EVALUATION OF THE ROLE OF GEMCITABINE AND ERLOTINIB IN STAGE IIIB AND STAGE IV NSCLC ADENOCARCINOMA OF LUNG AS A FIRST LINE CHEMOTHERAPY REGIMEN AND ASSESSING THE ACUTE TOXICITY, OVERALL SURVIVAL AND PROGRESSION FREE SURVIVAL RESPECTIVELY.

INTRODUCTION: 2 nd rd According to Globocan 2020 lung cancer is 2 most common malignancy in males and 3 most common in the females. st Previous studies have showed EGFR-tyrosine-kinase inhibitors erlotinib and getinib efcacy as 1 line treatment for patients with activating EGFR mutations. Also, Gemcitabine is drug of choice in inoperable and locally advanced metastatic NSCLC. With the purpose study was undertaken to evaluate the role of gemcitabine and erlotinib in stage IIIB and stage IV NSCLC adenocarcinoma of lung MATERIAL AND METHOD: 2 35 Patients with stage IIIB and IV fullling criteria were given Inj. Gemcitabine 1 gm/m D1 and D8 IV & Tab erlotinib 150 mg PO daily repeated every 21 days, 6 cycles. Post 6 cycles of chemotherapy tab erlotinib 150 mg given till disease progression. Tumor response assessed by RECIST 1.1. Toxicity assessed by CTCAE version 5.0. RESULT: Adrenal metastasis was most common followed by lung, bone, malignant pleural effusion and liver metastasis. a median follows up in this study was 33 weeks. Toxicities noted were anemia, thrombocytopenia, febrile neutropenia, GI toxicities and rash. In post 3 cycles of chemotherapy, out of 35 patients,62.86 % were having partial response for primary and 34.29 % (n=12) for metastatic lesions. In post 6 cycles of chemotherapy there was a reduction in the partial response patients and a steep rise in stable disease patients. In Post 12 weeks of 6 cycles of chemotherapy more patients having a progressive disease, very little, 5.71 % having PR and 25.71 % were having a stable disease. DISCUSSION: The median PFS and median OS was 4.1 and 5.6 months respectively whereas Grade 3 toxicity was also seen in gemcitabine plus erlotinib arm. INTACT 1 trial-getinib in combination with gemcitabine and cisplatin in advanced non-small-cell lung cancer: A phase III trial showed that getinib in combination with gemcitabine and cisplatin in chemotherapy-naive patients with advanced NSCLC did not have improved efcacy over gemcitabine and cisplatin alone. The median overall survival was 18.3 months and the median PFS was 7.6 months, in our study it come out to be 8.25 months and 4.5 months respectively. Also noted Grade 3 febrile neutropenia, anemia, thrombocytopenia, vomiting & diarrhea same as our study. CONCLUSION: Standard treatment for patients with an activating EGFR mutation is rst-line single-agent EGFR-tyrosine kinase inhibitor and combination chemotherapy such as gemcitabine plus erlotinib is improving survival

Characterization of the tumor immune-microenvironment of adenocarcinoma of lung with a metastatic lesion in the pancreas treated successfully with first-line, single-agent pembrolizumab

Single-agent immune checkpoint inhibitor therapy in advanced non-small cell lung cancer can significantly prolong progression-free and overall survival when compared with cytotoxic chemotherapy. Here, we report a case of newly diagnosed adenocarcinoma of the lung with a solitary brain metastasis and a biopsy confirmed adenocarcinoma in the tail of the pancreas. Cytomorphology and immunohistochemistry suggested the lung and pancreas tumors were distinct primaries. However, molecular analysis of the lung primary and tumor in the pancreas revealed the same mutations of functional significance in PIK3CA, NF1 and TP53, suggesting the tumors were clonal. A total of three cycles of single-agent pembrolizumab, and radiation to the lung and brain administered between cycles 1 and 2, resulted in marked responses in lung, brain and pancreatic tumors. Despite the discontinuation of the pembrolizumab after three cycles due to severe immune-mediated toxicities, the patient has had no progression 11 months after stopping all active treatment. Results of a novel 27-gene immuno-oncology (IO) expression assay revealed strong IO scores for the lung and pancreatic tumors, indicating a favorable tumor immune-microenvironment and possibly explaining the significant response.