CMET-10. EFFECT OF EGFR AND ALK MUTATIONS ON THE OUTCOME OF STAGE III LUNG CARCINOMA PATIENTS WITH BRAIN METASTASIS - CLEVELAND CLINIC EXPERIENCE

Abstract

Lung Cancer is the leading cause of mortality in men and women diagnosed with cancer world-wide. Among patients diagnosed with lung cancer, non-small cell lung cancer (NSCLC) is one of the most common type consisting predominantly Adenocarcinoma, Squamous cell carcinoma, and large cell carcinoma. Patients with stage III NSCLC are referred to multi-modality treatment protocols which includes chemo-therapy, radio-therapy or both and surgery when feasible. Molecular technology has enabled identification of mutations like EGFR (Epidermal growth factor receptor) and ALK (Anasplatic lymphoma kinase). With the advances in targeted therapy, the aim of the study is to compare the PFS and OS in the patients with positive mutations having brain metastasis to those who had negative mutation. In a retrospective study, the Cleveland Clinic’s database was used to identify stage III NSCLC patients treated through 2003–2014. There were a total of 734 patients in the study. NSCLC Stage III was characterized by clinical or pathological stage. Kaplan-Meier estimate was used to determine the survival of patients by conducting a regression of OS and PFS against time since treatment was begun. 2-year survival and 5-year survival were treated as binary variables. There were a total of 734 patients in the study. Overall 130 patients had brain metastasis out of 734 patients i.e. approximately 18%. 202 patients had a mutation status which was observed to be either positive or negative. 23 patients with mutation negative status had brain metastasis, 2 patients with EGFR positive and 1 patient with ALK positive mutation had brain metastasis. Hazard Ratio (HR) (95% CI); Overall Survival 0.36 (0.047, 2.80) p = 0.33; PFS 0.27 (0.035, 2.13) p = 0.21. In stage 3 lung carcinoma patients, no statistically significant difference was observed in the OS and PFS for patients with brain metastasis having positive mutation status.