scholarly journals Afatinib versus gefitinib or erlotinib in first-line setting for Malaysia patients with EGFR mutant advanced lung adenocarcinoma

2019 ◽  
Vol 30 ◽  
pp. ix164 ◽  
Author(s):  
C.S. Chai ◽  
C.K. Liam ◽  
O. Po Lin ◽  
Y.K. Pang ◽  
G.F. Ho ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
First Line ◽  
Egfr Mutant ◽  
Line Setting

Gefitinib versus erlotinib as first-line treatment in EGFR mutant advanced lung adenocarcinoma

2016 ◽  
Author(s):  
Chai Chee Shee ◽  
Liam Chong Kin ◽  
Pang Yong Kek ◽  
Kow Keng Siong ◽  
Poh Mau Ern ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Line Treatment ◽  
First Line ◽  
Egfr Mutant ◽  
First Line Treatment

scholarly journals Detailed Analysis and Radiomic Prediction of First Progression Sites of First-Line Targeted Therapy for EGFR-Mutant Lung Adenocarcinoma Patients With Systemic Metastasis

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaoyang Li ◽  
Runping Hou ◽  
Wen Yu ◽  
Xueru Zhu ◽  
Hongwei Li ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Kinase Inhibitor ◽  
Stage Iv ◽  
Clinical Information ◽  
Ct Images ◽  
First Line ◽  
Systemic Metastasis ◽  
Pre Treatment ◽  
Tki Treatment ◽  
Egfr Mutant

BackgroundWe aimed to analyze the first progression sites of first-line tyrosine kinase inhibitor (TKI) treatment for EGFR-mutant lung adenocarcinoma patients with systemic metastasis to recognize the potential candidates who might benefit from radiotherapy and establish a radiomic-based model to predict the first progression sites.Materials and MethodsWe retrospectively collected the clinical information and pre-treatment chest CT images of patients in Shanghai Chest Hospital from 2013 to 2017. All patients were diagnosed with stage IV EGFR-mutant lung adenocarcinoma and received TKI as first-line treatment. The first progression sites and survival were analyzed. The pre-treatment chest non-contrast CT images were utilized to establish a radiomic-based model to predict the first progression sites.ResultsWe totally collected 233 patients with systemic metastasis, among whom, there were 84 (36.1%) and 149 (63.9%) patients developing first progression in original lesions (OP) and new lesions (NP), respectively. The PFS and OS of patients with OP were longer than those with NP (PFS 11 months vs. 8 months, p = 0.03, OS 50 months vs. 35 months, p = 0.046). For 67.9% of the patients with OF, disease progressed within five sites (oligoprogression). The radiomic-based model could predict the progression sites with an AUC value of 0.736, a specificity of 0.60, and a sensitivity of 0.750 in the independent validation set.ConclusionAmong patients with systemic metastasis, there were 36.1% of patients developing OP at first progression who had a better prognosis than those developing NP. Patients with OP may be potential candidates who might benefit from radiotherapy. Radiomics is a useful method to distinguish patients developing OP and could provide some indications for radiotherapy.

Real-world data of osimertinib in the management of leptomeningeal metastases in EGFR mutant NSCLC: Light at the end of the tunnel?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21197-e21197
Author(s):  
Mansi Sharma ◽  
Shrinidhi Nathany ◽  
Satya Narayan ◽  
Pallavi Redhu ◽  
Parveen Jain ◽  
...  
Keyword(s):  
Prospective Trial ◽  
Intrathecal Chemotherapy ◽  
Leptomeningeal Metastases ◽  
Second Line ◽  
First Line ◽  
Real World Data ◽  
Treatment Naïve ◽  
Egfr Mutant ◽  
Line Setting

e21197 Background: Presence of leptomeningeal metastases (LM) in NSCLC is indicative of aggressive disease and the incidence is as high as 9%-16% in the EGFR mutant subgroup. Traditionally, these patients had a dismal outcome with WBRT and intrathecal chemotherapy. Osimertinib crosses the blood brain barrier and is efficacious in the second line setting, as seen in BLOOM trial (LM ORR of 62%) and AURA program (LM ORR 55%). Osimertinib has also demonstrated CNS efficacy in the first line (FLAURA trial). This study is a retrospective review of cases with LM treated with osimertinib, and their response outcomes. Methods: 16 patients of EGFR mutant NSCLC developed LM at some point in their disease course and were treated with osimertinib. Clinical features and response outcomes were retrieved from medical record archives. Descriptive statistics were done using SPSS v23 software. LM PFS was defined as the time between 1st dose of osimertinib and date of progression in LM. LM OS was defined as the time between the first dose of osimertinib to the date of last follow up/death. ORR was defined as the percentage of cases showing CR/PR to osimertinib. Results: Median age was 61 years (range: 33-79) with 9 males and 7 females. Del19 mutations were seen in 9 patients and L858R in 7 patients. Only one patient was given WBRT prior to TKI. 6 patients with LM at diagnosis were given 1st line osimertinib. 3 (50%) progressed in LM and 3 (50%) showed partial response. Median LM PFS and median LM OS was not reached. ORR for osimertinib in the first line was 83.3%. 10 patients developed LM later in the course of the disease and median time to onset of LM was 12.47 months. Median LM PFS for osimertinib was 7.9 months (95% CI:3.2-8.3). Median LM OS was 8.2 months (95% CI: 2.6-19.8 months). ORR for osimertinib in the later line was 60%. Conclusions: This early experience reveals superior efficacy of osimertinib in LM with an excellent LM ORR in the first line setting and concordant results with second line BLOOM Study. Despite the small numbers in this study, this report becomes clinically relevant owing to the rarity of LM occurrence and paucity of available data. Efficacy of osimertinib in EGFR treatment-naive patients with LM requires further investigation and a larger prospective trial with a longer follow up may help confirm our preliminary findings.

scholarly journals Selection of non-small cell lung cancer patients for intercalated chemotherapy and tyrosine kinase inhibitors

2017 ◽  
Vol 51 (3) ◽  
pp. 241-251 ◽  
Author(s):  
Matjaz Zwitter ◽  
Antonio Rossi ◽  
Massimo Di Maio ◽  
Maja Pohar Perme ◽  
Gilberto Lopes
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Kinase Inhibitors ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
First Line ◽  
Treatment Naïve ◽  
Egfr Mutant ◽  
Line Setting

AbstractBackgroundWhen treating patients with advanced non-small cell lung cancer (NSCLC) with tyrosine kinase inhibitors and chemotherapy, intercalated schedule with time separation between the two classes of drugs should avoid their mutual antagonism. In a survey of published trials, we focus on relation between eligibility criteria and effectiveness of intercalated treatment.MethodsPublished documents were identified using major medical databases, conference proceedings and references of published trials. Median progression-free survival (PFS) was taken as the basic parameter of treatment efficacy. Correlation between characteristics of patients and median PFS was assessed through the Pearson’s correlation coefficient and the coefficient of determination, separately for first-line and second-line setting.ResultsThe series includes 11 single-arm trials and 18 randomized phase II or phase III trials with a total of 2903 patients. Treatment-naive patients or those in progression after first-line treatment were included in 16 and 13 trials, respectively. In 14 trials, only patients with non-squamous histology were eligible. Proportion of patients with non-squamous carcinoma (in first-line setting), proportion of never-smokers (both in first- and second-line setting) and proportion of epidermal growth factor receptor (EGFR) mutant patients (both in first- and second-line setting) showed a moderate or strong correlation with median PFS. In six trials of intercalated treatment applied to treatment-naive EGFR-mutant patients, objective response was confirmed in 83.1% of cases and median PFS was 18.6 months.ConclusionsMost suitable candidates for intercalated treatment are treatment-naive patients with EGFR-mutant tumors, as determined from biopsy or liquid biopsy. For these patients, experience with intercalated treatment is most promising and randomized trials with comparison to the best standard treatment are warranted.

A survey on Japanese thoracic oncologists’ preference on treatment strategy for EGFR-mutant or EML4-ALK-mutant non-small cell lung cancer (NSCLC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19124-e19124
Author(s):  
Katsuyuki Hotta ◽  
Katsuyuki Kiura ◽  
Masarhiro Tabata ◽  
Nagio Takigawa ◽  
Mitsune Tanimoto ◽  
...  
Keyword(s):  
Survival Data ◽  
Good Condition ◽  
Genetic Alterations ◽  
First Line ◽  
Alk Rearrangement ◽  
Platinum Based Chemotherapy ◽  
Alk Positive ◽  
Gene Status ◽  
Egfr Mutant ◽  
Line Setting

e19124 Background: NSCLC pts have become categorized based on two genetic alterations in their tumors, EGFR and EML4-ALK, to provide personalized therapy. In EGFR-mutant NSCLC, EGFR-TKI yields a comparable survival with platinum-based chemotherapy, suggesting either of them can be initiated first, and its choice seems to depend partly on oncologists’ preference. As for the other, EML4-ALK, NCCN guideline recommends first-line crizotinib use despite no relevant survival data. The decision whether to choose crizotinib might be also influenced by oncologists’ preference. We here assessed their preference. Methods: The Japanese thoracic oncologists were asked to complete a self-administered questionnaire at the Japanese meeting specific for thoracic oncology. Results: Of 3,046 subjects, 871 (29%) responded voluntarily to a survey, mainly consisting of medical and surgical oncologists (93%). Majority considered EGFR mutation status should be checked at the time of diagnosis (89%), whereas only 60% and 33% reported EML4-ALK gene status would be assessed at the time of diagnosis and until the initiation of second-line setting, respectively. The subjects also considered pts with EGFR-wild-typed tumor and pts with clinical characteristics possibly related to EML4-ALK rearrangement should selectively receive EML4-ALK gene status check rather than all NSCLC pts (57%, 22% and 16%, respectively). Among the subjects, 52% preferred to choose gefitinib rather than platinum in the first-line setting in EGFR-mutant NSCLC, whilst 44% preferred crizotinib to platinum in the first-line setting in EML4-ALK-positive NSCLC. The major reasons why they chose gefitinib in EGFR-mutant NSCLC were ‘PFS is better’ (36%) and ‘it is easy to improve QOL’ (25%), whereas ‘PFS is better’ (43%), and ‘I want to prescribe when patients are still in good condition’ (19%) were the predominant reasons for choosing crizotinib in EML4-ALK-positive NSCLC. Conclusions: About half of the subjects preferred each molecular-targeted agent to the conventional cytotoxic chemotherapy in first-line setting. They considered better PFS was important in the treatment of EGFR-mutant or EML4-ALK-mutant NSCLC.

Molecular characterization of patients with advanced lung adenocarcinoma at diagnosis with next generation sequencing by liquid biopsy in the Mexican population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21511-e21511
Author(s):  
José Fabián Martínez-Herrera ◽  
Luis Martinez-Barrera ◽  
Jeronimo Rafael Rafael Rodriguez Cid ◽  
Carla Paola Sánchez-Ríos ◽  
Mario Alberto Sanchez-Prieto ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Lung Adenocarcinoma ◽  
Liquid Biopsy ◽  
Clinical Stage ◽  
Genetic Alterations ◽  
Next Generation ◽  
First Line ◽  
Tumor Biopsy ◽  
Line Setting ◽  
Generation Sequencing

e21511 Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide. Tumor biopsy represents the standard for molecular diagnosis, nevertheless it is not always feasible to obtain. Liquid Biopsy (LB) may offer an alternative in the first line setting. Methods: Retrospective review of case files and next generation sequencing report (NGS) from LB from patients in a Validation Trial, performed from January 2018 to September 2019. We present the molecular alterations and clinical characteristics of the population. Results: 147 records and LB reports of patients 18 years and older with metastatic lung adenocarcinoma without prior treatment were included. 40% of the population had been selected based on a commercial local PCR test for EGFR (Idylla). 49% of them were female with Mean age of 60.9 ± 12.7. 56% had a history of smoking with an average packs/year of 20.5 (1-156) and 39% had exposure to wood smoke, 92% had an ECOG 0-1. 65 % of the Patients were diagnosed in Clinical Stage (8th Edition) IVA and 22% in IVB. 13% had SNC metastasis. The LB detected genomic alterations in 85.5% of the cases. 78% represent pathogenic mutations and 7.5% variants of uncertain significance (VUS).14.5% of the biopsies could not detect any ctDNA. The most frequent aberrations reported were TP53 in 51.7%, KRAS 16%, EGFR 16%, ALK 9%, PIK3CA 4%, RET 4%, BRAF 3%, BRCA 3, and HER2 3%. In addition, 20% had bTMB ≥10. Only 20% of the patients could receive a targeted therapy or immunotherapy of the potential ≈50%. Most cases had co-mutations (1-6 x case). Looking for factors associated with the presence of bTMB by a logistic regression model, it was possible to identify the presence of CNS metastases and smoking as identified with an OR of 3,688 (p = 0. 0.042) and 3.952 (p = 0. 024) respectively. Conclusions: It is feasible to have tumor molecular analysis through liquid biopsy in most cases, with genetic alterations previously reported in tumor tissue in the first line setting. [Table: see text]

EGFRMutations Predict Survival Benefit From Gefitinib in Patients With Advanced Lung Adenocarcinoma: A Historical Comparison of Patients Treated Before and After Gefitinib Approval in Japan

2008 ◽  
Vol 26 (34) ◽  
pp. 5589-5595 ◽  
Author(s):  
Toshimi Takano ◽  
Tomoya Fukui ◽  
Yuichiro Ohe ◽  
Koji Tsuta ◽  
Seiichiro Yamamoto ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Survival Benefit ◽  
Growth Factor Receptor ◽  
Predictive Marker ◽  
Egfr Mutations ◽  
First Line ◽  
Historical Comparison ◽  
Before And After ◽  
L858r Mutation ◽  
Egfr Mutant

PurposeThis study evaluated whether the presence of epidermal growth factor receptor (EGFR) mutations is a predictive marker for survival benefit from gefitinib and/or a prognostic marker in patients with advanced lung adenocarcinoma.Patients and MethodsOverall survival (OS) was compared between patients with advanced lung adenocarcinoma who began first-line systemic therapy before and after gefitinib approval in Japan (January 1999 to July 2001 and July 2002 to December 2004, respectively). Deletional mutations in exon 19 or the L858R mutation in exon 21 of EGFR were evaluated using high-resolution melting analysis.ResultsEGFR mutations were detected in 136 (41%) of the 330 patients included in this study. OS was significantly longer among the EGFR-mutant patients treated after gefitinib approval compared with the OS of patients treated before gefitinib approval (median survival time [MST], 27.2 v 13.6 months, respectively; P < .001), whereas no significant survival improvement was observed in patients without EGFR mutations (MST, 13.2 v 10.4 months, respectively; P = .13). A significant interaction between the presence of EGFR mutations and a survival improvement was seen (P = .045). Among patients treated before gefitinib approval, those with EGFR mutations lived longer than those without EGFR mutations (MST, 13.6 v 10.4 months, respectively; P = .034). The response rates to first-line cytotoxic chemotherapy were not significantly different between patients with and without EGFR mutations (31% v 28%, respectively; P = .50).ConclusionEGFR mutations significantly predict both a survival benefit from gefitinib and a favorable prognosis in patients with advanced lung adenocarcinoma.

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