Journal Thoracic Oncology

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Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 1 Pulmonary Medicine, Fukushima Medical University, Fukushima/Japan, 2 Department of Pulmonary Medicine, Fukushima Medical University, Fukushima/ Japan Background: Afatinib, an irreversible ErbB family blocker, inhibits EGFR, HER2, and HER4. LUX-Lung 1 and 4 showed that afatinib was effective for patients with EGFR-mutated non-small cell lung cancer (NSCLC) who experienced progression after chemotherapy and gefitinib/erlotinib therapy. LUX-Lung 3 and 6 showed that afatinib had a significantly better response rate and prolonged progression free survival (PFS) compared with pemetrexed plus cisplatin or gemcitabine plus cisplatin in a first-line setting. However, those trials recruited only patients who met inclusion criteria. Thus, the relevance of the outcomes needs to be examined in a clinical setting. Moreover, diarrhea and skin rash are frequently observed in patients receiving afatinib. Establishing optimal management of adverse events is essential to improve clinical outcomes and quality of life in patients receiving afatinib. Methods: We retrospectively reviewed chart records of 15 EGFR-mutated NSCLC patients who had received afatinib from July 2014 to August 2015 at our institution. Results: Median age was 68 years (range, 53–72 years). Fourteen patients had adenocarcinoma. Nine and 4 patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 and 1, respectively. Three and 6 patients were treated as first- and third-line therapies, respectively. Thirteen patients had exon 19 deletion. One patient harbored both an L858R mutation in exon 21 and a de novo T790M mutation in exon 20. PFS of the 3 patients who were treated with afatinib as first-line therapy was 0.9, 6.8, and 16.4 months. Median PFS of 12 patients who had previous EGFR-TKI therapy was 4.0 months (95% confidential interval 2.1–5.9 months). The de novo T790M NSCLC patient experienced disease progression at 1.3 months. The response rate of pretreated patients was 16%. Fourteen patients were treated with afatinib 40 mg/day. One patient began afatinib 20 mg/day because of ECOG PS 2. Dose reduction was required in 8 (53%) patients. Grade 3 or 4 adverse events occurred in 3 (20%) patients. One patient had grade 3 paronychia and another patient had grade 3 diarrhea. Both patients could continue afatinib with dose reduction. Five patients had reduction of afatinib to 30 mg/day and 2 patients required reduction by 10-mg decrements down to 20 mg/day. Conclusion: Clinical outcomes in terms of PFS and objective response rate of afatinib in our EGFR-mutated NSCLC patients with prior therapy were comparable to LUX-Lung 1 and 4. Adverse events were tolerable and manageable with careful dose reduction. Keywords: afatinib, Non-small-cell lung cancer, EGFR mutation POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY EGFR CLINICAL – WEDNESDAY, DECEMBER 7, 2016 P3.02B-068 OUTCOMES OF PATIENTS WITH ADVANCED EGFR MUTATION POSITIVE ADENOCARCINOMA OF LUNG TREATED WITH GEFITINIB IN NORTHERN IRELAND 2010-2016 Michael-John Devlin, Paula Scullin, Lynn Campbell Northern Ireland Cancer Centre, Belfast/United Kingdom Background: First-line treatment with tyrosine kinase inhibitors (TKIs) improves overall response rates (RR) and progression free survival (PFS) within trial populations with advanced adenocarcinoma of the lung harbouring gain of function EGFR mutations, when compared to platinum based doublet chemotherapy. Moreover, TKI therapy is associated with improvement in quality of life and better toxicity profile. Gefitinib was the first such drug to be approved by NICE for this purpose. We aimed to investigate the outcomes of Gefitinib therapy in a non-trial population. Methods: Patients diagnosed with metastatic lung adenocarcinoma, with an EGFR activating mutation and subsequently treated with Gefitinib in Northern Ireland between 2010 and 2016 were identified by means of an electronic database. The Adult Comorbidity Evaluation scale (ACE-27) determined overall co-morbidity scores. Results: Thirty patients received gefitinib for this indication. The majority were female (n= 19, 63%), Caucasian (n=27, 90%) and never smokers (n=13, 54%). Mean age at diagnosis was 63 (43-86) and all were performance status (PS) ≤2. Exon 19 deletion and L848R accounted for 65.5% of mutations. 26 patients were evaluable for response. 3 died prior to CT assessment. Disease control rate was 69% (42% partial response + 30.7% stable disease). Grade 3/ 4 toxicity included rash (3.3%) and hepatotoxicity (13%). Median PFS was 211 days (55-684) and OS was 441 days (61-1428). An ACE-27 score>1 was associated with significantly poorer PFS (57 vs 246d, p=0.0007) and OS (91 vs 549d, p=0.0017), as was PS 2. Compared to other EGFR mutations, patients harbouring L858R also had inferior survival rates (PFS: 130 vs 260 d, p=0.006, OS: 312 vs 563d, p=0.0031). Conclusion: Gefitinib was well tolerated; however RR and PFS were lower than those reported in clinical trial, possibly reflecting our small, unselected population. High ACE-27 score, PS2 and L858R mutation were significantly associated with inferior survival. POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY EGFR CLINICAL – WEDNESDAY, DECEMBER 7, 2016 P3.02B-069 TO ASSESS EFFICACY OF FIRST LINE TKIS IN EGFR MUTANT ADVANCED NSCLC PATIENTS FROM NORTH INDIA Ullas Batra, Pankaj Goyal, Manish Sharma, Mohit Aggarwal, Parveen Jain, Akhil Jain, Rajat Bajaj Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi/India Background: The reversible EGFR tyrosine kinase inhibitors gefitinib and erlotinib are approved for first-line treatment of EGFR mutation-positive non-small-cell lung cancer (NSCLC). However, here is paucity of data on their efficacy from the Indian subcontinent Methods: This is a retrospective analysis including 43 patients. These patients were treated at a tertiary care center in north India. Advanced NSCLC patients (stage IV) having sensitive EGFR mutation who were treated with gefitinib (250 mg per day) or erlotinib (150 mg per day) were analysed for their outcome. Subgroup analysis by EGFR mutation (18,19,20,21), sex and status according to brain metastasis was also done using SPSS. Results: 43 patients with stage IV non-squamous NSCLC with EGFR sensitive mutation were treated with first line TKI. There were 16 male and 27 female patients with mean age of 62.5 years (ranging from 43 to 85 years). Mean PFS for all the patients on first line TKI was 11.63 months Mean PFS for male patients was 9.93 months and for female patients it was 12.7 months . There were 26 patients with exon 19 deletions and 16 with exon 21 mutation and 1 with exon 18 mutation. Mean PFS in patients with exon 19 deletions was 11.11 months and 10.44 months in patients with exon 21 mutation. Mean PFS in patients on erlotinib was 12.27 months (CI 6.2-18.3) and 11.4 months in patients on gefitinib. Twelve patients (27.9%) out of 43 had brain metastases. PFS of these 12 patients was 10.33 months and 12.08 months for patients without brain metastases. Conclusion: Erlotinib and gefitinib significantly improves PFS in patients with sensitive EGFR mutations. PFS is better in female patients, exon 19 mutation/deletion and without brain metastases in North Indian population. Keywords: NSCLC, EGFR mutation, TKIs, PFS POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY EGFR CLINICAL – WEDNESDAY, DECEMBER 7, 2016 P3.02B-070 NSCLC WITH DETECTABLE EGFR MUTATION: INSTITUTIONAL EXPERIENCE Jose Minatta 1 , Lorena Lupinacci 1 , Mercedes Dalurzo 2 , Esteban Mocetti 2 , Jose Lastiri 2 , Maria Labanca 2 1 Oncology, Hospital Italiano, Buenos Aires/Argentina, 2 Pathology, Hospital Italiano, Buenos Aires/Argentina Background: Background: EGFR is one of the most commonly mutated proto-oncogenes in lung cancer. The frequency of such mutations varies from approximately 10% of lung adenocarcinomas in North American and European populations to as high as 50% in Asia. The leucine to arginine substitution at position 858 (L858R) in exon 21 and short in-frame deletions in exon 19 are the most common sensitizing mutations, comprising approximately 90% of cases. Approximately 50% of EGFR TKI resistance is due to a second site mutation, the T790M mutation occurring within exon 20. We describe our experience in patients with lung cancer with detectable EGFR mutation. Methods: Describe S646 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 the epidemiological characteristics and the incidence of mutations in patients diagnosed with advanced NSCLC in our institution. Analyze toxicities and adherence to treatment. Evaluate treatments performed and the problem of the analysis of the biopsy. We analyzed patients from June 2012 to date. Results: We found 61 /326 ( 18.7%) patients with detectable EGFR mutation, 47 women (77 %) and 39% smokers, 47 patients had advanced or unresectable disease. The most common sites of metastases were bone and lymph nodes. 27 of the 61 patients had mutation of exon 19, 27 patients with mutation of exon 21, others in 18 and 20. Five of them with detectable T790M mutation confirmed by repeat biopsy after progressing to ITK. The most common side effects were diarrhea and rash, 12 patients had toxicities which had to reduce dose or discontinue treatment. Conclusion: The most common side effects were diarrhea and rash, 12 patients had toxicities which had to reduce dose or discontinue treatment. We had a low incidence of invalid or not evaluable biopsies. although not all patients with detectable mutation were treated with ITK, who received such treatment had good adhesion and a low percentage of patients had to discontinue treatment Keywords: EGFR, lung cancer, NSCLC POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY EGFR CLINICAL – WEDNESDAY, DECEMBER 7, 2016 P3.02B-071 FIRST-LINE GEFITINIB FOR EGFR-MUTATED LUNG ADENOCARCINOMA PATIENTS WITH BONE METASTASES - A SINGLE INSTITUTION EXPERIENCE Davorin Radosavljevic, Jelena Spasic, Nemanja Stanic, Marija Ristic, Milos Ratknic Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade/Serbia Background: Bone involvement has been considered as an adverse predictive factor in the systemic treatment of majority of malignant tumors. New horizon, opened with targeted agents, especially in lung cancer, faced us with encouraging results of treatment in advanced cancer patient population. Gefitinib, first generation tyrosine kinase inhibitor (TKI), has been a standard first-line treatment for EGFR mutated lung adenocarcinoma patients in Serbia since 2011. Methods: Fifty-one consecutive patients (pts) with advanced lung adenocarcinoma and EGFR mutation were treated with 1 st line gefitinib at IORS since 2011. Fourteen of them were with bone metastases (BM). We compared treatment outcome of BM group (n=14) with group of pts without BM (n=37) in terms of progression-free survival (PFS) and overall survival (OS) Results: In the group of 14 pts with BM F/M ratio was 9/6, median age 57 years (26-64), 5/14 were never smokers. Performance status (PS) 1 had 7 pts, PS2 4 pts and PS3 3 pts. Eight pts had deletion of exon 19, five pts mutation in exon 21, one patient had double mutation G719X/S7681. Bone only metastases had 4/14 pts, additional metastatic sites in 10 pts were as follows: lung in 3 pts, liver in 2 pts, pleura in 3 pts and pericardium in 2 pts. The best therapy response in pts with BM was as follows: partial response in 5 pts, stable disease in 7 pts, progressive disease in 2 pts. Median PFS in BM group was 10.91 months (5.87-15.94, CI 95%) and 5.78 months (3.41-8.15, CI 95%) in the group of 37 pts without BM (log rank p=0.47). Median OS in BM group was 21.95 months (17.68-26.71, CI 95%), 18.17 months (5.95-30.30, CI95%), in pts without BM (log rank p=0.26). Toxicity of gefitinib was as expected and mild: skin rash grade 1 and diarrhea grade 1 in 9 pts, elevated transaminases grade 1 in one patient and grade 2 in one patient. Conclusion: In this small set of TKI treated advanced lung adenocarcinoma patients in 1 st line, somewhat counterintuitive results were achieved: better PFS and OS results for BM group may be attributable to mutations more susceptible to TKI activity (mostly exon 19), absence of brain metastases in this group, good PS in one half of pts. But, it seems that stigma about poor results of systemic treatment in pts with BM should be set aside, at least in case of advanced adenocarcinoma of the lung and TKI. Keywords: adenocarcinoma of the lung, bone metastases, EGFR mutation, gefitinib POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY EGFR CLINICAL – WEDNESDAY, DECEMBER 7, 2016 P3.02B-072 A MULTICENTER PHASE II STUDY OF GEFITINIB IN SQUAMOUS NSCLC PATIENTS WHO FAILED FIRST-LINE CHEMOTHERAPY Hae Su Kim 1 , Tae Kyu Lim 1 , Seung-Hyun Nam 1 , Yoon Hee Choi 2 , Young-Woong Won 3 , Hoon-Gu Kim 4 , Jong-Mu Sun 5 , Jung Hye Kwon 6 , Ki-Hyang Kim 7 , Joung Soon Jang 8 , Jin Hyoung Kang 9 , Bong-Seog Kim 1 1 Division of Hematology-Oncology, Department of Medicine, Veterans Health Service Medical Center, Seoul/Korea, Republic of, 2 Division of Hematology- Oncology, Department of Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan/Korea, Republic of, 3 Hanyang University Guri Hospital, Guri/Korea, Republic of, 4 Gyeongsang National University, Jinju/Korea, Republic of, 5 Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul/Korea, Republic of, 6 Hallym University Medical Center, Seoul/Korea, Republic of, 7 Busan Paik Hospital, INJE University, Busan/Korea, Republic of, 8 Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul/Korea, Republic of, 9 Seoul St. Mary’s Hospital, the Catholic University of Korea College of Medicine, Seoul/Korea, Republic of Background: The role of EGFR tyrosine-kinase inhibitors in the second-line for patients with squamous non-small-cell lung cancer (NSCLC) remains unclear. We conducted a prospective phase II study to assess use of gefitinib in patients with squamous NSCLC as second-line chemotherapy, and investigated the predictive and prognostic value of a proteomic signature using VeriStrat test. Methods: Between December 2011 and October 2015, 56 patients with histologically confirmed, second-line, Stage IIIB or IV NSCLC were enrolled in 9 centres in Republic of Korea. Patients were treated with gefitinib (250 mg per day orally). The proteomic test classification was masked for patients and investigators. The primary end point was disease control rate (DCR) at 8-weeks, and the secondary end points included toxicity, progression-free survival (PFS), overall survival (OS), and correlation between the serum proteomic test classification and treatment. This study is registered with ClinicalTrials.gov, number NCT01485809. Results: The median age was 69 years (range, 41-83) and 55 (98%) patients were male, and 49 (88%) had an ECOG PS of 1. Fifty five (98%) of patients had received platinum-based chemotherapy. The DCR at 8 weeks was 50.0% (95% confidence interval [CI] 34.8-63.4). With a median follow-up of 5.5 months, the median PFS and OS were 2.8 (95% CI 1.3-4.3) and 6.4 (5.4-7.4) months, respectively. The most common adverse event were rash (16 [29%]) and diarrhea (14 [25%]). Pretreatment plasma was available for 50 samples, and VeriStrat testing was successful in 45 samples (90%) with 71% classified as Good. The median PFS were 3.2 (95% CI 1.9-4.7) and 2.4 (1.5-3.3) months for VeriStrat Good vs. Poor patients, respectively (p=0.639). The median OS of VeriStrat Good was longer than those of VeriStrat Poor (11.4 [5.7-17.0] vs 4.8 [2.5-7.0] months), which was not statistically significant (p=0.052). Conclusion: These data suggest that gefitinib is modest activity as second-line chemotherapy in patients with squamous NSCLC. Serum proteomic test using VeriStrat is not prognostic for both OS and PFS among squamous NSCLC patients treated with gefitinib. Keywords: Prospective study, NSCLC, gefitinib POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY EGFR CLINICAL – WEDNESDAY, DECEMBER 7, 2016 P3.02B-073 A PHASE II, LIQUID BIOPSY STUDY USING DIGITAL PCR IN EGFR MUTATED, LUNG CANCER PATIENTS TREATED WITH AFATINIB (WJOG 8114LTR) Hiroaki Akamatsu 1 , Yasuhiro Koh 1 , Satoshi Morita 2 , Daichi Fujimoto 3 , Isamu Okamoto 4 , Akihiro Bessho 5 , Koichi Azuma 6 , Kazuhiko Nakagawa 7 , Nobuyuki Yamamoto 1 1 Respiratory Medicine and Clinical Oncology, Wakayama Medical University, Wakayama/Japan, 2 Kyoto University, Kyoto/Japan, 3 Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe-City/Japan, 4 Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka/Japan, 5 Japanese Red Cross Okayama Hospital, Okayama/ Japan, 6 Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume/Japan, 7 Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama/Japan Background: Liquid biopsy is an ideal strategy to monitor mutation status of cancer repeatedly and less invasively. In chronic myeloid leukemia, early remission of mutated cells was reported as a surrogate of longer efficacy. In epidermal growth factor (EGFR) mutated non-small cell lung cancer (NSCLC), to detect resistant mutation (exon20 T790M) during treatment is clinically important because newer tyrosine kinase inhibitors (TKIs) have been developed. Although some reports have mentioned the utility of liquid biopsy in EGFR mutated NSCLC, most were single-institutional, retrospective studies. Methods: West Japan Oncology Group (WJOG) 8114LTR is a multi-institutional, prospective liquid biopsy study in advanced NSCLC. Chemotherapy naïve, advanced NSCLC patients with EGFR-sensitizing mutation will receive afatinib monotherapy (40 mg/body) until progressive disease (PD) or unacceptable toxicity. Plasma DNA will be obtained from patients at baseline, 2, 4, 8, 12, 24, 48 weeks, and at PD. Three types of common EGFR mutations (exon 19 deletion, exon 20 T790M and exon 21 L858R) will be analyzed using plasma DNA with multiplexed, pico-droplet digital PCR assay (RainDrop® system, RainDance Technologies, Billerica, MA). Copyright © 2016 by the International Association for the Study of Lung Cancer S647
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