The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 429
Slide Session
OS-072 Lung Cancer
A Randomized Phase III Study of Docetaxel Plus Cisplatin Versus Pemetrexed Plus Cisplatin in First Line Non-Squamous Non-Small Cell Lung Cancer (NSq- NSCLC)
Young Chul Kim1, In-Jae Oh1, Kyu-Sik Kim1, Tae-Won Jang2, Yoo Duk Choi1, Youn Seup Kim3, Kwan-Ho Lee4, Kyung-Chul Shin4, Chi Young Jung5, Sei-Hoon Yang6, Seung-Hun Jang7, Jeong-Seon Ryu8, Seung-Soo Yoo9, Suk-Joong Yong10, Kye-Young Lee11, Kwang- Ho In12, Min-Ki Lee13
Chonnam National University Hwasun Hospital, Korea1, Kosin University, Korea2, Dankook University, Korea3, Yeungnam University, Korea4, Keimyung University, Korea5, Wonkwang University, Korea6, Han- lym University, Korea7, Inha University, Korea8, Kyungpook National University, Korea9, Yonsei University, Korea10, Konkuk University, Korea11, Korea University, Korea12, Pusan National University, Korea13 Background: For patients with NSq-NSCLC, pemetrexed(A) plus cisplatin(P) was superior to gemcitabine(G) plus cisplatin(P) in terms of efficacy and toxicity.
However, there have been no prospective phase III trial directly comparing the effi cacy of AP with docetaxel+cisplatin (DP) in NSq-NSCLC.
Methods: We undertook an open-label phase III trial with recruitment between August 2011, and December 2013, at 14 centers in Korea. Patients with chemo- therapy-naive NSq-NSCLC were randomized into 3 weekly cisplatin 70 mg/m2 with either docetaxel 60mg/m2 (DP) or pemetrexed 500mg/m2 (AP) for up to 4 cycles with stratifi cation strata of performance status and sex. The primary ob- jective was to assess PFS and the secondary endpoints were response rate, overall survival (OS) and safety. Treatment response was evaluated according to RECIST version 1.1.
Results: After 149 patients were randomized into AP (n=77) and DP (n=72) arm, study team fi nished enrollment because of approval and popular use of mainte- nance pemetrexed treatment in Korea. Clinical characteristics including sex, age, and performance status were well balanced between the arms. Number of cycles and relative dose intensity were not significantly different between the arms.
Partial remission was observed in 24 (31.2%) and 24 (33.3%) cases of AP and DP group, respectively. Median PFS was 4.7 months (95% confi dence interval, CI 4.4~5.1) in AP arm and 4.6 months (3.7~5.6) in DP arm. Rate of grade 3 or 4 neutropenia and febrile neutropenia, number of serious adverse events were sig- nifi cantly higher in DP compared to AP arm.
Conclusions: Although both regimen showed similar PFS and response rate, more frequent adverse events and higher toxicities were observed in DP arm. (Clinical- Trials.gov Identifi er: NCT01282151)
OS-073 Lung Cancer
Surgical Resection of Nodular Ground-Glass Opacities Without Percutaneous Needle Aspiration or Biopsy
Jaeyoung Cho1,2, Sung-Jun Ko1,2, Se Joong Kim1,2, Yeon Joo Lee1,2, Jong Sun Park1,2, Young-Jae Cho1,2, Ho Il Yoon1,2, Sukki Cho3,4, Kwhanmien Kim3,4, Sanghoon Jheon3,4, Jae Ho Lee1,2, Choon-Taek Lee1,2
Department of Internal Medicine, Seoul National University College of Medicine, Korea1, Division of Pul- monary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Korea2, Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Korea3, Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Korea4
Background: Percutaneous needle aspiration or biopsy (PCNA or PCNB) is an estab- lished diagnostic technique that has a high diagnostic yield. However, its role in the diagnosis of nodular ground-glass opacities (nGGOs) is controversial, and the necessity of preoperative histologic confirmation by PCNA or PCNB in nGGOs has not been well addressed. Thus, we here evaluated the rates of malignancy and surgery-related complications, and the cost benefi ts of resecting nGGOs without prior tissue diagnosis when those nGGOs were highly suspected for malignancy based on their size, radio- logic characteristics, and clinical course.
Methods: Patients who underwent surgical resection of nGGOs without preoperative tissue diagnosis from January 2009 to October 2013 were retrospectively analyzed.
Results: Among 356 nGGOs of 324 patients, 330 (92.7%) nGGOs were resected without prior histologic confi rmation. The rate of malignancy was 95.2% (314/330). In the multivariate analysis, larger size was found to be an independent predictor of ma- lignancy (odds ratio, 1.086; 95% confi dence interval, 1.001-1.178, p = 0.047). A total of 324 (98.2%) nGGOs were resected by video-assisted thoracoscopic surgery (VATS), and the rate of surgery-related complications was 6.7% (22/330). All 16 nGGOs di- agnosed as benign nodules were resected by VATS, and only one patient experienced postoperative complications (prolonged air leak). Direct surgical resection without tissue diagnosis signifi cantly reduced the total costs, hospital stay, and waiting time to surgery.
Conclusions: With careful selection of nGGOs that are highly suspicious for malignan- cy, surgical resection of nGGOs without tissue diagnosis is recommended as it reduces costs and hospital stay.
OS-074 Lung Cancer
Factors Associated with Improved Pulmonary Function in Non-Small Cell Lung Cancer Patients after Video- Assisted Thoracic Surgery
Se Joong Kim1, Jinsoo Min1, Jisoo Park1, Yeon Joo Lee1, Jong Sun Park1, Young-Jae Cho1, Ho Il Yoon1, Jae Ho Lee1, Choon-Taek Lee1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National Uni- versity College of Medicine, Seoul National University Bundang Hospital, Korea1
Background: Paradoxically, some patients showed improved pulmonary function after surgery of non-small cell lung cancer (NSCLC). Video-assisted thoracic surgery (VATS) is currently widely performed and well known to preserve pulmonary function com- pared to open thoracotomy. However, it is unknown which factors are associated with the improvement of pulmonary function after VATS in NSCLC patients.
Methods: Three hundred and fi fty one patients with NSCLC who underwent VATS were enrolled. Pulmonary function tests were performed preoperatively and at 12 months postoperatively. Patients who showed improved forced vital capacity (FVC) or/
and forced expiratory volume in 1 second (FEV1) were compared with patients who did not. Multivariable analysis was performed to fi nd which factors are associated with the improvement of pulmonary function.
Results: FVC was improved after VATS in 94 (26.8 %) patients. They were signifi cantly related to have lower baseline FVC (P=0.03), undertake VATS wedge resection (P=0.03) and resect at right upper lobe (RUL; P=0.001). FEV1 showed improvement in 59 (16.8%) patients. Lower smoking amount (P=0.001), lower baseline FEV1 (P=0.002), VATS wedge resection (P<0.001), adenocarcinoma in histology (P=0.04) and RUL resection (P<0.001) were signifi cantly associated with FEV1 improvement. We further evalu- ated for patients who showed improvement in both FVC and FEV1 after VATS. They were signifi cantly associated with lower smoking amount (P=0.01), less than 85% of baseline FVC and FEV1 (P=0.02), VATS wedge resection (P<0.001), adenocarcinoma in histology (P=0.03) and RUL resection (P<0.001) in multivariable analysis.
Conclusions: Even if lower baseline pulmonary function levels, never or light smoking adenocarcinoma patients could improve the pulmonary function especially after VATS wedge resection at RUL.
