Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
terminal stage of advanced disease. Crizotinib is a small-molecule tyrosine
kinase inhibitor (TKI) for ALK-rearranged NSCLC patients that can improve
systemic outcomes. Herein, a retrospective analysis of Crizotinib was
performed in advanced ALK-rearranged NSCLC patients with brain
metastases, to explore how Crizotinib affects the control of brain metastases
and the overall prognosis in Chinese population in the real world. Methods:
Advanced NSCLC patients with brain metastases who underwent Crizotinib
treatment at the Cancer Hospital of the Chinese Academy of Medical Sciences
between April 2013 and April 2015 were included. ALK translocation was
determined by FISH, Ventana IHC test or RT-PCR. Brain metastases were
diagnosed by CT or MRI. Results: A total of 34 patients were enrolled, of whom
20 patients had baseline brain metastases at the initiation of Crizotinib
treatment. For patients with baseline metastases, overall survival (OS) after
brain metastases was significantly longer, compared with those developing
brain metastases during Crizotinib treatment (median OS, not reached vs.
10.3 months, p = 0.001). Among all the patients treated with chemotherapy at
the first line, OS after brain metastases in patients with baseline brain
metastases was significantly superior than those without (p = 0.023).
Whereas, patients receiving Crizotinib at the first line with baseline brain
metastases didn’t demonstrate such superior (p = 0.089). Among patients
who developed brain metastases during Crizotinib treatment, for those
receiving chemotherapy at the first line, though the result was not significant
by the cut-off date, time to brain metastases was longer, compared with
patients receiving Crizotinib at the first line (median time to brain
metastases, 17.1 months vs. 10.5 months, p = 0.072).
group had brain metastasis. Among these patients, brain metastasis
progression was observed in 7/15 (46.7%) in the gefitinib group and 0/12 (0%)
in the erlotinib group. Although event (brain metastasis progression)-free
survival was marginally better in the erlotinib group, erlotinib significantly
reduced brain metastasis progression in patients who had brain metastasis
prior to EGFR-TKI treatment compared with gefitinib (P = 0.011, Figure).
Conclusion: Although this was a retrospective analysis involving a small
sample size, erlotinib is potentially more promising than is gefitinib for brain
metastasis in patients with EGFR-mutant NSCLC, especially those with brain
metastasis prior to EGFR TKI treatment.
Keywords: metastasis, brain, EGFR-TKI, NSCLC
POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
BRAIN META –
TUESDAY, DECEMBER 6, 2016
Conclusion: Chinese ALK-rearranged NSCLC patients with baseline brain
metastases may benefit more from Crizotinib than those developing brain
metastases during Crizotinib treatment.
Keywords: non-small cell lung cancer, Brain metastasis, crizotinib, Real world
POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
BRAIN META –
TUESDAY, DECEMBER 6, 2016
P2.03B-019 COMPARISON OF THE EFFICACY OF FIRST-GENERATION
EGFR-TKIS IN BRAIN METASTASIS
Naoto Aiko 1 , Tsuneo Shimokawa 1 , Kazuhito Miyazaki 1 , Yuki Misumi 1 , Akira
Sato 1 , Yoko Agemi 1 , Mari Ishii 2 , Yukiko Nakamura 1 , Hiroaki Okamoto 3
1 Department of Respiratory Medicine, Yokohama Municipal Citizen’S Hospital,
Yokohama/Japan, 2 Department of Medical Oncology, Yokohama Municipal Citizen’S
Hospital, Yokohama/Japan, 3 Department of Respiratory Medicine and Medical
Oncology, Yokohama Municipal Citizen’S Hospital, Yokohama/Japan
Background: Epidermal growth factor receptor tyrosine kinase inhibitors
(EGFR-TKIs) are more effective in patients with advanced non-small-cell lung
cancer (NSCLC) with EGFR mutations, compared with standard
chemotherapy. In Japan, gefitinib, erlotinib, afatinib, and osimertinib have
been approved so far. However, data comparing the efficacies of different
EGFR-TKIs, especially in brain metastasis, are lacking. Methods: EGFR-TKInaive
patients with recurrent or stage IIIB/IV NSCLC with EGFR mutations,
excluding resistance mutations, were enrolled in this study. We
retrospectively analyzed the time to progression of brain metastasis in
patients who received either gefitinib or erlotinib using the Kaplan-Meier
method with the log-rank test. Results: Seventy-eight EGFR-TKI-naive
patients received either gefitinib (n = 56) or erlotinib (n = 22) from April 2010 to
April 2016 in our hospital. During EGFR-TKI treatment, brain metastasis
progression was observed in 10 of the 56 patients (17.8%) in the gefitinib
group and in 1 of the 22 patients (4.5%) in the erlotinib group. Prior to
EGFR-TKI treatment, 15 patients in the gefitinib group and 12 in the erlotinib
P2.03B-020 EGFR EXON 19 DELETION MUTATION PATIENTS OBTAIN
OPTIMAL SURVIVAL IN ICOTINIB TREATED NON–SMALL-CELL LUNG
CANCER PATIENT WITH BRAIN METASTASES
Xiao-Ling Xu 1 , An Zhao 2 , Weimin Mao 2
1 Department of Medical Oncology, Zhejiang Province Cancer Hospital, Hangzhou/
China, 2 Key Laboratory on Diagnosis and Treatment Technology on Thoracic Cancer,
Zhejiang Cancer Hospital (Zhejiang Cancer Research Institute), Hangzhou/China
Background: Lung cancer is characterized by the highest incidence of solid
tumor-related brain metastases. This is also one of the reasons why it can
cause significant mortality. Molecular targeted therapy plays a major role in
the management of brain metastases in lung cancer, which has become the
novel methods for treatment of lung cancer with brain matastases. Our study
aims to explore the efficacy of the EGFR targeted treatments in NSCLC brain
metastases, specially according to EGFR mutation sub-types.
Methods: We collected 116 patients with NSCLC brain metastases who
underwent EGFR-TKIs therapy from 2011-2015 of Zhejiang cancer hospital.
The data were analysed to get progression-free survival for intracranial
disease(MPFSI), median progression-free survival for extracranial
disease(MPFSE), median overall median progression-free survival(MPFS),
median overall survival (MOS), which were evaluated by Kaplan-Meier and
multivariate analysis were performed by Cox model.
Results: The overall response rate for 116 patients with Icotinib treatment
was 61%. No increase in neurotoxicity was detected. The overall response
rate was significant higher with EGFR exon 19 deletion mutation than with
EGFR exon 21 mutation, other type EGFR mutations or EGFR-wildtype (68%
VS 42%). MPFSI, MPFSE and MOS was also significantly longer with EGFR
exon 19 deletion mutation than with EGFR exon 21 mutation, other type EGFR
mutations or EGFR-wildtype (P