Author of

• 20193

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  P3.14 - Radiotherapy (ID 730)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Radiotherapy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 24541

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    P3.14-017a - Extra-Cranial Oligo-Progression upon 1st Line EGFR TKI in Advanced Non-Small Cell Lung Cancer Patients: Outcomes of Local Ablative Radiotherapy (ID 10096)

    09:30 - 09:30  |  Presenting Author(s): Florence Siu Ting Mok
    • Abstract

    Background:
    Continuation of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR TKI) in stage IV Non-small cell Lung cancer (NSCLC) patients harboring sensitive mutation (Exon 19 deletion /Exon 21 L858R mutation) upon first progression according to RECIST criteria were shown to be effective in ASPIRATION study and can prolong the use of EGFR TKI for 3 months till frank disease progression. Local ablative radiotherapy (LAR) on oligo-progression is increasingly advocated but the actual effect is to be determined.
    
    Method:
    Medical and radiotherapy records of patients given LAR from 2012-2017 were screened at a single centre. Patients with stage IV NSCLC harboring sensitive epidermal growth factor receptor (EGFR) activating mutations having extra-cranial oligo-progression and given LAR were included in the study. Patients’ demographics, site of oligo-progression, radiotherapy sites and dose/fractionation schedules were captured. Durations from starting of first line EGFR TKI to LAR was calculated (PFS1). Local progression free survival (L-PFS), overall progression free survival from LAR to further progression that led to stop of EGFR TKI (O-PFS) and overall survival (OS) were analyzed with Kaplan-Meier method.
    
    Result:
    There were 15 eligible patients with total 17 sites of oligo-progressive sites treated. There were 6 male and 9 female patients. The mean age was 59.6 years (36.5-82 years). All were treated with first-generation EGFR TKIs. The median duration PFS1 was 13.0 months (6.0-36.1 months). Treatment sites included 13 lung lesions and 4 bone lesions. The mean equivalent dose (2Gy) was 105Gy (64.5-122Gy). The median follow up time was 13.3 months. Ten out of 15 patients had CEA drop after treatment, with the median duration from treatment to first drop of CEA being 1.7 months. The median L-PFS and OS were not reached. The median PFS2 was 9.7 months (2.2-15.1 months). Eight out of 10 patients had second line/ third line treatment with either afatinib/ osimertinib chemotherapy or immunotherapy. Toxicities of radiotherapy were minimal and only grade 1 pneumonitis or pain flare documented. Duration of PFS1 was not found to affect duration of O-PFS.
    
    Conclusion:
    LAR appears to be a reasonable treatment approach in the event of oligo-progression in patients with advanced NSCLC harboring activating EGFR mutations. Longer follow-up and a larger cohort are underway to assess its impact on survival.