Annual Meeting Proceedings Part 1 - American Society of Clinical ...

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464s Lung Cancer—Non-small Cell Local-Regional/Small Cell/Other Thoracic Cancers 7052 General Poster Session (Board #36C), Sat, 1:15 PM-5:15 PM 5-day dosing schedule of temozolomide in relapsed sensitive or refractory small cell lung cancer (SCLC) and methyl-guanine-DNA methyltransferase (MGMT) analysis in a phase II trial. Presenting Author: Alexander Edward Dela Cruz Drilon, Memorial Sloan-Kettering Cancer Center, New York, NY Background: MGMT promoter methylation and loss of MGMT activity are associated with improved sensitivity to alkylating agents. We recently reported that the oral alkylating agent temozolomide is active in 2nd- and 3rd-line treatment of relapsed SCLC at 75mg/m2 /day for 21 out of 28 days (Pietanza et al, Clin Can Res 2012). Here we evaluate the 5-day dosing schedule of temozolomide in a second cohort of patients and analyze MGMT activity in both cohorts of patients on the same study. Methods: Patients with disease progression after 1 or 2 prior chemotherapy regimens received temozolomide at 200mg/m2 /day for 5 out of 28 days (n�25). Those with sensitive (S-SCLC, n�16) and refractory (R-SCLC, n�9) disease were enrolled to assess safety. Available tumor tissue from patients treated according to either schedule was assessed for MGMT promoter methylation status by PCR and MGMT expression by immunohistochemistry (IHC). Results: An overall response rate of 12% was noted (3 partial responses: 1 S-SCLC, 2 R-SCLC). 4 patients had stable disease for at least 3 cycles. Median progression-free survival and overall survival for all patients were 1.3 months and 7.9 months, respectively. Grade �3 thrombocytopenia and neutropenia was observed in 20% with a shorter mean duration of myelosuppression compared to the 21-day schedule. Results from MGMT evaluation of tumor samples from both dosing schedules were combined. Promoter methylation of MGMT was not significantly associated with response (p�0.23). However, patients that lacked MGMT expression by IHC had a higher response rate compared to those with MGMT-positive tumors (43% vs. 13%, p � 0.052; see table). Conclusions: The 5-day dosing schedule of temozolomide is both active and safe in patients with relapsed SCLC. A strong trend toward increased response was demonstrated in patients with MGMT-negative tumors compared to patients with MGMT-positive tumors by IHC. A trial combining temozolomide with the PARP inhibitor, ABT888, is planned. MGMT expression by IHC (n�38) PR Response SD � POD p Negative (n � 14) 43% (n�6) 57% (n�8) 0.052 Positive (n � 24) 13% (n�3) 88% (n�21) 7054 General Poster Session (Board #36E), Sat, 1:15 PM-5:15 PM Are the presenting characteristics and prognosis of primary salivary gland-type lung cancers (SG) similar to those of other non-small cell lung cancers (NSCLC)? Presenting Author: John M. Varlotto, Penn State Hershey Cancer Institute, Hershey, PA Background: SG, both adenoid cystic (ACC) and mucoepidermoid (ME) sub-types, are rare lung cancers. We choose to investigate the incidence of these rare sub-types and assess their difference in presentation and prognostic characteristics in comparison to adenocarcinomas (Ad) and squamous cell carcinomas (SCC) during the same time period. Methods: The SEER-17 database was used to collect data during the years 1988- 2008. Differences between populations were determined by the chi-square test. Survival curves were generated as Kaplan-Meier techniques. Cox proportional hazards test was used to compare survival differences. Results: During the 20-year study period, ACC (n �100) and ME (n� 178) accounted for 0.03% and 0.06% of NSCLCs. Mean follow-up was 34.5 months for all patients. In comparison to ACC, patients with ME were significantly more likely to be younger (52 yr vs. 60yr), Asian(11.7% vs. 7%), have Stage I disease (62.9% vs 24.0%), and less likely to be in the mainstem bronchi (17.2% vs. 6.3%). In comparison to patients with patients presenting with either SCC or Ad, both ME and ACC were significantly less likely to present with Stage IV disease (26.6% SCC, 41.29% Ad, 16.73% SG), have nodal involvement (35.1% SCC, 27.4% Ad, 23.37% SG), and be older (70 SCC, 68 Ad, 58 years SG). Stratified by stage and treatment, there was no survival (OS) or disease-specific survival difference (DSS) between ACC and ME. The OS of the combined group of ME and ACC was significantly better stage per stage than either Ad (Hazard ratio (HR) range � 0.26- 041), and SCC (HR range � 0.17-0.56). Lung Cancer-Specific survival at 2,3,5 years for surgically-resected Stage I ACC and ME were 83.5%, 80.4%, and 80.4%; and 82.6%, 78.0% and 78%, respectively. Conclusions: Patients with ACC and ME have rare sub-types of lung cancer that present differently and have better survival than patients presenting with either of the more common histologic sub-types (SCC and Ad) of NSCLC. We encourage prospective, multi-institutional studies of these rare sub-types so that care can be optimized. Optimal care may differ for SG because of their stage per stage better prognosis than other NSCLCs. 7053 General Poster Session (Board #36D), Sat, 1:15 PM-5:15 PM High-throughput targeted resequencing of lung adenocarcinoma. Presenting Author: Byung Chul Kim, Personal Genomics Institute, Genome Research Foundation, AICT, Suwon, South Korea Background: The mutational profiles are crucial for cancer diagnosis and classification, which lead to tailoring the best therapeutic strategy to each patient. Here, we present target sequencing of 30 hot spot genes in lung adenocarcinoma to identify new hot spot mutations in never-smoker, female lung adenocarcinoma patients. Methods: We targeted 30 genes that are known to be mutated frequently in lung adenocarcinoma. The exome capture was done using selector technology and sequencing was done using Illumina GA IIx Genome Analyzer. Exomic short reads from Illumina Pipeline 1.4 were aligned to human genome (NCBI build 36) with BWA 0.5.0. Variations and small indels were called by Samtools 0.1.7 and filtered by custom R scripts. Potential effects of these identified alterations were assessed with sequence analysis. Results: On average, 1.5 billion bases were uniquely mapped, and mean depth and coverage of exon regions were 38X and 96%, respectively. Filtering of data against public SNP database (dbSNP130), resulted in ~2,000 novel genetic alterations per sample, including single nucleotide variations, and small insertion and deletions in protein-coding regions. Among them, there were novel variants in LTK and EPHA5 genes. Conclusions: Our results demonstrated the feasibility of high-throughput mutation profiling with lung adenocarcinoma samples. We identified novel variants in hot target genes, which may provide an insight into the tumorigenesis signaling of lung adenocarcinoma. 7055 General Poster Session (Board #36F), Sat, 1:15 PM-5:15 PM Would screening benefit 75- to 84-year-old patients with non-small cell lung cancer (NSCLC)? Presenting Author: Jessica Lake, Penn State College of Medicine, Hershey, PA Background: The Lung Cancer Screening Trial has shown an overall survival (OS) benefit and reduced lung cancer mortality in the 55-74 age group (gp). We chose to evaluate whether NSCLC patients aged 75-84 are increasing in the USA and whether they would benefit from aggressive therapy. Methods: SEER-17 was used to calculate NSCLC rates during the years 2000-2008. SEER-9 was used to estimate the proportional change in both 55-74 and 75-84 gp from 1973-2008. OS was analyzed in a modern population from SEER-17 (2004-2008) to assess the effects of increasingly aggressive therapy (observation(Ob), radiation (RT) or lobectomy (LB)) for a proposed screening population with T1N0 tumors. Chi-square test and Cox Regression (CR) were used to evaluate OS. Paired T-tests assessed changes in rates and proportions over time. Results: The 55-74 gp rose from 64.4% in 1973 to 67.25% in 1984, but fell to 58.8% by 2008, while the 75-84 gp rose from 12.1% in 1973 to 24% in 2008 (p�0.01), similar in both sexes. The rates/100,000 have been increasing in the 75-84 gp (p�0.02), mainly in females (p�0.003) while the rates in the 55-74 gp did not vary, but fell for men (p�0.03). In the Ob gp (n�1344), NSCLC was the most common cause of death (COD) in the 55-74 (29.8%) and 75-84 gp (40.6%), more than all other CODs combined (median survival (MS) � 11mn). CR revealed that OS was associated with the 55-74 gp (0.59) and females (0.62) (p � 0.001). In the RT gp (n�1870), MS was 14mn and lung cancer was the most common COD at 27.7% (55-74) and 28.8% (75-84), again more than all other CODs combined. CR found that females (0.68) and black race (0.72) had better OS (p�0.017), but age was not. MS was 24 mn in the LB group (n�9384). COD from NSCLC and all other CODs was 8.2% and 6.1% (55-74) and 10.9% and 11.4% (75-84). CR showed that 55-74 (0.36), females (0.58), and Asians (0.73) had lower death rates (all p�0.015). Mean OS between the 55-74 (26.0) and 75-84 (24.2) gp showed a small yet significant difference. Conclusions: Rates and proportions of NSCLC have been steadily increasing in the 75-84 gp. These data show that COD by lung cancer decreased significantly with increasingly aggressive treatment and treatment reduced the effects of age gp on survival. We feel that screening may be of benefit to the 75-84 gp. Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.
Lung Cancer—Non-small Cell Local-Regional/Small Cell/Other Thoracic Cancers 7056 General Poster Session (Board #36G), Sat, 1:15 PM-5:15 PM Prognostic value of MAGE-A3 and PRAME gene expression in non-smallcell lung cancer (NSCLC). Presenting Author: Albert Linder, Lungenklinik Hemer, Hemer Nordrhein-Westfalen, Germany Background: We investigated the expression of some cancer–testis genes and their association with disease prognosis. Here we report our results for the expression, in resected NSCLC samples, of two tumor-specific antigens (Ags): MAGE-A3 and PRAME, both under evaluation in clinical trials. Methods: We conducted a single-center, uncontrolled, retrospective study of tissue from resected stage I–III NSCLC patients (pts): 650 were in stage I, 215 in stage II and 395 in stage III. 1260 FFPE tumor tissue samples from the tumor tissue bank of the Department of Pathology, Lungenklinik Hemer (Germany), were tested for MAGE-A3 and PRAME expression by specific qRT-PCR assays. The prognostic value of these Ags was determined by estimating the median overall survival (OS), disease-free interval (DFI) and disease-free survival (DFS). Results: Expression rates were 36% for MAGE-A3 and 66% for PRAME. The co-expression rate was 30%. Almost all tumors expressing MAGE-A3 also expressed PRAME. We observed no difference overall in Ag expression according to stage, tumor size and pts’ age. Squamous tumors expressed MAGE-A3 and PRAME more frequently than did adenocarcinomas (43 vs. 27 % and 80 vs. 44% respectively), and PRAME expression rates were higher in males than in females (70 vs. 53%). In the overall population, which included stages IA–IIIB, no prognostic value was detected for the expression of either Ag. In subset analyses, we found in 83 stage IIIB pts a trend to worse OS linked to MAGE-A3 expression (HR�1.977, p�0.0312). In 395 stage IB pts, PRAME expression was associated with worse OS (HR�1.483, p�0.0344) and DFS (HR�1.492, p�0.0167). Conclusions: The MAGE-A3 expression rate found is consistent with the results observed in the phase III MAGRIT trial (J-H Kim et al., 2011). No prognostic value for either PRAME or MAGE-A3 was observed in the overall population, in contrast to previous reports with smaller sample sizes (Gure et al., 2005, Boli et al., 2002) and in other tumors (Vourch’jourdain et al., 2009, Epping et al., 2008). We observed a trend toward poor prognostic value of MAGE-A3 in stage IIIB pts and of PRAME in stage IB pts. 7058 General Poster Session (Board #37A), Sat, 1:15 PM-5:15 PM Prognostic role of FOXP3/CD4 ratio in resectable NSCLC. Presenting Author: Marta Usó, Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain Background: Tregs play a critical role in immune tolerance to tumor cells and have been related to prognosis. The aim of this study was to determine the expression of Tregs makers genes by RT-PCR and to correlate them with clinico-pathological and prognostic variables in NSCLC. Methods: RNA was isolated from frozen lung specimens (tumor and normal lung) from resectable NSCLC patients (n�175). RT-PCR was performed to analyze the expression of: CD4, CD8A, CTLA-4, FoxP3, IL-10, CD25, CD127 and TGF�-1. Relative expression was normalized by an endogenous gene (GUSB) using the Pfaffl formulae. Statistical analyses were considered significant at p�0.05. Results: Tumor samples had significantly lower expression of CD127 (x0.45) and a tendency toward higher expression of CD25 (x1.81), FoxP3 (x1.57) and CTLA-4 (x1.53) compared to normal lung tissues, reflecting a Treg phenotype infiltrating the tumor. Survival analyses revealed that patients with higher FoxP3 expression had reduced OS (median 29.8 vs 67 months, p� 0.026). We also found that those patients with high levels FoxP3/CD4 ratio had worse TTP and OS (median 22.1 months vs NR, p� 0.021 and 29.8 vs NR months, p�0.003, respectively). A multivariable Cox regression model for TTP and OS was built using variables that were found significant in the univariate analysis (nodal involvement, histology, tumor size, PS, and FoxP3/CD4 ratio). This analysis revealed that FoxP3/CD4 ratio was an independent prognostic marker for both TTP and OS (see table). Conclusions: FoxP3 is a transcription factor necessary and sufficient for induction of the immunosuppressive functions in Tregs. In concordance, our results indicate that higher levels of FoxP3/CD4 ratio in tumor samples is a poor prognostic markers for TTP and OS. Furthermore, the multivariable COX regression analysis showed that FoxP3/CD4 ratio is an independent prognostic marker. Therefore, this ratio could be used as a new biomarker of prognosis in resectable NSCLC. Supported by grants PS09-01149 and RD06/0020/1024 from ISCIII. TTP OS HR 95% IC P HR 95% IC P Histology 1.14 1.01-1.29 .027* - - - Nodal involvement 1.38 1.06-1.81 .016* 1.34 1.00-1.80 .045* Tumor size 2.505 1.449-4.330 .001* 2.030 1.173-3.512 .011* FoxP3/CD4 ratio 2.11 1.24-3.63 .006* 2.42 1.38-4.24 .002* 465s 7057 General Poster Session (Board #36H), Sat, 1:15 PM-5:15 PM Prognostic value of pathologic complete response to preoperative chemotherapy in early-stage non small cell lung cancer: Combined analysis of two IFCT randomized trials. Presenting Author: Guillaume Mouillet, University Hospital, Besançon, France Background: Our study aimed to evaluate whether pathologic complete response (pCR) in early-stage non-small cell lung cancer (NSCLC) following neoadjuvant chemotherapy resulted in improved outcome and to determine predictive factors for pCR. Methods: Eligible patients with stage IB or II NSCLC were included in two consecutive Intergroupe Francophone de Cancérologie Thoracique (IFCT) phase III trials evaluating platinum-based neoadjuvant chemotherapy, with pCR defined by the absence of viable cancer cells in the resected surgical specimen. Results: Among the 492 patients analyzed, 41 (8.3%) achieved pCR. In the pCR group, 5-year overall survival (OS) was 80.0% compared to 55.8% in the non-pCR group (p�0.0007). In multivariate analyses, pCR was a favorable prognostic factor of OS (RR�0.34; 95% CI�0.18-0.64) in addition to squamous cell carcinoma (SCC), weight loss �5%, and stage IB disease. Five-year disease-free survival (DFS) was 80.1% in the pCR group compared to 44.8% in the non-pCR group (p�0.0001). Two patients (4.9%) in the pCR group experienced disease recurrence compared to 193 patients (42.8%) in the non-pCR group. SCC subtype was the only independent predictor of pCR (OR�4.30; 95% CI�1.90-9.72). Conclusions: Our results showed that pCR after preoperative chemotherapy was a favorable prognostic factor in Stage IB-II NSCLC. Our study is the largest published series evaluating pCRs following preoperative chemotherapy. The only factor predictive of pCR was SCC. Identifying molecular predictive markers for pCR may help in distinguishing patients likely to benefit from neoadjuvant chemotherapy and in choosing the most adequate preoperative chemotherapy regimen. 7059 General Poster Session (Board #37B), Sat, 1:15 PM-5:15 PM A systematic analysis of high-dose radiation in the treatment of surgically unresectable, locally advanced non-small cell lung cancer. Presenting Author: Madhusmita Behera, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA Background: The 5-year survival rate for locally advanced non-small cell lung cancer (NSCLC) is � 25% with concomitant chemoradiotherapy. High-dose radiation appears to confer additional benefit based on surrogate endpoints from relatively small clinical trials. However, survival advantage of higher-dose radiation delivered by conventional fractionation of 1.8-2 Gy is unclear. We conducted a systematic review of pooled outcome data from published results of studies that evaluated the role of high-dose radiation in the management of locally advanced NSCLC. Methods: A detailed search of published clinical trials was conducted using computerized databases (MEDLINE, EMBASE, Cochrane library) and meeting proceedings. Single arm studies using high dose (�66Gy) or randomized trials of high versus standard radiation dose (60-63Gy) for locally advanced NSCLC were selected. A systematic analysis of extracted data was performed using Comprehensive Meta Analysis (Version 2.2.048) software under the random effect model. Clinical outcome in patients treated with high versus standard radiation dose was compared using point estimates for weighted values of median overall survival (OS), progression free survival (PFS), and response rate (RR). Treatment-related toxicities data between the two arms was compared using T-test and chi-square test. Results: Analytic data was retrieved from the results of 44 eligible studies reported between 1994 and 2012. The studies enrolled 3699 patients, 62% males, 2095 and 1604 treated with standard and high dose radiation respectively. The weighted median age was 63 and 61 years (p�0.66) for standard and high dose patients respectively. The weighted median OS was 19.1 vs. 16.4 months (p� 0.97); weighted RR of 76% vs. 70% (p�0.79) and survival rates after up to 3 years of follow up of 39% vs. 46% (p�0.45) for standard and high dose arms respectively. There was no significant difference in the rate of grade �3 toxicities between the two treatment groups. Conclusions: High-dose radiation therapy does not result in improved survival over standard radiotherapy dose in patients with locally advanced NSCLC. Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.
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Volume 30, Issue 15S, Part I of II
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Editor: Michael A. Carducci, MD Man
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Volume 30, Issue 15S Supplement to
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2012 ASCO Annual Meeting Proceeding
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Author Index Note: Numerals refer t
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Alexanian, Raymond 8093 Alexeev, Bo
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Arkenau, Hendrik-Tobias 2540, 3000,
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Ballen, Karen K. 6606, 6617, 6618,
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Ben-Aharon, Irit 548, 2556, e13080
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Blancas, Isabel e11535, e11545, e21
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Brandes, Johann Christoph 7048, 106
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Cakir, Betul 9567 Calabek, Bernadet
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Ceraulo, Domenica 4017 Cerbone, Lin
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Chinen, Ludmilla T.D. e16046 Chinen
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Come, Steven E. 9071, 9100 Comis, S
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Dahlheimer, Tambra 2546 Dahmane, El
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DeLacure, Mark D. e16052 Delage, Ju
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Domingo, Gelenis 6568, 6575, 6588 D
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El Sherbeiny, Esam e15129 El-Deiry,
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Fayad, Luis 6501, 8067 Fayette, Jer
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Gang, Wu 7091, e14511 Gangaram, Anj
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Gimenez Capitan, Ana 4068, 10596, e
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Granowetter, Linda 9537 Grant, Barb
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Hainsworth, John D. 618, 1018, 1086
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Heerschap, Arend e13111 Heersink, M
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Hong, Seung-Mo 3568 Hong, Sook Hee
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Im, Young-Hyuck 598^, 644, TPS649,
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Ji, Yongling e17527 Jia, Jingquan e
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Kaparelou, Maria 583 Kapaun, Christ
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Kim, Chan Kyu e14688 Kim, Chang Won
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Komatsu, Yoshihiro e14689 Komatsu,
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Loupakis, Fotios 3518, 3540, 3546,
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Mathieu-Nicot, Florence e19623 Math
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Mergenthaler, Hans-Guenther e15026
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Munoz-Sanchez, MM e19590 Munsell, M
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Piwnica-Worms, Helen 3047 Pizzo, Fa
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Sha, Dan 3564 Sha, Huifang e13528 S
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Yasuda, Hiromi e14029 Yasuda, Hiroy
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Zhang, Xinmin e16022 Zhang, Xu Dong
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