Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
ECOG PS PS0-1 0.62 0.48-0.82 0.001
PS2 0.51 0.23-1.10 0.087
POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
EGFR CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
Presence of liver
metastasis
Presence of brain
metastasis
Yes 0.55 0.33-0.91 0.020
No 0.63 0.48-0.85 0.002
Yes 0.56 0.30-1.06 0.073
No 0.61 0.46-0.80 0.000
P3.02B-092 CENTRAL NERVOUS SYSTEM (CNS) RESPONSES
TO OSIMERTINIB IN BRAIN METASTASES FROM LUNG CANCER
(NSCLC) WITH T790M: EFFECTIVENESS OF THE 80 MG DOSE
Wungki Park 1 , Raja Mudad 2
1 Sylvester Comprehensive Cancer Center, University of Miami, Miami/United States
of America, 2 Sylvester Comprehensive Cancer Center, University of Miami, Miami/
FL/United States of America
Table 1 : Impact of gefitinib on progression free survival in different
subgroups. Conclusion: The study confirms superiority of gefitinib against
the the most active chemotherapy regimen of pemetrexed platinum in EGFR
mutated NSCLC patients.
Keywords: EGFR mutation, NSCLC, Adenocarcinoma, gefitinib
POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
EGFR CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.02B-091 LIVER METASTASES IS THE NEGATIVE PREDICTIVE
FACTOR FOR FIRST-LINE EGFR TKIS THERAPY IN NSCLC PATIENTS
WITH EGFR MUTATION
Tao Jiang, Caicun Zhou
Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University
School of Medicine, Shanghai/China
Background: Whether liver metastases (LM) could predict the treatment
outcome of patients with non-small-cell lung cancer (NSCLC) and epidermal
growth factor receptor (EGFR) mutation receiving first-line EGFR tyrosine
kinase inhibitors (TKIs) remains controversial. Methods: A total of 598
patients with advanced NSCLC receiving EGFR detection were included. 99
NSCLC patients had LM and 56 of them with EGFR mutation received EGFR-
TKIs as first-line therapy. Results: In EGFR mutation group, patients with LM
had shorter progression-free survival (PFS: 7.4 vs. 11.8 months, P = 0.0002) and
overall survival (OS: 20.8 vs. 31.5 months, P = 0.0057) compared to patients
without LM when they received first-line EGFR-TKIs therapy. EGFR-mutated
patients with LM received first-line chemotherapy had similar PFS and OS
to patients without LM (PFS, 4.7 vs. 5.9 months, P = 0.3051; OS, 12.7 vs. 14.5
months, P = 0.3783). In EGFR wild type group, PFS and OS were also similar in
patients with LM vs. without LM (PFS, 6.3 vs. 5.1 months, P = 0.2092; OS, 12.6
vs. 16.2 months, P = 0.4885). Univariate cox regression analyses identified only
never smoking (HR = 0.536, P = 0.012) were significantly associated with better
OS in NSCLC patients with LM.
Background: Patients with progressive CNS metastases from NSCLC who fail
radiation therapy (RT) have a poor prognosis and short survival. Systemic
chemotherapy is not very effective in controlling CNS metastases that
failed RT. Patients with EGFR mutated NSCLC have a higher incidence of
CNS metastases on presentation, and during the course of their illness.
First and second generation tyrosine kinase inhibitors (TKI) at standard or
pulse doses, may produce some clinically significant responses in the brain.
Osimertinib is a potent irreversible EGFR TKI selective for activating EGFR
and T790M resistance mutations. It has improved CNS penetration compared
to older generations TKI. Previous reports have demonstrated the activity
of osimertinib in the CNS at 160 mg. We report two patients who had failed
RT treatment in the brain, who responded very well to the standard dose
of osimertinib at 80 mg. Methods: Retrospective review of the charts of
two patients was performed. Results: A 41-year old man diagnosed with
metastatic adenocarcinoma of the lung with bilateral pulmonary nodules and
3 small brain micro metastases in April 2014. His lung biopsy revealed an EGFR
Del 19. He was treated with cyberknife to the brain and Afatinib/Bevacizumab
with an excellent response that lasted 11 months. Progressive brain
metastases developed in May 2015 and treated with whole brain RT (WBRT).
Lumbar puncture was negative for leptomeningeal disease. He was continued
on Afatinib/Bevacizumab until November 2015, when he progressed in the
lungs and the brain. Repeat lung biopsy revealed an EGFR T790M. He was
not a candidate for additional RT. He was started on osimertinib at 80 mg
in December 2015. Two months later, brain MRI revealed near complete
resolution of the lesions, PET scan showed a significant response. Five
months later, brain MRI remains negative and he remains in near complete
systemic remission. An 84-year old female was diagnosed with multiple
brain lesions in January 2015. Work up revealed a right lung mass, biopsy
showed adenocarcinoma. She received WBRT. Blood-based cell-free DNA
assay (Guardant 360) revealed an EGFR Del 19. She was treated with Erlotinib
for 4 months and developed progression in the lungs. Repeat Guardant 360
revealed an EGFR T790M. Osimertinib 80 mg was started. She remains alive
at 18 months with an excellent response in the brain . Conclusion: These
two cases highlight the significant activity of osimertinib in the CNS at the
standard 80 mg dose. Prospective studies should confirm this finding.
Keywords: osimertinib, T790M, EGFR mutation, CNS metastases
POSTER SESSION 3 – P3.02B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
EGFR CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.02B-093 ZOLEDRONIC ACID ENHANCES THE EFFECTS OF
ICOTINIB ON NON-SMALL CELL LUNG CANCER PATIENTS WITH
BONE METASTASES
Wenxian Wang 1 , Zhengbo Song 2 , Yiping Zhang 3 , Ying Jin 4
1 Chemotherapy, Zhejiang Cancer Hospital, Zhejiang/China, 2 Chemotherapy,
Zhejiang Cancer Hospital, Hangzhou/China, 3 Chemotherapy, Zhejiang Cancer
Hospital, Hangzhou,zhejiang/China, 4 Zhejiang Cancer Hospital, Hangzhou/China
Conclusion: Liver metastases is not only the negative predictive factor for
first-line EGFR-TKIs therapy in NSCLC patients with EGFR mutation but also
predicts poor effect of chemotherapy in NSCLC patients with EGFR wild type.
Keywords: non-small cell lung cancer, Liver Metastasis, EGFR mutation, TKI
Background: Epidermal growth factor receptor (EGFR)-tyrosine kinase
inhibitors (TKIs) are widely used as molecularly targeted drugs for the
treatment of non-small cell lung cancer (NSCLC), with icotinib being one such
EGFR-TKI. Bone metastases occur in 30–40 % of patients with advanced
non-small cell lung cancer (NSCLC). Zoledronic acid is a third-generation
bisphosphonate, and is effective for the reduction of the skeletal-related
events (SREs). In addition, some reports have described the possibility of
direct and indirect antitumor effects of zoledronic acid. However, most of
these studies are preclinical research or combination with chemotherapy.
Methods: We retrospectively analyzed data of 184 patients received icotinib
with progression-free survival more than 6 months and used zoledronic
acid at least once from July 2011 to May 2015 in Zhejiang cancer hospital.
Progression free survival (PFS) and overall survival (OS) were calculated with
the Kaplan-Meier method. Multivariate regression was performed using the
Cox proportional hazards model. Results: A total of 184 NSCLC patients with
bone metastases were treated with zoledronic acid and icotinib. 140 (76.1%)
patients were with EGFR mutations (75 with deletions within exon 19, 63 with
Copyright © 2016 by the International Association for the Study of Lung Cancer
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