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H. Wang
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-013 - Uncommon Mutation Types of EGFR and Response to EGFR Tyrosine Kinase Inhibitors in Chinese Non-Small Cell Lung Cancer Patients (ID 8076)
09:30 - 09:30 | Author(s): H. Wang
- Abstract
Background:
Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is the standard therapy for advanced lung adenocarcinomas with common EGFR mutations. However, the efficacy of EGFR-TKIs in patients with these uncommon EGFR mutations (other than exon 19 deletions or exon 21 L858R mutation) remains undetermined.
Method:
Seven hundred and fifty-five non-small cell lung cancer (NSCLC) patients with EGFR mutation analyses for TKI therapy were identified between October 2010 and December 2015 in East of China. And 66 patients bearing uncommon EGFR mutations were included to collect data from TKI response and prognosis.
Result:
Rare sensitive mutations (G719X, L861Q, S768I), primary resistant mutation (Ex20 ins), and complex mutations (G719X + L861Q, G719X+S768I, 19 del+T790M, 19 del+L858R, L858R+S768I, and L858R+T790M) of EGFR were identified in 37 (56.1%), 9 (13.6%), and 20 (33.3%) patients, respectively. TKI treatment in patients harboring uncommon EGFR mutations exhibited a tumor response rate of 28.8% and a median progression-free survival (PFS) of 4.8 months. Importantly, patients with complex EGFR mutations had significantly longer PFS when compared with the remaining sensitizing rare mutations or Ex20 ins (8.6 versus 4.1 versus 3.1 months; p=0.041). Furthermore, complex EGFR mutations were independent predictors of increased overall survival in NSCLC patients (Hazard Ratios=0.31; 95% confidence intervals: 0.11-0.90; p=0.031). Among them, patients harboring Del-19 compound L858R mutations showed a tendency to have higher response rate and improved median PFS than those regarding patients with other complex mutations patterns (66.7% verse14.3%, p=0.021; 10.1 verse 8.6 months, p=0.232).
Conclusion:
Personalized treatment should be evolving in different types of uncommon EGFR mutations. And complex mutations of EGFR may benefit more from EGFR-TKIs than other uncommon mutations in Chinese NSCLC patients.
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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): H. Wang
- 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.
