Interstitial lung disease associated with amrubicin in the treatment of patients with small cell lung cancer

e19018

Background: Amrubicin is a novel anthracycline agent with significant activity against small-cell lung cancer (SCLC). The adverse pulmonary effects of amrubicin are less well known. We investigated the incidence of acute interstitial lung disease (ILD) in SCLC patients receiving amrubicin. Methods: Medical records were used to retrospectively investigate a total of 100 SCLC patients treated with single-agent amrubicin at the National Cancer Center Hospital East between June 2003 and March 2008. The radiographic records and clinical data of these patients were reviewed to find patients who developed acute ILD after being treated with amrubicin. Results: Seven of 100 SCLC patients subsequently developed pulmonary infiltrates without underlying heart disease after receiving amrubicin, and were identified as cases of acute ILD associated with amrubicin. The median time from the start of amrubicin treatment to the development of ILD was 22 days (15–94 days). Among 7 patients who developed ILD, 6 patients received treatment with corticosteroids and ILD improved in 3 patients. However 3 patients died of respiratory failure. The incidence of ILD was 33% (4/12) in patients with preexisting pulmonary fibrosis and 3% (3/88) in patients without preexisting pulmonary fibrosis, and the difference between the two groups was statistically significant (P = 0.0036). Conclusions: Our findings indicate that amrubicin can cause severe ILD, and that the incidence of ILD might be higher in the patients with preexisting pulmonary fibrosis. Physicians need to be alert to the possibility.

No significant financial relationships to disclose.

Analysis of optimal timing of gefitinib in sensitive non-small cell lung cancer (NSCLC) patients: Should we use gefitinib as first-line chemotherapy?

8068

Background: In gefitinib-sensitive NSCLC such as Asian origin, adenocarcinoma, and never/light smoker, the superiority of gefitinib relative to carboplatin/paclitaxel as first-line chemotherapy was recently demonstrated (IPASS). However, the optimal timing of this agent is still controversial. Methods: To assess the optimal timing of gefitinib for sensitive NSCLC, we retrospectively reviewed 720 NSCLC patients treated with this agent at National Cancer Center Hospital East between 2002 and 2008. Results: A total of 190 patients responded to gefitinib monotherapy (response rate 26%) were analyzed in this study. Forty-four patients (23%) were treated with gefitinib as first-line chemotherapy, and 146 (77%) as second or more-line chemotherapy. Patient characteristics (first-line/second or more-line) were as follows: median age (range) 68 (44–82)/64 (33–82); female 84/67%; non-smoker 80/57%; PS0–1 84/74%; adenocarcinoma 93/97%; stage IV 43/54%; recurrence after surgical resection 45/26%. There were some imbalances between the two groups in terms of female (p=0.0296) and recurrence after surgical resection (p=0.0187). Although 64% of second or more-line group received platinum-based chemotherapy in their clinical course, only 27% of first-line group received it. Median follow-up time was 17.2 months. Progression free survival (PFS) from the start of gefitinib was similar between first-line and second or more-line groups (median PFS: 11 vs. 11 months, p=0.3085). However, overall survival (OS) from the start of first-line chemotherapy was significantly longer in second or more-line group (median OS: 23 vs. 33 months, p=0.0298). Conclusions: Even if gefitinib is administered to sensitive patients as first-line or second or more-line chemotherapy, it should have similar efficacy. The significantly longer survival in second or more-line group may be on account of more percentage of patients receiving platinum-based chemotherapy.

No significant financial relationships to disclose.

Cisplatin + irinotecan versus cisplatin + etoposide in extensive stage small cell lung cancer (E-SCLC): Final “common arm”: Comparative outcomes analysis of JCOG 9511 and SWOG 0124

8027

Background: S0124 was a large North American phase III trial (n=651) that failed to confirm a survival benefit for cisplatin/irinotecan over cisplatin/etoposide in patients with E-SCLC, contrary to the results of J9511, a phase III trial exclusively in Japanese patients (n=154). As S0124 and J9511 protocols used identical treatment regimens and similar eligibility criteria, we compared demographics, toxicity, and outcomes using patient-level data and a “common arm” analysis to explore potential reasons for the divergent results. Methods: In both trials, patients with documented E-SCLC and adequate end-organ function were randomized to receive either cisplatin 60 mg/m2 day 1 + irinotecan 60 mg/m2 days 1, 8, & 15 Q 4 weeks or cisplatin 80 mg/m2 day 1 + etoposide 100 mg/m2 days 1–3 Q 3 weeks. Demographics and outcomes data were compared among 805 patients enrolled in J9511 and S0124 receiving identical treatment using a logistic model adjusted for age, sex, and performance status. Results: Of 671 patients in S0124, 651 were eligible. Patient characteristics (J9511 & S0124, respectively): Mean age - 61 & 62 years; Male sex - 132 (86%) & 370 (57%), p<0.001; Performance status 0 - 19 (12%) & 211 (32%), p<0.001. Efficacy and toxicity comparisons are summarized below. Conclusions: Significant differences in patient demographics, toxicity, and efficacy exist between J9511 and S0124 populations. These results, relevant in the current era of clinical trials globalization, warrant 1) consideration of differential patient characteristics and outcomes amongst populations receiving identical therapy; 2) utilization of the “common arm” model in prospective trials; and 3) inclusion of pharmacogenomic correlates in cancer trials where ethnic/racial differences in drug disposition are expected.

[Table: see text]

[Table: see text]

Comparison of gefitinib and docetaxel in patients with pretreated advanced non-small cell lung cancer (NSCLC): Meta-analysis from four clinical trials

8011

Background: Four open-label, randomized trials evaluated gefitinib (G) vs docetaxel (D) in unselected patients with pre-treated advanced NSCLC: INTEREST (Lancet 2008; 372: 1809), V-15–32 (J Clin Oncol 2008; 26: 4244), ISTANA (J Clin Oncol 2008; 26: Abs 8025), SIGN (Anticancer Drugs 2006; 17: 401). Reported here is a meta-analysis using the patient data from each of these trials. Methods: The meta-analysis compared efficacy of G (250 mg/day) and D (75 mg/m2 [V-15–32 60 mg/m2]) using appropriate analysis populations from INTEREST (1466 patients randomized), V-15–32 (489), ISTANA (161) and SIGN (141). Meta-analyses (unadjusted and adjusted for covariates) were performed by Cox proportional hazards for OS and PFS, and by logistic regression for ORR. Results: G demonstrated similar OS and PFS and superior ORR to D in the primary analyses. Secondary analyses demonstrated similar results. Conclusions: Results were consistent with those of the individual studies. Given the similar/superior efficacy demonstrated by G, its favorable tolerability profile, quality of life benefits and oral administration, G has a favorable benefit-risk profile compared with D in a broad pre-treated advanced NSCLC patient population.

[Table: see text]

[Table: see text]

Chemoradiation therapy in patients (pts) with small cell lung cancer (SCLC) with pericardial effusion but no distant metastasis

7555

Background: Our previous retrospective analysis demonstrated that the survival of the limited-disease (LD) SCLC pts with ipsilateral pleural effusion was intermediate between those of LD pts without ipsilateral pleural effusion and extensive-disease (ED) pts, and that long-term survival was achieved by LD-SCLC pts with ipsilateral pleural effusion who successfully underwent chemoradiotherapy (CRT) (J Thorac Oncol 2008;3:723–7). We retrospectively investigated the clinical course and outcome in pts with SCLC with pericardial effusion but no distant metastasis and examined the overall survival in pts who received chemotherapy and definitive thoracic radiotherapy (TRT). Methods: The medical records of SCLC pts who received treatment at the National Cancer Center Hospital East between July 1992 and December 2007 were reviewed. During this period 767 pts were newly diagnosed as having SCLC. Four-hundred seventeen pts had no distant metastasis. Ninety-six of those 417 pts (23%, 95% confidence interval (CI): 19–27%) had pleural or pericardial effusion or disseminated pleural nodules, and were included in this study. The 96 pts were divided into two groups: group A included pts with pericardial effusion (n=33), and group B included pts who had pleural effusion and/or disseminated pleural nodules, but did not have pericardial effusion (n=63). Sixteen pts had both pleural and pericardial effusion. Results: All but one patient received systemic chemotherapy. A remaining patient with pleural effusion received only best supportive care. In group A, 19 pts received chemoradiotherapy. TRT was conducted concurrently with 3 or 4 cycles of chemotherapy in 12 pts and sequentially in 7 pts. The response rate for first-line chemotherapy was 79%. In group B, 26 pts received chemoradiotherapy. Survival data were shown as below. Conclusions: Long-term survival was seldom achieved by SCLC pts with pericardial effusion but no distant metastasis, even if they underwent chemoradiotherapy.

[Table: see text]

No significant financial relationships to disclose.

Use of a genome-wide association study to detect candidate polymorphisms associated with overall survival in stage IV pancreatic adenocarcinoma patients receiving gemcitabine monotherapy

4611

Background: Individual variations in overall survival time (OS) or antitumor effects may be partly explained by host genetic factors, which have not yet been identified. We performed a genome-wide association study (GWAS) in Japanese patients with stage IV pancreatic adenocarcinoma receiving gemcitabine (Gem) monotherapy. Methods: Metastatic pancreatic ductal adenocarcinoma patients who had previously received neither radiation nor chemotherapy were eligible in this study. Gem was administered as a 30-min i.v. infusion at either 800 or 1000 mg/m2. The peripheral blood leukocyte DNA samples were genotyped at 110,000 SNPs using Illuimina's Human-1 Genotyping BeadChip. Statistical analyses were performed by the log-rank test and Cox proportional hazards model in consideration of linkage disequilibrium. Results: From Jul 2002 to Jul 2006, 67 patients (male/female: 44/23, PS 0/1/2: 31/32/4, 36–78 (median: 62) years of age were enrolled. The median survival time (MST) of these 67 patients was 5.8 months. In the GWAS, we detected 11 candidate SNPs which were associated with significantly shortened OS. Eventually, 6 SNPs were MAF>5% and remained statistically significant even after multiple comparison adjustment: rs1861674 in the LOH12CR1 gene (MST for CC [n=60] and CT [n=7] + TT [n=0] were 6.4 and 1.6 months, respectively; P=1.0×10-7, HR=8.25 (3.3–20.9)), rs10504551 in the TCEB1 (MST for CT [n=28] + CC [n=36] and TT [n=3] were 5.8 and 1.0 months. P=1.1×10-7, HR=14.9 (3.9–56.1)), rs1132750 (MST for AC [n=18] + AA [n=45] and CC [n=4] were 6.3 and 1.1 months. P=4.6×10-11, HR=23.5 (6.1–91.7)), rs2055943 in the GABRA4 (MST for AC [n=27] + CC [n=36] and AA [n=4] were 6.3 and 1.2 months. 1.3×10-11, HR=26.1 (6.4–107), rs2589506 in the MAPK10 (MST for AG [n=29] + GG [n=31] and AA [n=7] were 6.4 and 1.1 months. P=3.2×10-6, HR=5.9 (2.6–14.1)) and rs2586404 in the DNM3 (MST for CT [n=30] + CC [n=33] and TT [n=3] were 5.8 and 0.62 months. P=3.4×10-9, HR=18.6 (4.9–71.5)). Conclusions: GWAS is a powerful tool to search for new prognostic biomarkers for patients with stage IV pancreatic adenocarcinoma receiving Gem monotherapy and may reveal as yet unexplored molecular pathways which correlate with drug response.

[Table: see text]

Biomarker analyses from a phase III, randomized, open-label, first-line study of gefitinib (G) versus carboplatin/paclitaxel (C/P) in clinically selected patients (pts) with advanced non-small cell lung cancer (NSCLC) in Asia (IPASS)

8006^

Background: IPASS demonstrated overall superiority of first-line G vs C/P for progression-free survival (PFS) in never/light ex-smokers with stage IIIB/IV adenocarcinoma NSCLC in Asia. PFS favored CP initially and then G. Outcome was correlated with biomarkers (preplanned exploratory objective). Methods: 683 patients provided tissue samples. Analyses included primary endpoint PFS (Cox proportional hazards) and secondary endpoint objective response rate (ORR; logistic regression) by biomarker status. Results: EGFR mutation (M) status was evaluable in 437 pts by Amplification Refractory Mutation System (ARMS; 60% M+). M+ pts had significantly longer PFS and higher ORR and M- pts significantly shorter PFS and lower ORR with G than C/P. In M unknown pts PFS and ORR were similar to overall population. Post hoc analysis of overall survival favored G in M+ pts (31% maturity; HR 0.78; 95% CI 0.50–1.20) and C/P in M- pts (53% maturity; HR 1.38; 95% CI 0.92–2.90); differences were not statistically significant and follow-up is ongoing. EGFR gene-copy number was evaluable in 406 pts by fluorescence in situ hybridization (FISH; 61% FISH +). Similar PFS and ORR results to analyses by M status were observed, driven by the overlap in EGFR FISH and M status. EGFR protein expression (PE) was evaluable in 365 pts by immunohistochemistry (73% PE+). PFS outcomes did not differ statistically between PE+ and PE-. ORR favored G in both PE+ and - pts. Conclusions: EGFR M status was a strong predictive biomarker for the efficacy of G vs C/P in this clinically selected first-line setting.

[Table: see text]

No significant financial relationships to disclose.

ASCO Conflict of Interest Policy and Exceptions

In compliance with the guidelines established by the ASCO Conflict of Interest Policy (J Clin Oncol. 2006 Jan 20;24[3]:519–521) and the Accreditation Council for Continuing Medical Education (ACCME), ASCO strives to promote balance, independence, objectivity, and scientific rigor through disclosure of financial and other interests, and identification and management of potential conflicts. According to the ASCO Conflict of Interest Policy, the following financial and other relationships must be disclosed: employment or leadership position, consultant or advisory role, stock ownership, honoraria, research funding, expert testimony, and other remuneration (J Clin Oncol. 2006 Jan 20;24[3]:520). The ASCO Conflict of Interest Policy disclosure requirements apply to all authors who submit abstracts to the Annual Meeting.

For clinical trials that began accrual on or after April 29, 2004, ASCO's Policy places some restrictions on the financial relationships of principal investigators (J Clin Oncol. 2006 Jan 20;24[3]:521). If a principal investigator holds any restricted relationships, his or her abstract will be ineligible for placement in the 2009 Annual Meeting unless the ASCO Ethics Committee grants an exception. Among the circumstances that might justify an exception are that the principal investigator (1) is a widely acknowledged expert in a particular therapeutic area; (2) is the inventor of a unique technology or treatment being evaluated in the clinical trial; or (3) is involved in international clinical oncology research and has acted consistently with recognized international standards of ethics in the conduct of clinical research. NIH-sponsored trials are exempt from the Policy restrictions. Abstracts for which authors requested and have been granted an exception in accordance with ASCO's Policy are designated with a caret symbol (^) in the Annual Meeting Proceedings.

For more information about the ASCO Conflict of Interest Policy and the exceptions process, please visit www.asco.org/conflictofinterest .

Identification of prognostic factors for patients with advanced pancreatic cancer by proteomics

4615

Background: Gemcitabine monotherapy is the current standard for patients with advanced pancreatic cancer (PC). Its efficacy, however, varies significantly depending on individuals. This study was aimed at discovering a new diagnostic biomarker that can estimate the outcome of patients after receiving the therapy. Methods: All patients included in this study (304 patients) had metastatic PC and received at least two cycles of gemcitabine monotherapy. We compared the baseline plasma proteome between representative 29 short-term survivors (survived for less than 100 days) and 31 long-term survivors (survived for more than 400 days) using quantitative mass spectrometry (MS). Results: Among a total of 45,277 peptide peaks, we identified 637 peaks whose intensities were significantly different (p<0.001, Welch's t-test). The 2 MS peaks with the highest statistical significance (p=2.57×10-4 and 5.03×10-4) were revealed to be derived from α1-antitrypsin (AT) and α1-antichymotrypsin (ACT), respectively, by tandem MS. The levels of AT and ACT, WBC count, platelet count, alkaline phosphatase, and ECOG performance status were selected using a forward stepwise procedure by Akaike's information criterion, and a scoring system (nomogram) was constructed to estimate the prognosis of individual patients. Among the selected parameters the AT level was found to be the second most significant contributor to the nomogram (p=0.0003; Table ). This survival prediction model was internally validated using a bootstrap approach with 200 resamples. Conclusions: Our survival prediction model including values of AT and ACT seems to have high practical utility and may lead to tailoring the treatment of patients with advanced PC. Modification of therapeutics may need to be taken into consideration for patients with increased AT and ACT.

[Table: see text]

[Table: see text]

Trends in chemotherapy for elderly patients with non-small cell lung cancer: The experience of one institution

e19081

Background: In approximately the year 2000, the results of a number of important studies of non-small-cell lung cancer (NSCLC) were published. These included the first elderly-specific phase III trial and phase III trials showing a survival benefit for docetaxel when used as second-line chemotherapy. These results had a significant impact on clinical practice relating to advanced NSCLC in elderly patients. Methods: Between July 1992 and December 2003, 223 patients with NSCLC aged ≥70 years received chemotherapy alone as their initial treatment at the National Cancer Center Hospital East. These patients were divided into 2 groups: those that began treatment between 1992 and 1999 (group A) and between 2000 and 2003 (group B). The details of chemotherapy regimens and outcomes were compared. Results: In group A, 83% of patients received platinum-based chemotherapy, two-thirds of these regimens comprised platinum[[Unsupported Character -  ]]plus second-generation combination chemotherapy. In contrast, although 55% of patients received platinum-based chemotherapy in group B, 41% of patients received non-platinum-based chemotherapy. Among patients in group B, performance status was significantly associated with the selection of platinum-based or non- platinum-based chemotherapy; age was marginally associated with this selection. In group A, second-line chemotherapy was administered to only 4 patients (5%) and no patients received third-line chemotherapy. In group B, second-line and third-line chemotherapy was administered to 62 (42%) and 22 (15%) patients, respectively. Median survival time (MST), 1-year survival rate, and 2 year-survival rate were 6.7 months, 14%, and 7%, respectively, in group A, and 8.1 months, 35%, and 20% in group B (p = 0.0109). However, these differences disappeared when patients treated with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) were removed from the analysis (6.7 months in group A vs. 6.9 months in group B, p = 0.3684). Conclusions: In and after the year 2000, chemotherapy regimens changed greatly and survival of elderly patients significantly improved. However, the improvement in survival seems to be due mostly to the use of EGFR-TKI treatment.

No significant financial relationships to disclose.

Randomized, open-label, multicenter phase II study of bevacizumab in combination with carboplatin and paclitaxel in chemotherapy-naive Japanese patients with advanced or recurrent nonsquamous non-small cell lung cancer (NSCLC): JO19907

8036^

Background: Two phase III trials (ECOG 4599 and BO17704) demonstrated that the addition of bevacizumab (Bev) to platinum-based regimens improved overall and/or progression-free survival (PFS) in patients (pts) with advanced non-squamous NSCLC (Sandler et al. NEJM 2006; Manegold et al. ESMO2008). However, no investigation with Bev has been conducted in Japanese NSCLC pts. Methods: This randomized, open-label phase II study compared a 3-weekly regimen of 15mg/kg of Bev plus carboplatin/paclitaxel (CP) versus CP alone. The primary endpoint was PFS; secondary endpoints included overall survival (OS), response rate (RR) and safety. Eligibility criteria: histologically or cytologically documented previously untreated advanced or recurrent non-squamous NSCLC; ECOG PS 0–1; no brain metastases. A size of 180 pts was planned to be randomized to: C AUC=6 and P 200mg/m2 q3 wks for up to 6 cycles plus Bev continued to progression at 15mg/kg q3 wks, or CP alone at the randomization ratio of 2:1. The study was designed to observe a 20% reduction in the risk of a PFS event in the Bev arm compared with control. Results: Between 4/07 and 3/08, 180 pts were accrued. Three pts of them were ineligible and 3 pts were not dosed at all. PFS (as assessed by investigators) and RR were significantly improved. OS is immature due to short duration of follow up. Updated PFS results as assessed by the central review committee and OS data will be provided. No new safety signals for Bev were detected. Conclusions: This is the first study of Bev in Japanese pts with NSCLC. The addition of 15mg/kg of Bev to CP significantly improved PFS and RR. The HR of PFS seemed at least as good as previous trials outside Japan. Safety of Bev was within a range already reported. This study confirms the efficacy and safety of Bev in Japanese pts with NSCLC.

[Table: see text]

[Table: see text]

ASCO Conflict of Interest Policy and Exceptions

In compliance with the guidelines established by the ASCO Conflict of Interest Policy (J Clin Oncol. 2006 Jan 20;24[3]:519–521) and the Accreditation Council for Continuing Medical Education (ACCME), ASCO strives to promote balance, independence, objectivity, and scientific rigor through disclosure of financial and other interests, and identification and management of potential conflicts. According to the ASCO Conflict of Interest Policy, the following financial and other relationships must be disclosed: employment or leadership position, consultant or advisory role, stock ownership, honoraria, research funding, expert testimony, and other remuneration (J Clin Oncol. 2006 Jan 20;24[3]:520). The ASCO Conflict of Interest Policy disclosure requirements apply to all authors who submit abstracts to the Annual Meeting.

For clinical trials that began accrual on or after April 29, 2004, ASCO's Policy places some restrictions on the financial relationships of principal investigators (J Clin Oncol. 2006 Jan 20;24[3]:521). If a principal investigator holds any restricted relationships, his or her abstract will be ineligible for placement in the 2009 Annual Meeting unless the ASCO Ethics Committee grants an exception. Among the circumstances that might justify an exception are that the principal investigator (1) is a widely acknowledged expert in a particular therapeutic area; (2) is the inventor of a unique technology or treatment being evaluated in the clinical trial; or (3) is involved in international clinical oncology research and has acted consistently with recognized international standards of ethics in the conduct of clinical research. NIH-sponsored trials are exempt from the Policy restrictions. Abstracts for which authors requested and have been granted an exception in accordance with ASCO's Policy are designated with a caret symbol (^) in the Annual Meeting Proceedings.

For more information about the ASCO Conflict of Interest Policy and the exceptions process, please visit www.asco.org/conflictofinterest .

Genome-wide association scan detected candidate polymorphisms associated with overall survival (OS) in advanced non-small cell lung cancer (NSCLC) treated with carboplatin (CBDCA) and paclitaxel (PTX)

8031

Background: The combination of CBDCA and PTX is one of the standard chemotherapy for patients with advanced NSCLC. Genome-wide association studies (GWAS) are a powerful tool for identifying genes for biomarkers of common diseases. This prospective study was investigated whether candidate polymorphisms in GWAS could influence OS in advanced NSCLC patients treated with CBDCA and PTX. Methods: Chemotherapy naïve stage IIIB or IV NSCLC patients, treated with CBDCA (AUC=6mg/ml/min) and PTX (200mg/m2, 3-hour), were eligible in this study. The DNA samples were extracted from peripheral blood mononuclear cells before treatment and 110,000 SNPs were obtained by Illuimna's Sentrix Human-1 Genotyping BeadChip. Statistical analyses were performed by the log-rank test and Cox proportional hazards model in consideration of the linkage disequilibrium. Results: From July 2002 to May 2004, 117 patients (male/female: 85/32, PS 0/1/2: 22/92/3, stage IIIB/IV: 50/67), aged 29–80 (median: 61) years, received a total of 387 cycles of treatment. The median survival time (MST) of 117 patients was 17.1 months. In the GWAS, four SNPs were associated significantly with shortened OS: rs1656402 in the EIF4E2 Gene (MST for AG [n = 54] + AA [n = 44] and GG [n = 19] were 18.2 and 7.7 months, respectively; p = 4.2× 10-7, HR = 3.58 [2.1–6.1]), rs1209950 in the ETS2 gene (MST for AA [n = 105] and AG [n = 12] + GG [n = 0] were 17.7 and 7.0 months, respectively. p = 9.2×10-8, HR = 4.95 [2.6–9.5]), rs10074374 (MST for CC [n = 114] and CT [n = 3] + TT [n = 0] were 17.1 and 2.2 months, respectively. p = 2.2×10-6, HR = 23.2 [6.3–85.1]) and rs2063681 (MST for CT [n = 45] + CC [n = 61] and TT [n = 11] were 17.8 and 6.6 months, respectively. p = 5.2×10-8, HR = 5.47 [2.8–10.9]). These four SNPs were statistically significant even after multiple comparison adjustment. Conclusions: GWAS is a powerful tool to search for new prognostic biomarkers for patients with stage IIIB or IV NSCLC who receive CBDCA and PTX as the first-line chemotherapy and may unveil an unexplored molecular pathways correlated with the drug response.

[Table: see text]

Tumor response category for the indicator of prognosis: Analysis of survival data in a Four-Arm Cooperative Study (FACS) for advanced non-small cell lung cancer (NSCLC)

8088

Background: Tumor response, categorized into CR (complete response), PR (partial response), SD (stable disease) and PD (progressive disease), is a surrogate endpoint for survival and could be expected as a possible indicator of the prognosis. To evaluate whether the tumor response category might be used as an indicator of the prognosis, we conducted an analysis of the best overall response and survival data obtained from FACS, a phase III randomized trial comparing four platinum-based regimens for advanced NSCLC. Methods: A total of 602 patients (pts) with advanced NSCLC from 44 hospitals in Japan were registered in FACS. A retrospective review of the FACS database, including the tumor response and survival, was conducted. The tumor response as evaluated by the investigators was applied with and without confirmation of complete or partial responses at the determination of best overall response. Survival was calculated by the Kaplan-Meier method, and differences among prognostic groups were analyzed by Cox regression analysis. Results: Forty-five pts were excluded from the analysis due to nonavailability of sufficient data. The results are shown in the Table . The response categories of CR, PR and SD could not be categorized into prognostic groups, either with or without confirmation. There were, otherwise, two distinct prognostic groups: non-PD (CR, PR and SD) and PD. Conclusions: The disease control rate was a more sensitive indicator of the prognosis than the response rate in pts with advanced NSCLC registered in FACS.

[Table: see text]

[Table: see text]

Phase III, randomized, open-label, first-line study of gefitinib (G) versus carboplatin/paclitaxel (C/P) in selected patients (pts) with advanced non-small cell lung cancer (NSCLC) (IPASS): Evaluation of recruits in Japan

8044^

Background: The IRESSA Pan Asia Study (IPASS) demonstrated superiority of G vs C/P in 1,217 clinically selected chemonaïve pts in Asia with advanced NSCLC. PFS favored C/P initially then G, likely driven by different outcomes according to EGFR mutation (M) status. We report the planned analyses of 233 recruits in Japan (19% of overall population). Methods: From Mar 06 to Oct 07, chemonaïve, never/light ex-smokers with stage IIIB/IV NSCLC and adenocarcinoma histology were randomized to G 250 mg/day (n=114) or C (AUC 5 or 6)/P (200 mg/m2) (n=119). Primary objective was PFS in ITT population; a treatment by country interaction test (Japan vs other) was performed. Secondary endpoints were overall survival (OS), objective response rate (ORR, RECIST), QoL (FACT-L, TOI), symptom improvement (LCS subscale of FACT-L), and tolerability. Results: PFS results in pts in Japan did not significantly differ from other pts (interaction test p=0.4736). G demonstrated superior PFS compared with C/P (HR 0.69; 95% CI 0.51–0.94; p=0.0191); effect was not constant over time, favoring C/P initially then G. Preliminary OS (25% maturity; follow-up ongoing) was similar for G and C/P (HR 0.89; 95% CI 0.53–1.48). ORR for G was 41% vs 35% for C/P;odds ratio [OR] 1.34; 95% CI 0.78–2.30; p=0.2967. QoL improvement rate (TOI) was 43% for G and 28% for C/P (OR 1.92; 95% CI 1.11–3.34; p=0.0200); QoL (FACT-L 41 vs 43%; OR 0.94; 95% CI 0.56–1.60; p=0.8263) and symptom (LCS 42 vs 46%; OR 0.85; 95% CI 0.50–1.43; p=0.5340) improvement rates were similar for G and C/P. Tolerability profile was more favorable with G than C/P. There were no deaths due to ILD-type events (frequency 1.8% [G] vs 0% [C/P]). Conclusions: Efficacy and safety data for pts in Japan were generally consistent with overall population. G demonstrated improved PFS and ORR, similar OS, higher QoL (TOI) and similar symptom improvement rates, and a more favorable tolerability profile compared with C/P in chemonaïve, never/light ex-smokers with advanced NSCLC and adenocarcinoma histology. In IPASS, EGFR M status appeared to be a strong predictive biomarker for G efficacy compared with C/P.

[Table: see text]

ASCO Conflict of Interest Policy and Exceptions

In compliance with the guidelines established by the ASCO Conflict of Interest Policy (J Clin Oncol. 2006 Jan 20;24[3]:519–521) and the Accreditation Council for Continuing Medical Education (ACCME), ASCO strives to promote balance, independence, objectivity, and scientific rigor through disclosure of financial and other interests, and identification and management of potential conflicts. According to the ASCO Conflict of Interest Policy, the following financial and other relationships must be disclosed: employment or leadership position, consultant or advisory role, stock ownership, honoraria, research funding, expert testimony, and other remuneration (J Clin Oncol. 2006 Jan 20;24[3]:520). The ASCO Conflict of Interest Policy disclosure requirements apply to all authors who submit abstracts to the Annual Meeting.

For clinical trials that began accrual on or after April 29, 2004, ASCO's Policy places some restrictions on the financial relationships of principal investigators (J Clin Oncol. 2006 Jan 20;24[3]:521). If a principal investigator holds any restricted relationships, his or her abstract will be ineligible for placement in the 2009 Annual Meeting unless the ASCO Ethics Committee grants an exception. Among the circumstances that might justify an exception are that the principal investigator (1) is a widely acknowledged expert in a particular therapeutic area; (2) is the inventor of a unique technology or treatment being evaluated in the clinical trial; or (3) is involved in international clinical oncology research and has acted consistently with recognized international standards of ethics in the conduct of clinical research. NIH-sponsored trials are exempt from the Policy restrictions. Abstracts for which authors requested and have been granted an exception in accordance with ASCO's Policy are designated with a caret symbol (^) in the Annual Meeting Proceedings.

For more information about the ASCO Conflict of Interest Policy and the exceptions process, please visit www.asco.org/conflictofinterest .

Current trend in incidence of severe interstitial lung disease (ILD) due to gefitinib in Japan

e19075

Background: Although gefitinib is a promising agent for the treatment of advanced non-small cell lung cancer, ILD occurs in Japanese patients and sever ILD sometimes becomes fatal toxicity. ILD has been reported to be associated with preexisting ILD, smoking, and poor performance status. On the other hand, it has been reported that female gender, adenocarcinoma, non-smoker, and EGFR mutation are associated with sensitivity to gefitinib. Methods: To investigate the trend in incidence of severe ILD and patient characteristics receiving gefitinib, a total of 751 patients who were administered gefitinib in National Cancer Center Hospital East between 2002 and 2008 were retrospectively reviewed. To investigate how oncologists avoid administering gefitinib to patients with preexisting ILD, pretreatment chest CT films of all patients were also reviewed by two thoracic radiologists. Results: The patient number who received gefitinib in 2002/2003/2004/2005/2006/2007/2008 were 134/141/88/93/125/98/72, respectively. In these patients, percentages of female were 36/43/42/55/59/52/54%, adenocarcinoma 76/78/93/88/95/93/92%, non-smoker 35/30/40/53/49/48/46%, respectively. Almost all of the patient receiving gefitinib was recently restricted to adenocarcinoma. Grade 3–5 severe ILD was observed in 1.9% of all patients. However, the incidence rate of sever ILD were decreased as 3.0/2.8/2.3/1.1/0.8/1.0/1.4%, respectively. The rates of patients with preexisting ILD were also decreased as 22/14/15/5/2/3/6%, respectively. Conclusions: The correct information about efficacy and severe ILD about gefitinib influenced patient selection by oncologists, and it is reasonable to select more effective and safe patients in Japan. It is estimated that the incidence rate of severe ILD should be consequently controlled by the spread of these information.

No significant financial relationships to disclose.

Vandetanib plus docetaxel versus docetaxel as second-line treatment for patients with advanced non-small cell lung cancer (NSCLC): A randomized, double-blind phase III trial (ZODIAC)

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The full, final text of this abstract will be available in Part II of the 2009 ASCO Annual Meeting Proceedings, distributed onsite at the Meeting on May 30, 2009, and as a supplement to the June 20, 2009, issue of the Journal of Clinical Oncology.

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Homozygous CDA*3 is a major cause of life-threatening toxicities in gemcitabine-treated Japanese cancer patients

Among 242 Japanese pancreatic cancer patients, three patients (1.2%) encountered life-threatening toxicities, including myelosuppression, after gemcitabine-based chemotherapies. Two of them carried homozygous CDA*3 (CDA208G>A [Ala70Thr]), and showed extremely low plasma cytidine deaminase activity and gemcitabine clearance. Our results suggest that homozygous *3 is a major factor causing gemcitabine-mediated severe adverse reactions among the Japanese population.

A new statistical screening approach for finding pharmacokinetics-related genes in genome-wide studies

Biomedical researchers usually test the null hypothesis that there is no difference of the population mean of pharmacokinetics (PK) parameters between genotypes by the Kruskal-Wallis test. Although a monotone increasing pattern with a number of alleles is expected for PK-related genes, the Kruskal-Wallis test does not consider a monotonic response pattern. For detecting such patterns in clinical and toxicological trials, a maximum contrast method has been proposed. We show how that method can be used with pharmacogenomics data to a develop test of association. Further, using simulation studies, we compare the power of the modified maximum contrast method to those of the maximum contrast method and the Kruskal-Wallis test. On the basis of the results of those studies, we suggest rules of thumb for which statistics to use in a given situation. An application of all three methods to an actual genome-wide pharmacogenomics study illustrates the practical relevance of our discussion.

Emerging ethnic differences in lung cancer therapy

Although global clinical trials for lung cancer can enable the development of new agents efficiently, whether the results of clinical trials performed in one population can be fully extrapolated to another population remains questionable. A comparison of phase III trials for the same drug combinations against lung cancer in different countries shows a great diversity in haematological toxicity. One possible reason for this diversity may be that different ethnic populations may have different physiological capacities for white blood cell production and maturation. In addition, polymorphisms in the promoter and coding regions of drug-metabolising enzymes (e.g., CYP3A4 and UGT1A1) or in transporters (e.g., ABCB1) may vary among different ethnic populations. For example, epidermal growth factor receptor (EGFR) inhibitors are more effective in Asian patients than in patients of other ethnicities, a characteristic that parallels the incidence of EGFR-activating mutations. Interstitial lung disease associated with the administration of gefitinib is also more common among Japanese patients than among patients of other ethnicities. Although research into these differences has just begun, these studies suggest that possible pharmacogenomic and tumour genetic differences associated with individual responses to anticancer agents should be carefully considered when conducting global clinical trials.

A randomised phase II trial of preoperative chemotherapy of cisplatin-docetaxel or docetaxel alone for clinical stage IB/II non-small-cell lung cancer results of a Japan Clinical Oncology Group trial (JCOG 0204)

Preoperative chemotherapy is a promising strategy in patients with early-stage resectable non-small-cell lung cancer (NSCLC); optimal chemotherapy remains unclear. Clinical (c-) stage IB/II NSCLC patients were randomised to receive either two cycles of docetaxel (D)-cisplatin (P) combination chemotherapy (D 60 mg m(-2) and P 80 mg m(-2) on day 1) every 3-4 weeks or three cycles of D monotherapy (70 mg m(-2)) every 3weeks. Thoracotomy was performed 4-5 weeks (DP) or 3-4 weeks (D) after chemotherapy. The primary end point was 1-year disease-free survival (DFS). From October 2002 to November 2003, 80 patients were randomised. Chemotherapy toxicities were mainly haematologic and well tolerated. There were two early postoperative deaths with DP (one intraoperative bleeding and one empyema). Pathologic complete response was observed in two DP patients. Docetaxel-cisplatin was superior to D in terms of response rate (45 vs 15%) and complete resection rate (95 vs 87%). Both DFS and overall survival were better in DP. Disease-free survival at 1, 2 and 4 years were 78, 65 and 57% with DP, and were 62, 44 and 36% with D, respectively. Preoperative DP was associated with encouraging resection rate and DFS data, and phase III trials for c-stage IB/II NSCLC are warranted.