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X. Yu
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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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P2.01-057 - Activity of Pemetrexed on Wild-Type and Unknown Status EGFR Genes with Brain Metastases from Non-Small Cell Lung Cancer (ID 10612)
09:00 - 09:00 | Author(s): X. Yu
- Abstract
Background:
Brain metastases (BM) are a common cause of morbidity and mortality in patients with non-small-cell lung cancer (NSCLC). For patients with wild-type EGFR genes, therapeutic options for BM are even limited. Besides local therapy, pemetrexed is the preferred chemotherapy in NSCLC, but the efficacy of this treatment is uncertain. This study evaluated the efficacy of wild-type and unknown status EGFR patients with BM receiving pemetrexed based chemotherapy and analyze the prognostic factors.
Method:
We retrospectively studied 138 EGFR wild-type and unknown EGFR status patients with BM, who had received first line pemetrexed based chemotherapy between 2010 and 2015 at Zhejiang Cancer Hospital. Unknown EGFR status patients were treated with EGFR TKIs after progression. Patient follow-up by telephone was done until January 2016. Treatment response was evaluated and survival data were collected and analyzed.
Result:
Among the 138 patients, 49(35.5%) were EGFR wild type and 89(64.5%) were unknown EGFR status. And 80(58.0%) received whole-brain radiotherapy (WBRT), 19(13.8%) received stereotactic radiosurgery (SRS)/surgery, 10(7.2%) were treated with WBRT plus SRS/surgery, 29(21.0%) didn’t receive any local therapy. The median overall survival (OS) from diagnosis of BM was 21.0 months for the whole cohort (95% CI, 17.2-24.8 months), the intracranial progression-free survival (iPFS) was 9.5 months (95% CI, 6.6-12.4 months) and extracranial PFS was 8.3 months (95% CI, 6.9-9.7 months). Patients with unknown EGFR status had a longer iPFS and OS than EGFR wild-type (11.7 vs. 7.6 months, P=0.23; 24.0 vs. 17.7 months, P=0.24). The combination of pemetrexed and platinum showed better iPFS than single agent of pemetrexed in patients, although it did not reach statistical significance (10.7 vs. 7.2 months, P=0.27). Patients with more than 6 cycles of chemotherapy tend to have longer iPFS and OS than those who received less than 6 cycles or 4 cycles (12.6 vs. 10.3 vs. 8.3 months, P=0.52; 47.9 vs. 27.9 vs. 19.2 months, P=0.18).
Conclusion:
Pemetrexed shows good tolerability and efficiency in EGFR wild-type and unknown EGFR status patients with brain metastases from advanced NSCLC, and have a good control of activity on brain localizations.
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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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P3.01-069 - Three Treatments for EGFR-Mutant Non-Small-Cell Lung Cancer with Brain Metastases (ID 10610)
09:30 - 09:30 | Author(s): X. Yu
- Abstract
Background:
Brain metastases (BM) are a common cause of morbidity and mortality in patients with non-smallcell lung cancer (NSCLC). EGFR-TKIs, whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and chemotherapy are treatment options available. But the optimal management, the combination or sequence, remains undefined. This study evaluated the efficacy of EGFR-mutant NSCLC patients with BM receiving multiple regimens and analyze the prognostic factors.
Method:
We retrospectively studied 45 EGFR-mutated NSCLC patients with BM, who had received EGFR TKIs、radiation therapies (WBRT or SRS) and pemetrexed based chemotherapy successively between 2010 and 2015 at Zhejiang Cancer Hospital. Patient follow-up by telephone was done until January 2016. Treatment response was evaluated and survival data were collected and analyzed.
Result:
Among the 45 patients, 22(48.9%) had an EGFR exon 19 deletion and 23(51.1%) had an EGFR exon 21 L858R mutation. Thirty (66.7%) patients received upfront radiation therapies (RT). 28 patients (62.2%) were treated with pemetrexed based chemotherapy as the first line treatment while 17 (37.8%) received first line EGFR TKIs instead. The median overall survival (OS) from diagnosis of BM was 28.0 months for the whole cohort (95% CI, 17.3-38.7 months). Patients with the exon 19 deletion had a longer median OS than patients with the exon 21 L858R mutation (not reached vs. 23.2 months, P=0.031). There was no difference in OS between the upfront RT group and the deferral group (26.5 vs. 28.0 months, P=0.57), and similar results were found between the first line chemotherapy group and the TKIs group (28.0 vs. 23.2 months, P=0.499). Patients with a higher GPA score showed better survival. In multivariate analysis, the prognosis was correlated with EGFR mutation type (P=0.017). Patients with extracranial metastases showed the strongest trend toward decreased OS, although it did not reach statistical significance (P = 0.070).
Conclusion:
Applying three treatments can significantly improve OS of patients, especially those with EGFR exon 19 deletion. Different sequences of treatments and timing of RT need further studies to identify the optimal treatment model.
