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Jun Chen
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P3.01 - Advanced NSCLC (ID 621)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.01-021 - A Multicenter, Non-Interventional Study on Real World EGFR Testing and in Patients with IIIB/IV NSCLC in Northern China (ID 8897)
09:30 - 09:30 | Author(s): Jun Chen
- Abstract
Background:
EGFR mutation plays a dominant role in the precise treatment of non-small cell lung cancer (NSCLC), and EGFR-TKIs has been recommended for patients with positive EGFR-sensitive mutation as a standard regimen in clinical practice. In China, application of EGFR-TKIs without knowing EGFR mutation status has been a common phenomenon due to various reasons including the vast territory, uneven distribution of medical resources, differences level of testing technology and others. Therefore, we prospectively conducted a real-world investigation to understand the actual situation of EGFR testing in Northern China, and identify the underlying causes affecting EGFR detection, in order to provide references to improve the standardized treatment.( NCT02620657)
Method:
The patients with IIIB/IV NSCLC who were firstly diagnosed or postoperative recurrence between 2014-1-1 and 2014-12-31 in 28 research centers of Northern China were analyzed. The primary endpoint was testing rate，the secondary endpoints were factors affecting EGFR testing, EGFR mutation status, detection methods and the survival outcomes of patients.
Result:
Among 2809 patients, 2250(90.78%) were adenocarcinoma, 208(7.40%) were squamous carcinoma, 51(1.82%) were other pathologic types. Testing rate was 42.54%(1195/2809) and was significantly related to city level (first-tier cities vs. new first-tier cities vs. second-tier cities vs. third-tier and above cities : 69.04% vs. 38.08% vs. 34.05% vs. 14.11%, P < 0.001), smoking status (never smoking vs. ever smoking vs. smoking: 45.42% vs. 51.10% vs. 33.37%, P<0.001), ECOG PS(0 vs.1vs.2vs.≥3:47.93%vs. 44.48vs.34.89%vs.20.37%, P=0.011), pathological type (adenocarcinoma vs. squamous carcinoma: 44.94% vs.19.23%, P=0.003) and medical insurance situation (social basic medical insurance vs. new rural cooperative medical insurance vs. own expense: 44.98% vs. 36.49% vs. 29.55%, P=0.001). EGFR sensitive mutation rate was 46.44%, the most common subtype was 19Del(42.16%), followed by L858R(40.00%), Exon 20 insertions(1.62%) and other subtypes(16.20%). The most common methodology is ARMS(63.77%), the second common one is DNA sequencing(5.36%). The 1-year and 2-year survival rate in patients receiving EGFR testing was 73.6%and 51.9%, compared with 64.3% and 43.7% respectively in patients without EGFR testing.
Conclusion:
There were regional differences in EGFR testing rates among IIIB/IV NSCLC patients in Northern China. The intention of doctors and patients, medical insurance coverage and differences technical level are major factors affecting the testing rate of EGFR. Approaches should be taken to improve the situation, such as strengthening the training, expanding the coverage of medical insurance, and relying on commercial gene detection companies, and further standardize the molecularly pathological diagnosis and treatment of NSCLC.
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P3.03 - Chemotherapy/Targeted Therapy (ID 719)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.03-029 - ROS1 Alterations in Lung Adenocarcinoma: The Prognostic Role of Rearrangement and Copy Number Variation (ID 10400)
09:30 - 09:30 | Presenting Author(s): Jun Chen
- Abstract
Background:
ROS1 rearrangements define a distinct molecular subset of lung adenocarcinoma and patients (pts) experience significant improvements with oncogene-directed therapies. Break-apart/Split Fluorescence in situ hybridization (FISH) is a commonly used detection method for rearranged genes as well as the copy number variation (CNV). Based upon FISH, we aimed to thoroughly evaluate the prognostic role of ROS1 alterations in lung adenocarcinoma.
Method:
Between 1997 and 2016, 634 pts with complete FISH test data were enrolled and followed for outcome research. According to ratios of separated signals, ROS1 rearrangement status were dichotomized into positive and negative. Due to combinative patterns of the signals, positive ones were divided into typical (separation), atypical (single 3' signal) and rare patterns (single 5' signal), and CNV were divided into normal, amplification and deletion.
Result:
ROS1 rearrangement was present in 24 (3.8%) pts, including 17 (2.7%) typical or atypical patterns and 7 (1.1%) rare patterns. ROS1 rearranged pts confer sensitivity to treatment with ALK/ROS1/MET inhibitor crizotinib as the overall response rate (ORR: CR+PR) is 37.5% and the overall disease control rate (DCR: CR+PR+SD) is 75.0%; for 1st line therapy, these rates are 50.0% and 83.3%, respectively. However, the ORR and DCR were dramatically decreased in 2nd or 3rd line therapy as 25.0% and 25.0%. Overall survival rates differ among three kinds of rearranged patterns; rare pattern pts tend to have the worst prognosis. Multivariate Cox regression analysis indicated that ROS1 rearrangement (hazard ratio [HR], 0.49) was significantly associated with improved overall survival (OS) while disease free survival (DFS) was equivocal (HR=0.66; p=0.22), and CNV was not an independent prognostic factor for both OS and DFS. ROS1-negative pts had worse fatigue and lung cancer symptoms than positive ones, while CNV did not predict recent QOL. Younger age (<60 years), female gender, non-smoker and advanced stage (IIIb-IV) were significant indicators for ROS1 rearrangement.
Conclusion:
ROS1 rearrangement confers favor OS and QOL in lung adenocarcinoma pts and crizotinib induced preferable clinical remission, while CNV showed no exact implications, which might only act as an minor aspect of genetic heterogeneity in tumor cells. Therefore, our results highlight the importance of screening for ROS1 rearrangement in pts with lung adenocarcinoma, which should help to prolong pts’ survival time and maintain or improve QOL.
