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S. Ryan
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P3.02 - Biology/Pathology (ID 620)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.02-054 - Prognostic Implications of ROS1 Positivity in Non-Small Cell Lung Cancer (NSCLC): A Systematic Review of Published Literature (ID 9915)
09:30 - 09:30 | Author(s): S. Ryan
- Abstract
Background:
Oncogenic ROS1 mutations are found to occur in 1-2% of NSCLCs, and efficacy of single-agent Crizotinib (a ROS1 tyrosine-kinase inhibitor) has been demonstrated in ROS1-positive NSCLC. However, our knowledge on the natural disease course in ROS1-positive compared to ROS1-wild type (WT) NSCLC is currently limited. Furthermore, since no randomized prospective trials are likely to be planned to assess treatment outcomes in ROS-1 positive patients, the question whether ROS1-positivity is a favorable or an unfavorable prognostic factor in advanced NSCLC, may remain unanswered. To address this important question, we undertook a systematic review of published literature on the natural history of ROS1-positive NSCLC.
Method:
Databases were mined for published studies on ROS1-positive NSCLC. Studies that included outcomes (either Progression-Free Survival (PFS) or Overall Survival (OS)) with either prior treatment or treatment naïve patients were selected for the analysis. For each study identified, investigators independently extracted and tabulated relevant findings. Data such as ROS1 status, type of diagnostic test, treatment received and response to treatment was extrapolated. To determine if ROS1 status was prognostic, efficacy outcomes (PFS and / or OS) for ROS1-positive patients were compared to the ROS1-WT patients.
Result:
Fifteen publications where survival data for ROS1-positive patients was compared to ROS1-negative patients or other oncogenic driver mutations were selected. Majority (12/15) of these studies were retrospective in nature. Most studies had small numbers of ROS1-positive patients (ranging from 4 to 33). Altogether 179 out of 8292 NSCLC patients were identified as ROS1-positive (2.1%) by various standard diagnostic methodologies. Lack of randomisation and variable study designs limited a formal statistical comparison. The reported benefit in terms of a superior median overall survival (mOS) in ROS1-positive patients was observed in 3 out of 15 studies, whereas 12 out of 15 studies either demonstrated no significant difference or worse clinical outcomes in ROS1-positive vs ROS1-WT patients. Notably, majority of the ROS1-positive patients in the 3 studies showing a superior overall survival received treatment with either Pemetrexed or Crizotinib or Afatinib (an EGFR inhibitor) depending on the absence or presence of concomitant oncogenic driver mutations (EGFR , ALK or KRAS).
Conclusion:
Cumulatively, based on current analyses the body of evidence suggests that ROS1 positivity is unlikely to be a favourable prognostic factor in NSCLC. Importantly, this data may be useful in relatively assessing the impact of emerging therapies such as Crizotinib in ROS1-positive NSCLC patients.
