431P First-line treatment of advanced nonsquamous non-small cell lung cancer (NSCLC) in China in the era of precision medicine

Abstract

Background Over 40% of advanced nonsquamous NSCLC patients in China have an epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) fusion and would benefit from treatment with EGFR or ALK tyrosine kinase inhibitors (TKIs), which are associated with significantly higher response rates and longer progression-free survival. We analysed first-line treatment according to gene aberration test status in advanced nonsquamous NSCLC patients in China (CTONG- 1506). Methods Our survey of 12 tertiary hospitals in China included advanced nonsquamous NSCLC patients admitted for first-line anti-cancer treatment from August 2015 to March 2016. Data extracted from medical charts for analysis were patient demographics, tumor histologic type, gene aberration test status and results (if performed), and first-line anti-cancer treatment regimen. Results The gene aberration test rate for patients (N = 932; median age, 59 years; male, 56%) with advanced nonsquamous NSCLC was 71% and varied with hospital location (Beijing, Shanghai, Guangzhou vs other locations) and type (general vs specialist), and patient residence (urban vs rural). Although 67% of patients with EGFR mutations (mainly in exons 19 or 21; n = 280) received first-line EGFR TKIs, 31% received first- line chemotherapy (chemo.; Table). Most patients with ALK fusions received first-line chemotherapy (56%) or ALK TKIs (35%); 3 patients had co-existing EGFR mutations and received first-line EGFR TKIs (Table). Nearly all patients with negative or unknown gene aberration status (96%) received first-line chemotherapy (Table), of which pemetrexed (66%, 367/554) was the predominant nonplatinum chemotherapy- backbone agent.Tabled 1Table: 431PGene aberrationn (%)PositiveNegative/UnknownEGFRALKROSIN = 309N = 48N = 1N = 574TKIs207 (67)20 (42)115 (3)EGFR2053015ALK11710VEGFR1000Chemo.a95 (31)27 (56)0554 (96)TKIs 1 Chemo.7 (2)1 (2)05 (1)EGFR7002nonEGFR0103 Open table in a new tab aIncluding bevacizumab-triplet Conclusions Results from our survey of tertiary hospitals in China suggest that first- line treatment of advanced nonsquamous NSCLC patients is mostly aligned with the presence or absence of gene aberrations. Clinical trial indentification Chinese Thoracic Oncology Group (CTONG) study number 1506 Legal entity responsible for the study Lilly Suzhou Pharmaceutical Co. Ltd., China Funding: Lilly Suzhou Pharmaceutical Co. Ltd., China Disclosure Q. Shi, L.L. Yang, P.H. Zhang: Employee of Lilly Suzhou Pharmaceutical Co., China. Y-L. Wu: Honoraria: F. Hoffmann-La Roche, Eli Lilly, AstraZeneca, Pfizer. All other authors have declared no conflicts of interest.