Ryoji Kato

CT-guided fine-needle aspiration and core needle biopsies of pulmonary lesions: a single-center experience with 750 biopsies in Japan.

OBJECTIVE CT-guided lung biopsy is a well-established diagnostic method for pulmonary lesions. The aim of our study was to evaluate the diagnostic outcomes and safety profile of conventional CT-guided lung biopsies. MATERIALS AND METHODS We retrospectively analyzed the results of CT-guided lung biopsies for 750 patients to determine the diagnostic accuracy, complication rates, and independent risk factors for diagnostic failure and severe pneumothorax. RESULTS Diagnostic accuracy was 92.9%. Independent risk factors for diagnostic failure were malignant lesions (odds ratio [OR], 4.20; 95% CI, 1.66-14.1; p = 0.001), lesions in the lower lobe (OR, 2.01; 95% CI, 1.17-3.47; p = 0.011), lesions 2.0 cm or smaller (OR, 2.87; 95% CI, 1.59-5.48; p < 0.001), and the presence of pneumothorax during the procedure (OR, 2.18; 95% CI, 1.27-3.78; p = 0.004). Pneumothorax requiring drainage occurred in 7% of patients. Independent risk factors for pneumothorax requiring drainage were age of 73 years or older (OR, 2.19; 95% CI, 1.21-4.05; p = 0.009), the presence of emphysema (OR, 4.29; 95% CI, 2.05-8.82; p < 0.001), benign lesions (OR, 2.33; 95% CI, 1.20-4.40; p = 0.012), supine positioning of the patient (OR, 2.61; 95% CI, 1.44-4.84; p = 0.001), and length from the pleura to the lesion of 1.5 cm or greater (OR, 3.08; 95% CI, 1.63-6.17; p < 0.001). CONCLUSION CT-guided lung biopsy has a high diagnostic accuracy. Complication rates were acceptable and comparable to those of previous studies.

Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer

Background Data on characteristics, outcomes, and prognosis of advanced non-small-cell lung cancer (NSCLC) patients who develop pneumonitis during systemic anti-cancer therapy (pneumonitis) are currently lacking. Methods We conducted a retrospective cohort study of 910 consecutive patients diagnosed with advanced NSCLC between January 2004 and January 2014. Of these, 140 patients were excluded because they did not receive systemic anti-cancer therapy at this hospital. Results A total of 770 patients were included in the study, of whom 44 (6%) were diagnosed with pneumonitis. The mortality rate of pneumonitis was 36%. The incidence of pneumonitis was independently associated with pre-existing ILD (adjusted odds ratio, 2.99, P = 0.008), and survivors were significantly associated with younger age (P = 0.003) and radiographic non-acute interstitial pneumonia pattern (P = 0.004). In all patients, pneumonitis was identified as an independent predictor of overall survival (OS) (adjusted hazard ratio 1.53, 95% CI, 1.09–2.09, P = 0.015). Performance status was poor in 82% of survivors of pneumonitis; in 62% of survivors, the PS worsened after the pneumonitis improved. Additionally, 54% of survivors received no further systemic anti-cancer therapy after pneumonitis. The median survival time of survivors after pneumonitis was 3.5 months (95% CI, 2.3–7.2 months). Conclusions Our study indicated that 6% of patients with advanced NSCLC developed pneumonitis during systemic anti-cancer therapy. The early mortality rate of pneumonitis is high, and the survival and PS after pneumonitis is extremely poor. Additionally, pneumonitis has an adverse impact on the survival of patients with advanced NSCLC. These data should be considered for the management of pneumonitis, and we recommend that future work focuses on pneumonitis particularly to improve the survival of patients with advanced NSCLC.

Analysis of advanced lung cancer patients diagnosed following emergency admission

Data on prognosis and predictors of overall survival in advanced lung cancer patients diagnosed following emergency admission (DFEA) are currently lacking. We retrospectively analysed data from 771 patients with advanced nonsmall cell lung cancer between April 2004 and April 2012. Of the 771 patients, 103 (13%) were DFEA. DFEA was not an independent predictor of overall survival by multivariate Cox proportional hazard models, whereas good performance status (PS), epidermal growth factor receptor gene mutation, stage IIIB, adenocarcinoma and chemotherapy were independent predictors of overall survival (hazard ratio (95% CI) 0.36 (0.29–0.44), p<0.001; 0.49 (0.38–0.63), p<0.001; 0.64 (0.51–0.80), p<0.001; 0.81 (0.67–0.99), p=0.044; and 0.40 (0.31–0.52), p<0.001, respectively). Good PS just prior to opting for chemotherapy, but not at emergency admission, was a good independent predictor of overall survival in DFEA patients (hazard ratio (95% CI) 0.26 (0.12–0.55); p<0.001). DFEA is relatively common. DFEA and PS at emergency admission were not independent predictors of overall survival, but good PS just prior to opting for chemotherapy was an independent predictor of longer overall survival. Efforts to improve patient PS after admission should be considered vital in such circumstances. Efforts to improve performance status after admission are vital in patients diagnosed following emergency admission http://ow.ly/C3BDQ

1286PEGFR-TYROSINE KINASE INHIBITOR (TKI) RECHALLENGE WITH BEVACIZUMAB IN EGFR-MUTANT NON-SMALL CELL LUNG CANCER (NSCLC)

ABSTRACT Aim: Several reports demonstrated efficacies of EGFR-TKI rechallenge in EGFR-mutant NSCLC, but the efficacies were only moderate (response rate [RR], 0-10% disease control rate [DCR], 20-30%, and progression-free survival [PFS], 2-3 months). Some preclinical studies suggested synergistic effects of bevacizumab and EGFR-TKI in TKI-resistant models. The aim of our study was to evaluate the efficacy and safety of EGFR-TKI rechallenge with bevacizumab after acquired resistance to TKI in EGFR-mutant NSCLC. Methods: Between January 2010 and January 2014, twenty-one NSCLC patients, previously treated with EGFR-TKIs, received EGFR-TKI rechallenge in combination with bevacizumab. We retrospectively evaluated the RR, DCR, PFS, overall survival (OS), and safety. Re-biopsy was performed in all cases to examine T790M resistant mutation status. The efficacy was compared between T790M-positive and –negative populations. Results: The eligible 21 patients were all EGFR mutant. Previous EGFR-TKI treatments were 8 gefitinib, 11 erlotinib, and 2 afatinib. 11 patients had EGFR-TKIs rechallenge with bevacizumab successively without interval, and 10 patients received same after 1-4 intervening systemic regimens. EGFR-TKIs for rechallenge in combination with bevacizumab were 2 gefitinib and 19 erlotinib. Two (9.5%) had partial response, 12 (90%) had stable disease. The RR and DCR were 9.5% and 95%, respectively. The median PFS was 3.6 months (95% confidence interval (CI); 2.5-14.9 months), and the median OS was 13.5 months (95% CI; 9.7-21 months). On re-biopsy, 6 patients had T790M with the initial sensitive mutation. The RR, DCR, median PFS and median OS for T790M positive vs negative were 0% vs 13% (p = 0.23), 100% vs 93% (p = 0.40), 3.6 months vs 4.1 months (p = 0.78), and 15.1 months vs 13.5 months (p = 0.656), respectively. Severe adverse events (≧grade 3) were as follows: grade 3 hypertension in one (4.8%) and grade 3 anemia in one patient (4.8%). Conclusions: EGFR-TKI rechallenge with bevacizumab demonstrated higher DCR and modestly longer PFS, compared with EGFR-TKI monotherapy rechallenge. Its activity did not differ according to T790M status. EGFR-TKI rechallenge with bevacizumab can be a therapeutic option for EGFR-mutant NSCLC with acquired resistance regardless of resistant mechanisms. Disclosure: All authors have declared no conflicts of interest.