Supervisors info:
Συρίγος Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κοττέας Ηλίας, Αναπληρωτής καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χαρπίδου Ανδριανή, Ακαδημαϊκή υπότροφος, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Lung cancer remains the most common and deadly malignancy in the world. Nevertheless, in recent years, the identification of specific mutations has led to significant changes in the treatment of local advanced, non-operative and metastatic non-small cell lung cancer (NSCLC). The identification of driven mutation and the use of appropriate Tyrosine Kinase Inhibitors (TKIs) have brought about significant changes in the management, treatment approach, and outcome of patients with advanced disease, particularly adenocarcinomas.
EGFR mutations in advanced NSCLC belong in the subgroup of mutations with proven biological and therapeutic target, detected in 15-20% of adenocarcinomas. They are detected in about 30-40% of patients of Asian origin with adenocarcinoma and in 10-20% of white or black race patients, they are more common in women and non-smokers.
ALK rearrangements are identified in 5% of patients with adenocarcinoma. As in the demographic profile of patients with EGFR mutations, ALK rearrangements are more commonly found in non-smokers.
The presence of a driven mutation is predictive of a specific TKI use. The presence of EGFR mutation and ALK rearrangement is associated with improved prognosis . Retrospective analysis of the overall survival of patients with advanced non-operative NSCLC and EGFR mutation, who have been treated with TKI, report an overall survival of 25-31 months and a five-year survival of 15-20%.
Most studies regarding the non-operative or metastatic NSCLC with driven mutations are based on East Asian populations due to their higher incidence. "Real-world data" of routine clinical practice on treatment and long-term survival in Caucasian patients with NSCLC and driven mutation are still rare.
In the present study, a retrospective analysis was performed on a mutant patient population. The prevalence of driven mutations, the treatment methods and the analysis of resistance mechanisms in a part of the Greek patients, who were treated in a reference center for lung cancer, are recorded.
Demographics, clinical features, subtypes of mutations and treatment were recorded from the register. Outcomes evaluated were disease-free survival (PFS), development of TKI resistance, and overall survival (OS).
The assay focuses on a total of 69 individuals with locally advanced, non-operative or metastatic NSCLC carrying a driven mutation, EGFR or ALK.
Systematic data analysis of the OS of EGFR (+) patients regarding the sex, the Performance Status (PS) and subtypes of EGFR mutations was performed.
The average overall survival (OS) of EGFR (+) patients is 23.6 months. The average OS is 23.8 months in men, and 23.5 months in women. Patients with good overall health (PS 0 / I) at diagnosis have a higher overall survival. The average survival for EGFR (+) exon 19 del patients is 25.2 months, while for EGFR (+) exon 21 mutation patients reaches 22.5 months.
Overall survival is 13.1 months for ALK (+) patients. A clear predominance of women was observed, with the average OS for women is 21.2 months while the average overall survival for men is 10 months.
In terms of overall health at diagnosis, patients with good overall health (PS 0 / I) at diagnosis have a higher overall survival.
Keywords:
Non small cell lung cancer, Driven mutations, Caucasian population, EGFR, ALK
