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P. Incharoen
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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-017 - Sequence of EGFR-TKI Therapy and BIM Deletion Polymorphism Affect the Outcome of Treatment in EGFR Positive NSCLC (ID 4096)
14:30 - 14:30 | Author(s): P. Incharoen
- Abstract
Background:
Bcl-2- like protein 11 (BIM) is a key protein in promoting apoptosis. BIM deletion polymorphism has been proposed as the intrinsic EGFR-TKI resistance and to predict poor response to EGFR-TKI treatment. However, there were conflict results of BIM deletion as the predictive biomarker in previous studies and EGFR-TKI reimbursement is a problem in most low and middle income countries. This study evaluated sequence of EGFR-TKI therapy and role of BIM deletion to maximize the cost-effectiveness of treatment in Thai population.
Methods:
Advanced EGFR-positive NSCLC patients were identified from database between 9/2012 and 12/2014. Retrospective review of 185 medical records was performed. Only 139 patients received EGFR-TKI. Archive tissues were available 129 samples. RT-PCR amplification designed to detect BIM deletion (2903 bp) in intron 2. The correlations of BIM deletion, sequence of EGFR-TKI, and survivals were analyzed.
Results:
Prevalence of BIM deletion was 26/129 (20.2%). Median follow-up time was 17.4 months. BIM deletion patients had trend of shorter both PFS and OS compared to wild-type. L858R patients who received first-line EGFR-TKI had significant longer PFS and higher RR compared to whom received later-line EGFR-TKI (12.6 vs 6.3 mos, P=0.03), (78% vs 49%), respectively. OS in EGFR-positive NSCLC was significantly longer in patients whom received EGFR-TKI compare to chemotherapy alone (28.9 vs 7.4 mos, HR= 0.25 [0.16-0.40], P<0.001). The absolute OS difference between patients whom received EGFR-TKI compared to chemotherapy alone was significantly longer in BIM wild-type group (28.9-7.4=21.5 months) compared to BIM deletion group (25.8-17.9=7.9 months). Figure 1
Conclusion:
BIM deletion polymorphism could be one of the predictive biomarker to maximize the benefit of EGFR-TKI treatment. Furthermore, L858R patients have longer survival if received EGFR-TKI as the first-line treatment. These results could help the low and middle income countries to maximize the cost-effectiveness and to solve reimbursement problem of EGFR-TKI therapy.
