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Found 1 Presentation For Request "1226p"
1226P - Curative treatment in EGFR mt+ NSCLC stage III by induction TKI-chemotherapy combination: Feasibility and outcome in 7 cases
- Lukas Heukamp (Cologne, Germany)
Abstract
Background
EGFR TKI’s are a mainstay in the treatment of metastatic NSCLC with EGFR mutations, however their use in the curative setting is not yet standard of care. Recently, combination of TKI and chemotherapy has been shown to improve ORR, PFS and OS in the metastatic setting. Induction therapy with chemotherapy with or without radiotherapy is an established approach in stages II and III, however no data exist for induction therapy with TKI and chemotherapy in EGFR mt+ NSCLC. Here we describe the outcome of 7 patients with EGFR mt+ NSCLC, all stage III, treated with 1st generation TKI in combination with chemotherapy as induction therapy.
Methods
7/7 patients had adenocarcinoma, 5 with EGFR exon 19 and 2 with EGFR L858R. Patients received erlotinib (n=2) or gefitinib (n=5) for 10 days followed by TKI in combination with chemotherapy (docetaxel/cisplatin (n=4), paclitaxel/carboplatin (n=3)) for 3 cycles. RECIST radiologic response as well as regression grading according to Junker et al. was performed on the resection specimens.
Results
All 7 patients achieved radiologic PR after 2 cycles, all tumors were R0 resected. pCR was achieved in the primary tumor in 2/7, while the other 5 patients did not achieve pCR or MPR in the primary tumor. In the mediastinal lymph nodes, MPR was achieved in 6/7 patients (1 pCR). With the exception of the 2 patients achieving pCR in the primary tumor, all other 5 patients relapsed at 8 to 17 (median 12) months, 3/5 with CNS as 1st relapse site and 2/5 with other sites. With a median follow up of 46 months (13-68), 3 patients are alive at 13+, 44+, 67+ months and one patient died in CR of secondary cancer at 51 months. Median OS of the 7 patients was 51 months and median PFS was 17 months.
Conclusions
In conclusion 1st generation TKI-chemotherapy induction in EGFR mt+ NSCLC is feasible, leads to high MPR rates in mediastinal lymph nodes and lower pathologic response rates in the primary tumors. pCR in the primary tumor may predict better outcome. As CNS is the most frequent site of relapse this site might be of special interest in further induction studies on EGFR mt+ NSCLC.
Legal entity responsible for the study
Pius Hospital Oldenburg.
Funding
Partly funded by AstraZeneca.
Disclosure
L. Heukamp: Honoraria (self), Advisory/Consultancy: AstraZeneca; Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy: Novartis; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: Pfizer; Honoraria (self), Advisory/Consultancy: BMS; Honoraria (self), Advisory/Consultancy: MSD; Honoraria (self), Advisory/Consultancy: Siemens. J. Roeper: Honoraria (self): Boehringer Ingelheim; Honoraria (self): AstraZeneca; Honoraria (self): Roche. M. Falk: Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Advisory/Consultancy: Pfizer; Honoraria (self): Roche; Honoraria (self): AstraZeneca. M. Tiemann: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Novartis; Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy: MSD; Honoraria (self), Advisory/Consultancy: BMS; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: AstraZeneca. F. Griesinger: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: MSD; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Siemens; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Takeda; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Lilly; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses: Celgene; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: AbbVie. All other authors have declared no conflicts of interest.