130P - EGFR mutations in lung adenocarcinoma and brain metastases: A Croatian single institution experience

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Thoracic malignancies
Presenter Katherina Sreter
Citation Annals of Oncology (2017) 28 (suppl_2): ii28-ii51. 10.1093/annonc/mdx091
Authors K.B. Sreter1, S. Kukulj2, S. Smojver-Jezek2, S. Seiwerth3, M. Jakopovic2, M. Samarzija2
  • 1Department Of Clinical Immunology, Pulmonology, And Rheumatology, University Hospital Centre "Sestre Milosrdnice", 10 000 - Zagreb/HR
  • 2University Hospital Centre Zagreb, Clinic for Respiratory Diseases "Jordanovac", Zagreb/HR
  • 3University of Zagreb, School of Medicine, Zagreb/HR

Abstract

Background

The brain, bones and lungs are common sites of metastasis in non-small cell lung cancer. We aimed to investigate the metastatic pattern of epidermal growth factor receptor (EGFR) mutations by analyzing the incidence of different metastatic sites in EGFR positive (+) lung adenocarcinoma patients with brain metastases (BM).

Methods

Data from medical records at the Clinic for Respiratory Diseases "Jordanovac" were collected for this retrospective cohort study. Caucasian Croatian patients with primary lung adenocarcinoma (PLA) and EGFR+ mutation status (2014-2015) were included.

Results

Of 116 EGFR+ patients, 24 (21.0%) were diagnosed with BM. The majority of EGFR+ patients (n = 17, 70.8%) were less than 65 years old at BM diagnosis. There were fewer males (n = 4, 16.7%) than females. Only four patients (all female, 16.7%) were active smokers at diagnosis of PLA. Median age at diagnosis of BM was 62 years (range: 43-78 years). Most patients (n = 20, 83.3%) had good performance status (PS, ECOG 0-1) and normal to increased body mass index (n = 17, 70.8%). Weight loss at presentation was reported by 10 patients (41.6%). The majority (n = 16, 66.7%) initially presented to the emergency department. In 8 patients (33.3%), symptoms related to BM appeared prior to or at the same time as the PLA. Oral tyrosine kinase inhibitor (TKI) treatment was received in second line (n = 8, 33.3%) after progression of disease following first line chemotherapy. Most patients with multiple BM (n = 18, 75.0%) received whole brain palliative radiotherapy; three could not due to poor PS. The main extracranial sites of metastases were bone (n = 16, 66.7%), liver (n = 7, 29.2%) and pleura (n = 19, 79.2%). The most common EGFR mutations were single exon 19 deletion (n = 13, 54.2%) and exon 21 L858R (n = 5, 20.8%). One patient (4.2%) had a double mutation (exon 19 and 21) and another (4.2%) had a rare single exon 18 mutation. Exon 20 T790M mutation occurred in 16.7% of patients (n = 4). The median overall survival (mOS) was 7.7 months versus 20.1 months from time of diagnosis of BM versus from PLA, respectively.

Conclusions

Early diagnosis of BM and extracranial metastases in EGFR mutant PLA patients is key to improving clinical outcomes, quality of life, and overall survival.

Clinical trial identification

Legal entity responsible for the study

University Hospital Centre Zagreb, Clinic for Respiratory Diseases \"Jordanovac\"

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.