors (TKIs) in NSCLC patients with MPE for different EFGR mutations was less reported. The purpose of this study is to investigate the effect of first-line and second-line EGFR-TKIs in the treatment of NSCLC with MPEs harboring exon 19 deletion and L858R mutation.
Methods:
From 2010 to 2015, 203 NSCLC patients with MPEs harboring EGFR mutation treated with EGFR- TKIs were reviewed. The efficacy were evaluated with Pearson chi-square or Fisher's exact tests, Log-rank test and Cox proportional hazards model.
Results:
The objective response rate (ORR) and disease control rate (DCR) for patients treated with first-line and second-line EGFR-TKIs were 21.9%, 91.4% and 14.7%, 85.3%, respectively. The overall median PFS and OS of enrolled NSCLC patients with MPE were 9.3 months (95% Cl, 8.4-10.2 months), 20.9 months (95% Cl, 18.9-22.9 months) after first-line TKIs, and 7.6 months (95% Cl, 6.6-8.6 months), 15.3 months (95% Cl, 13.6-15.9 months) after second-line TKIs, respectively. The exon 19 deletion arm had a longer median PFS (9.4 vs. 7.1 months, p=0.003) and OS (16.8 vs. 13.8 months, p=0.003) compared with the L858R mutation arm after second-line TKIs. ECOG PS (PFS: P=0.004; OS: P=0.01) and TNM stage (PFS: P<0.001; OS: P=0.002) were independent predictors of PFS and OS for NSCLC patients with MPE treated by first-line TKIs. ECOG PS (0-1) (PFS: p=0.004; OS: p<0.001) , TNM stage (Ⅳa) (PFS: p=0.04; OS: p=0.007) and exon 19 deletions (PFS: p=0.02; OS: p=0.02) were related to a longer PFS and OS for patients treated with second-line TKIs. Gender was also an independent predictor of OS (p=0.04) for patients treated with second-line TKIs. There was no significant difference on side effects between NSCLC patients with exon 19 and 21 mutations in the first or second-line EGFR-TKIs.
Conclusion:
EGFR genotype was an independent predictor of PFS and OS. No significant side effects differences between the two mutation groups was observed for first or second-line EGFR-TKIs. This study demonstrated that EGFR mutations are significant predictors for advanced NSCLC patients with MPE receiving second-line EGFR-TKIs treatment.
