Lung Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_27_3583 - Characteristics of EGFR, ALK, or KRAS Mutant Positive Non-Small Cell Lung Cancer (NSCLC) Patients Treated in a Single Institution

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Characteristics of EGFR, ALK, or KRAS Mutant Positive Non-Small Cell Lung Cancer (NSCLC) Patients Treated in a Single Institution
E. Chung1, and T. Biswas2; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2University Hospitals Seidman Cancer Center, Cleveland, OH

Purpose/Objective(s): Activating mutations and oncogene fusion in the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) have been associated with prolonged progression-free survival (PFS) in patients with advanced non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitors (TKIs) and ALK inhibitors. KRAS on the other hand, has been shown to be a prognostic marker for poorer outcomes. In this study, we analyzed patient and tumor characteristics harboring, EGFR, ALK, and KRAS mutations diagnosed and treated in a single institution.

Materials/Methods: From our institutional database, 2287 NSCLC patients were diagnosed from 2009-2016. Of these patients, 2.3% had EGFR mutations, 2.5% had KRAS mutations, and <1% had ALK mutations. Of these patients, we included 33 EGFR, 8 ALK, and 27 KRAS positive patients with complete clinical information. Demographic and clinical data including age, gender, initial treatment modality, response to RT, and sites of metastasis were recorded. Median age at diagnosis was 67.3 (range 29.9-89.5) for EGFR patients, 58.5 (range 33.7-75) for ALK patients, and 59.9 (48.3-84.3) for KRAS patients. 60%, 62% and 48% EGFR, ALK, and KRAS mutant patients were female, respectively. Median follow up was 31.9 months for EGFR patients, 46.1 months for ALK patients, and 20.1 months for KRAS patients.

Results: In all three groups, over 70% of patients were diagnosed with stage IV disease; stage III disease in 12%, 25% and 17.5% with EGFR, ALK and KRAS, respectively. In stage IV EGFR patients, 33.3% received targeted therapy alone as definitive treatment, 45.8% received palliative thoracic RT and targeted therapy, and 12.5% received palliative thoracic RT and chemotherapy (CT). Average PFS in EGFR patients with palliative thoracic RT was 15.0 months compared to 14.8 months without RT (NS). In stage IV ALK patients, 50% received targeted therapy alone for definitive treatment and 33.3% received RT and CT. Again, there was no difference seen with addition of palliative thoracic RT. In stage IV KRAS patients, 66.7% were treated with CT and palliative radiation and 9.5% were treated with CT alone. PFS was 8.5 months for palliative RT with CT and 6.9 months for CT alone (NS). In EGFR patients, 81.8% received at least 1 TKI and 42.4% received 2 or more TKIs. In ALK patients, 50% received 1 targeted therapy and 25% received 2 or more targeted therapies. The most common sites of metastasis were bone (n=9, 36%) and brain (n=6, 24%) in EGFR patients, brain (n=4, 57%), and liver (n=3, 43%) in ALK patients, and brain (n=14, 51.8%) and bone (n=9, 33.3%) in KRAS patients.

Conclusion: This single institutional series of NSCLC with these known mutations shows no significant benefit of palliative thoracic RT added to targeted therapy or CT in advanced disease. Routine use of thoracic RT in combination with targeted therapy or CT is not recommended based on this result.

Author Disclosure: E. Chung: None. T. Biswas: None.

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