P3.02b-037 Does Tissue EGFR Mutation Status Predict Treatment Response and Mortality in Adenocarcinoma Lung?

P3.02b-037 Does Tissue EGFR Mutation Status Predict Treatment Response and Mortality in Adenocarcinoma Lung?

January 2017 sites and the treatments following EGFR-TKIs. Progression sites were divided into two groups at each site, the appearance of new lesions...

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January 2017

sites and the treatments following EGFR-TKIs. Progression sites were divided into two groups at each site, the appearance of new lesions (NLs) or the progression of existing lesions (ELs). PPS was calculated from the date of PD after initiation of EGFR-TKIs to the date of patient’s death. Results: Among 85 patients, 78 (91.8%) had major EGFR mutation and 64 (75.3%) received EGFR-TKIs as their first-line treatment. The progression sites (NLs, ELs) were lung (18.8%, 28.2%), central nerve system (CNS) (18.8%, 15.3%), bone (7.1%, 10.6%) and others (5.9%, 3.5%). Next treatments following EGFR-TKIs failure were continuation of the same EGFR-TKI; 27 (31.8%), switch to another EGFR-TKI; 24 (28.2%), switch to cytotoxic agents; 19 (22.4%), addition of cytotoxic non-platinum agents to EGFRTKI; 8 (9.4%) and best supportive care; 7 (8.2%), respectively. Local therapies such as radiotherapies were included in each treatment. Median PPS was 342 days. The patients over 70 years old were comparable with those in younger patients (median PPS:  70 vs. < 70 years ¼ 338.7 vs. 333.5 days, p ¼ 0.705). Major EGFR mutation was associated with significantly longer PPS (297.9 vs. 85.7 days, p ¼ 0.021). The patients who exhibited CNS-NLs progression showed the tendency for longer PPS (median PPS: NLs vs. ELs vs. non-progression of CNS ¼ 619.0 vs. 237.1 vs. 300.2 days, p ¼ 0.080). Conclusion: Major EGFR mutation and the new appearance of CNS lesions may be predictive factors for longer PPS after the failure of EGFR-TKIs. Keywords: non-small cell lung cancer, Epidermal growth factor receptor tyrosine kinase inhibitor, Recurrence

P3.02b-037 Does Tissue EGFR Mutation Status Predict Treatment Response and Mortality in Adenocarcinoma Lung? Topic: EGFR Biomarkers Anant Mohan,1 Ashutosh Dhanuka,1 Ashraf Ansari,1 Mirza Masroor,2 Kalpana Luthra,3 Alpana Saxena,2 Karan Madan,1 Vijay Hadda,1 G. Khilnani,1 Randeep Guleria4 1Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi/India, 2Biochemistry, Maulana Azad Medical College, New Delhi/India, 3Biochemistry, All India Institute of Medical Sciences, New Delhi/India, 4Dept of Pulmonary

Abstracts

S1209

Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi/India Background: Targeted therapy with tyrosine kinase inhibitors (TKI) in EGFR positive patients is associated with superior response rates in Caucasian and East Asian populations. Whether similar response is observed in Asian Indians with lung cancer is not yet clear. We aimed to compare the response rates and survival between EGFR positive and negative patients with advanced adenocarcinoma lung at a tertiary level center in North India. Methods: Treatment naive patients of adenocarcinoma lung were recruited. All patients underwent complete staging and tissue EGFR mutation analysis using DNA extraction and Polymerase chain reaction. EGFR positive patients were treated with oral Gefitinib 250 mg once daily and EGFR negative patients with 3-weekly cycles of platinum based doublet chemotherapy. Treatment response was evaluated after 3 months of Gefitinib or after 4 cycles of chemotherapy using CT-PET scan and categorized as complete metabolic remission (CR), partial response (PR), stable disease (SD), and progressive disease (PD). The proportion of responders (CR + PR) and non-responders (SD+PD), and short term survival at 3 months were compared between EGFR positive and negative patients. Results: 59 patients completed response evaluation at 3 months / 4 cycles. These included 41 males (59.5%), with a mean (SD) age 55.9 (11.2) years. Majority (89.4%) had metastatic stage IV disease. 34 patients (67.5%) were current or previous smokers, with median smoking index of 400 (range, 0-1500). 76% patients had KPS of 80 or above, and 78% had ECOG of 0-1. Overall, 17 patients (29.3%) were tissue EGFR positive for either of exons 18, 19, or 21. The 3-month outcomes in EGFR positive and negative groups were: complete response e 1.6% vs 0 %, partial response 61 % vs 24.4%, stable disease e 5.6% vs 26.8%, progressive disease e 11.1% vs 17.1%, and mortality in 16.7% vs 31.7% respectively. EGFR positive group had higher responders compared to EGFR negative patients (p¼0.002) although mortality rate did not differ significantly. Conclusion: EGFR mutation positive patients treated upfront with TKI are more likely to show objective response at three months and demonstrate a trend towards lower mortality compared to EGFR negative patients treated with conventional chemotherapy. Keywords: Adenocarcinoma, EGFR mutation, responder, lung cancer