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Poster Discussion - Non-metastatic NSCLC and other thoracic malignancies

6093 - BRCA1 expression level as prognostic factor for recurrence in resected NSCLC with adjuvant chemotherapy. SCAT Trial

Date

29 Sep 2019

Session

Poster Discussion - Non-metastatic NSCLC and other thoracic malignancies

Presenters

Bartomeu Massuti

Citation

Annals of Oncology (2019) 30 (suppl_5): v585-v590. 10.1093/annonc/mdz258

Authors

B. Massuti1, J.M. Sanchez Torres2, M. Cobo Dols3, M.T. Moran Bueno4, J.L. Gonzalez-Larriba5, I.C. Barneto Aranda6, J. De Castro Carpeno7, L. Iglesias8, M.A. Muñoz9, G. López Vivanco10, M.D. Isla Casado11, R. López12, R. de las Penas Bataller13, D. Rodriguez Abreu14, A. Artal-Cortes15, E. Esteban16, M. Provencio17, E. Pereira18, J. Sanchez-Paya19, R. Rosell20

Author affiliations

  • 1 Department Of Medical Oncology, Hospital General Universitario de Alicante, 03010 - Alicante/ES
  • 2 Medical Oncology, Hospital Universitario de La Princesa, 28006 - Madrid/ES
  • 3 Medical Oncology, Hospital Regional Universitario de Málaga, 29009 - Málaga/ES
  • 4 Department Of Medical Oncology, Catalan Institute of Oncology (ICO Badalona), Hospital Germans Trias i Pujol, 08916 - Badalona/ES
  • 5 Department Of Medical Oncology, Hospital Clinico Universitario San Carlos, 28040 - Madrid/ES
  • 6 Department Of Medical Oncology, University Hospital Reina Sofia, 14004 - Cordoba/ES
  • 7 Medical Oncology, Hospital Universitario La Paz, Madrid/ES
  • 8 Oncology, University Hospital 12 de Octubre, Madrid/ES
  • 9 Medical Oncology, IVO - Fundación Instituto Valenciano de Oncología, 46009 - Valencia/ES
  • 10 Medical Oncology, Hospital Universitario Cruces, 48903 - Barakaldo/ES
  • 11 Medical Oncology, Hospital Clinico Universitario Lozano Blesa, 50009 - Zaragoza/ES
  • 12 Medical Oncology, Hospital Clínico Universitario de Santiago (CHUS), 15706 - Santiago de Compostela/ES
  • 13 Medical Oncology, Hospital Provincial Castellon, 12002 - Castellón/ES
  • 14 Medical Oncology, Hospital Universitario Insular de Gran Canaria, 35016 - Las Palmas/ES
  • 15 Dept. Medical Oncology, Hospital Miguel Servet, 50009 - Zaragoza/ES
  • 16 Medical Oncology, Hospital Universitario Central de Asturias, 33006 - Oviedo/ES
  • 17 Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 - Madrid/ES
  • 18 Office Management, Spanish Lung Cancer Group Office, 08027 - Barcelona/ES
  • 19 Epidemiology, ISABIAL, 03010 - Alicante/ES
  • 20 Laboratory Of Cellular And Molecular Biology, Institut for Healh Sciences Germans Trias i Pujol, 08916 - Badalona/ES
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Resources

Abstract 6093

Background

Post-operative platinum-based chemotherapy is the standard of care for resected NSCLC with nodal involvement. Expression of genes involved in DNA repair may have a prognostic role for the outcome. BRCA1 plays an important role in DNA repair pathways and could have a prognostic impact in this setting. The SCAT trial results found that for low BRCA1 levels subgroup Cis-Gem was superior to Cis-Doc and in high BRCA1 subgroup docetaxel single agent without platinum achieved similar survival to Cis-Doc. Risk of recurrence analysis according BRCA-1 levels has been performed.

Methods

From Jun/2007 to May/2013 591 patients were screened and 500 were included, 108 in the control arm treated with Cis-Docetaxel and 392 in the experimental arms treated with Cis-Gem, Cis-Doc or docetaxel alone according to terciles of BRCA1 expression level. With a cut-off September 30th 2018 and a median follow-up of 60 months, recurrence patterns were analysed for the whole group according BRCA1 levels in tumor tissue and comparison were made for risk of recurrence, single/multiple recurrence, thoracic/extrathoracic and metastatic sites (liver, bone, brain).

Results

Cumulative recurrence was evaluable in 232/456 patients (50.8%), 182/354 patients treated in the experimental arm and in 50/102 patients treated in the control arm (RR 1.04; 0.83-1.30) (p = 0.672). The majority of recurrences 159/232 (68.5%) were single site intrathoracic recurrences in 121/232 (52%) while 111/232 were extrathoracic (47.8%). Overall recurrence was 56.5% (113/200 p) for low tercile BRCA1 vs 48.8% (63/129) for intermediate tercile vs 44% (56/127) for high tercile (p = 0.025). No differences were seen between tercile groups for single site (p = 0.35), multiple site (p = 0.26), intrathoracic (p = 0.36), or extrathoracic (p = 0.38). More frequent distant metastatic sites were: bone (42 patients), brain (38 patients) and liver (11 patients). RIsk reduction was seen for brain metastases in patients with higher tercile BRCA1 (p = 0.003).

Conclusions

For NSCLC resected patients with lymph node involvement risk of recurrence remains high with a cumulative rate > 50%. Relative risk of recurrence was lower for tumors with higher BRCA1 levels. Distant metastases were seen in 47.8% of patients. Brain metastases risk was significant lower for patients with low BRCA1 expression. BRCA1 levels acts as a prognostic factor in early stages NSCLC.

Clinical trial identification

EudraCT: 2007-000067-15; NCT 00478699.

Editorial acknowledgement

Legal entity responsible for the study

Spanish Lung Cancer Group - Grupo Español Cáncer de Pulmón.

Funding

Sanofi Aventis.

Disclosure

All authors have declared no conflicts of interest.

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