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A. Janu
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-021 - FISH and IHC Discordance in ALK Rearranged Non Small Cell Lung Cancer (ID 10474)
09:30 - 09:30 | Author(s): A. Janu
- Abstract
Background:
There is a small proportion of lung cancer patients who are ALK positive by IHC but negative by FISH, or vice versa. Outcome of this subset of patients when treated with crizotinib is not well known. This analysis was planned to study the FISH and IHC discordance in ALK rearranged NSCLC.
Method:
We retrospectively collected data from a prospectively maintained database in medical oncology department. We analyzed 257 patients who had been diagnosed with ALK rearranged NSCLC cancer. Patients who had discordant FISH and IHC findings for ALK were selected for this analysis. Their response rates, progression free survival and overall survival were calculated. Progression free survival and overall survival were estimated using Kaplan Meier method.
Result:
Out of 257 patients, 28 patients (10.9%) had discordance. 7 patients had IHC -ve status while had FISH positive status for ALK rearrangement. 21 patients had vice-versa. The response rate for crizotinib in IHC-/ FISH+ was 57.1% versus 71.4% in IHC+/FISH - group ( p-0.331). The overall median progression free survival was 8.7 months and median overall survival was not reached. There was no statistical difference in PFS and OS between the 2 groups.
Conclusion:
In around 1/10th of ALK rearranged NSCLC patients, FISH and IHC have discordant findings, however these patients also benefit from crizotinib.
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P1.01-023 - ALK-Positive NSCLC: A TMH Experience (ID 10491)
09:30 - 09:30 | Author(s): A. Janu
- Abstract
Background:
ALK gene rearranged NSCLC are a rare subset of lung cancers. However, treatment with crizotinib leads to an improvement in outcomes. In this study, we have audited the outcomes of ALK-rearranged NSCLC at our institute.
Method:
This was a subset analysis of a prospective observational study. It was approved by the institutional ethics committee and was carried out in accordance with good clinical practice guidelines and declaration of Helsinki. For this analysis all Alk rearranged NSCLC patients, diagnosed at our center between November 2011- April 2017 were selected. The treatment received and the outcomes were noted. Progression-free survival and Overall survival were estimated using Kaplan-Meier method.
Result:
We had diagnosed 257 patients during this period. The median age was 50 years ( 23-77 years). There were 102 females (39.7%) and 155 males (60.3%). Only 49 patients were smokers (19.1%). The ECOG PS was 0-1 in 197 patients (76.7%), 2 in 28 patients (10.9%) and 3-4 in 32 patients (12.4%). The median number of sites of metastasis was 2 (0-7). Brain metastasis was seen in 36 patients (14.0%). The upfront treatment received was crizotinib in 168 patients (65.3%), pemetrexed -platinum doublet in 57 patients (22.2%), taxane-platinum in 4 patients (1.6%), gemcitabine-platinum in 4 patients (1.6%), others in 14 patients (5.4%). The crizotinib received was started upfront in 88 patients and after a few cycles chemotherapy in 80 patients. In these 80 patients, 53 patients were started as soon as the ALK rearrangement report was available while 27 patients were started after a few cycles once finances were available. The median PFS for crizotinib was 16.1 months versus 11.4 months in pemetrexed platinum (p-0.159) The median PFS in the patients receiving upfront crizotinib was 17.1 months versus 14.7 months in patients receiving crizotinib after the switch (p-0.399). The median overall OS was 39.9 months and it was similar between the two strategies of crizotinib(p-0.964). There were 57 patients (22.1%) who never received crizotinib. The median OS in patients who never received crizotinib was 11.0 months versus it was not reached in patients receiving crizotinib in any line (p-0.000). The 3 year OS in patients receiving crizotinib in any line was 67.0%.
Conclusion:
Crizotinib substantial improves outcomes in ALK-rearranged patients whether given upfront or post start of few cycles of chemotherapy.
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-051 - Randomized Study of Pemetrexed Versus Erlotinib as Maintenance Therapy in Metastatic /Locally Advanced EGFR Mutation Negative NSCLC (ID 10362)
09:00 - 09:00 | Author(s): A. Janu
- Abstract
Background:
Maintenance treatment of locally advanced or metastatic non small cell lung cancer ( NSCLC ) other than predominantly Squamous cell histology in patients whose disease has not progressed following 4 to 6 cycles of platinum based doublet therapy has been standard of care . Pemetrexed and Erlotinib both have been used as either continuous maintenance or switch maintenance therapy.
Method:
All patients of NSCLC other than the Squamous cell carcinoma , who have completed either 4 or 6 cycles of platinum and pemetrexed and have either CR /PR/SD on response assessment scan post induction treatment and willing to participate in study ,were randomized to receive either pemetrexed or erlotinib . Quality of life (QoL) questioners were collected every 8 weeks till disease progression or unacceptable toxicities. Patients were followed up till death. PFS and OS were calculated for each arm and indirectly compared.
Result:
Two hundred patients were randomized to receive either pemetrexed or erlotinib) from November 2014 to March 2017. Median age of cohort was 55 (28-79).One hundred and thirty two patients were male and 68 were female. PS was 0-1 in 195 patients. Sixty three percent were smokers (126/200). Majority of patients (62.5 %) has stable disease post completion of induction chemotherapy (125 /200).Median number of cycle of maintenance pemetrexed was 4 (4-6). Median PFS in pemetrexed arm was 4.46 month ( 95 % confidence interval (CI); 3.98 to 4.95 ) while in erlotinib arm median PFS was 4.5 month ( 95 % CI ; 3.98 to 4.95),( hazard ratio , 0.98 ; 95% CI , 0.714 to 1.369 , p value 0.945).Median OS from starting induction chemotherapy in pemetrexed arm was 16.56 months ( 95 % CI ; 14.83 to 18.29 ) while in erlotinib arm median OS was 18.33 months ( 95% CI ; 13.74 to 22.92),(hazard ratio , 1.23 ; ( 95 % CI ; 0.829 to 1.831 , p value 0.0302)
Conclusion:
Maintenance treatment with pemetrexed and erlotinib has similar PFS and OS in indirect comparison. QoL analysis in both arms is ongoing.
