Abstract 491P
Background
Leptomeningeal metastases (LM) remain challenging for patients with non-small cell lung cancer. EGFR mutation shows a higher incidence rate of LM with poor prognosis. 3rd generation TKI has better cerebral-spinal fluid(CSF) penetration and may be a promising treatment. Here we collected LM clinical features and outcome in EGFR-mutant lung adenocarcinoma in high EGFR mutation prevalence area.
Methods
This is a retrospective observational cohort study, conducted in a tertiary medical center in Taiwan. Patients with newly diagnosed advanced lung adenocarcinoma with common EGFR mutation were enrolled. LM were diagnosed by brain imaging study or cytology study of CSF analysis. Patients without initial brain MRI imaging or patients who underwent CNS surgery initially were excluded. All the data is valid up to Dec 31, 2017.
Results
From 2013 to 2015, a total of 283 patients was included. All patients were treated with first-line TKIs as systemic treatment initially. Thirty-four patients had LM, accounting for 12.0% (34/283) of this cohort. Only four patients in the LM group (11.7%) received CSF study, and three of them showed malignant cells in their CSF. Patients with LM had median overall survival(OS) 26.2 months, whereas patients with brain tumor progression had median OS 42.3 months. (p = 0.002) For patients with LM, the median OS after LM is 5.1 months. Patients with younger age(HR0.63[0.45-0.90], p = 0.01) and initial M1b(HR 2.86[1.81-4.53], p < 0.001) were associated with higher risk or intracranial progression. Among 34 patients, 6 patients received 3rd generation TKI and revealed significant better OS than those without 3rd TKI. (OS 15.3 months vs 3.7 months, p = 0.03).
Conclusions
LM show poor prognosis for patients with EGFR-mutant lung adenocarcinoma, compared with other types of brain metastases. Younger age and initial M1b associated with higher risk. Patients with 3rd generation TKI may bring benefit to these patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Taipei Veterans General Hospital.
Disclosure
C-H. Chiu: Honoraria (self): AstraZeneca; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Roche. All other authors have declared no conflicts of interest.
Resources from the same session
273P - MALT1- A20 and NF-κB expression pattern in patients with non-Hodgkin lymphomas
Presenter: Alshimaa Alhanafy
Session: Poster display session
Resources:
Abstract
274P - Treatment stratification of non-Hodgkin large B-cell lymphoma patients based on the identification of mutational c-MYC gene
Presenter: Raimkul Karakulov
Session: Poster display session
Resources:
Abstract
275P - Primary central nervous system lymphoma treated with high-dose methotrexate and rituximab: Preliminary results in Vietnam
Presenter: Gia Nguyen Hoang
Session: Poster display session
Resources:
Abstract
276P - Chronic myelod leukemia in chronic phase (CML-CP) with lymphadenopathy at diagnosis: A retrospective analysis
Presenter: GEDALA Veni Prasanna
Session: Poster display session
Resources:
Abstract
277P - Characteristics of BCR-ABL rearrangement variants in Pakistani patients with chronic myeloid leukemia and acute lymphocytic leukemia
Presenter: Zeeshan Ahmed
Session: Poster display session
Resources:
Abstract
278P - A systematic literature review of the cost-effectiveness of treatments, costs, and resource use in patients with Burkitt lymphoma
Presenter: Gautamjeet Mangat
Session: Poster display session
Resources:
Abstract
280P - Risk stratification of CML-CP in a real-world scenario, comparison of S.H.E. with rate of fall of BCR/ABL
Presenter: Kundan Mishra
Session: Poster display session
Resources:
Abstract
281P - Selective depletion of tumour-associated SAMHD1 by HSP90 inhibitors enhances the anti-AML effect of cytarabine
Presenter: Jing Sun
Session: Poster display session
Resources:
Abstract
282P - Inhibition of miR-144 and miR-199 promote myeloma pathogenesis via upregulation of versican and FAK/STAT3 signaling
Presenter: Nidh Gupta
Session: Poster display session
Resources:
Abstract
283P - Effect of study-level factors on treatment-free remission rate in patients with chronic myeloid leukemia: A systematic review and meta-analysis
Presenter: Jinhyun Cho
Session: Poster display session
Resources:
Abstract