Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) have been the standard of care as first-line (1L) therapy for patients with advanced EGFR mutated lung cancer since 2009. In Thailand, however, it was not fully introduced to all health care funds until 2020. The purpose of this study was to determine the overall survival (OS) and treatment pattern in the period before EGFR-TKI became universally available to all patients. Methods: This was a retrospective study conducted at 10 medical centers in Thailand. Patients harboring the common mutation (exon 19 deletion or exon 21 L858R) diagnosed during January 2013 and December 2019 were enrolled. Results: This study included 284 patients with a median follow-up time of 19.8 months and a death rate of 80.3% (228/284). Clinical characteristics included median age 62.5 years, female 65.5%, never-smoking 74.3%, stage 3B/4/recurrence 2.1/93.3/4.6%, exon 19/exon 21- 60.9/38.7%. Treatment patterns to EGFR-TKI included not receiving (NR) (9.5%), first-line (1L) (56.0%), switch maintenance (MN) (3.5%), second-line (2L) (21.8%) and third-line (3L) or more (9.2%). Median OS of patient receiving EGFR-TKI as NR, 1L+MN, 2L and 3L or more was 11.10 (95%CI: 8.21 to14.00), 19.08 (95%CI: 15.76 to 22.41), 23.06 (95%CI: 15.91 to 30.21) and 32.46 (95%CI: 21.61 to 43.30) months (p=0.006), respectively. Factors contributing to poor prognosis in the multivariate model included poor ECOG-PS (HR 3.17, 95%CI: 1.96-5.13), not receiving EGFR-TKI (HR 3.83, 95%CI, 1.94-7.56) and receiving EGFR-TKI 1L (HR 2.30, 95%CI: 1.40-3.79) Conclusion: OS of patients with EGFR mutation positive lung cancer treated with EGFR-TKIs in Thailand was comparable to clinical studies. EGFR-TKI treatment should be provided to patients as early as possible, but TKI remained beneficial at later points in the treatment timeline.

Introduction: Chemotherapy-induced severe neutropenia requires dose reduction, delay in treatment, or discontinuation, and induces neutropenic complications resulting in poor outcomes and increased healthcare costs. This study aims to identify the risk factors for chemotherapy-induced severe neutropenia and outcome in advanced-stage NSCLC. Method: From July 2014-January 2019, advanced-stage NSCLC who received chemotherapy were retrospectively analyzed. Demographic and risk factors data were collected from the electronic medical record system. Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe neutropenia. Survival curves were estimated using the Kaplan–Meier method. Results: Among 259 patients, 37 (14.28%) and 3 patients (1.2%) developed severe neutropenia and febrile neutropenia respectively. In multivariate analysis, restriction of protein diet (OR 9.54; 95%CI 2.44-37.24; P=0.001), concomitant use herbal medicine (OR 8.66; 95% CI 1.04-72.07; P=0.045), high BMI (OR3.1; 95% CI 1.07-8.99; P=0.04), renal disease (OR 3.9; 95% CI 1.7-8.91; P=0.001), number of cycle chemotherapy > 4 (OR 3.97; 95% CI 1.11-14.18; P=0.03) were significant predictors of Chemotherapy-induced severe neutropenia. No difference in response rate, progression-free survival and overall survival among groups (RR 18.9% vs 26.7%; median PFS; 9.6 vs 8.2 months, P=0.32 and median OS 13.8 vs 16.7 months, P=0.79 in severe and non-severe neutropenia respectively).Conclusions: The present study indicates that protein-restricted diet, concomitant use of herbal medicine, BMI ≥ 25 kg/m2, renal disease, and more than 4 cycles of chemotherapy are significant risk factors for chemotherapy-induced severe neutropenia. Therefore, patients with these risk factors should be more carefully monitored.

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Background Survival after diagnosis of brain metastases in non-small cell lung cancer (NSCLC) patients was dismal even after local therapy (surgery or brain irradiation), partly because of the systemic burden. Paucities of medical oncologists and molecular testing plus disparities in health care coverage resulted in limited access to systemic chemotherapy, let alone targeted drug or immunotherapy, for brain metastatic non-small cell lung cancer (BM-NSCLC) in Thailand. In this study, we aimed to explore prognostic factors affecting overall survival and evaluate survival outcome in BM-NSCLC limited access to systemic therapy. Methods We retrospectively collected 83 BM-NSCLC from a tertiary care hospital in Thailand. Data regarding clinical characteristics and treatment factors including age, sex, performance status, histology, neurologic symptom, extra-cranial metastasis (ECM), receiving whole brain radiotherapy (WBRT) and receiving systemic treatment were collected as independent factors. Associations between these variables and time to death were analyzed using the Cox proportional hazard regression. Results The patients' mean age was 63.1 year (SD 8.9). Most of the patients had adenocarcinoma (73%), presented with major neurological symptom (84%), and had brain metastases at their initial diagnosis of lung cancer (65%). Nearly 30% had ECM while 14% received systemic treatment. Three-quarters of patients received WBRT. Less than 15% were tested for actionable mutations. The median survival time was 2.7 months (95%CI: 2.2–4.1 months). One-month, three-month, six-month, and one-year survival probability was 78.3% (95%CI: 52.6–73.2%), 47.0% (95%CI: 36.0-57.2%), 26.5% (95%CI: 17.6–36.3%), and 9.6% (95%CI: 4.5–17.1%), respectively. Multivariable analysis showed that having extra-cranial disease was significantly associated with death (HR 4.22, 95%CI:1.27-14.0,p = 0.019 for first diagnosis lung with any ECM; HR 6.33, 95%CI:1.62–24.79, p = 0.008 for controlled lung & ECM; and HR 11.32, 95%CI:2.89–56.1, p = 0.003 for uncontrolled lung or ECM). Receiving systemic treatment was significantly associated with a reduced risk of death (HR0.39, 95%CI:0.18–0.80, p = 0.011). WBRT was insignificantly associated with prolonged survival (HR 0.79, 95%CI:0.43–1.44, p = 0.441). Conclusion Extracranial disease and lack of systemic treatment significantly shortened survival in BM-NSCLC.

Background: Bone is the one common metastasis site in advance stage non small cell lung cancer metastasis and a half of them occurred skeleton related event. 2 years overall survival was 11.3%. Although the sensitivity of bone scan is quite high, its specificity is not satisfactorydue to false positive or false negative in osteolyticlesion. CXCL12/CXCR4 axis is the one role of various cancer metastasis included NSCLC and bone metastasis in prostate cancer. In the past, there were studies showed that higher plasma CXCL12 in NSCLC patients versus normal population, higher CXCL12 in malignant pleural effusion versusnon malignant pleural effusion. Method: In this study,cross-sectional analytic study, we enrolled patients with advance stage NSCLC in KCMHduring May 2013-January 2014. We collation of blood was taken place before systemic treatment to compare plasma CXCL12 level in patients who had bone metastasis versus no bone metastasis for primary endpoint. Secondary endpoint was evaluating correlation plasma CXCL12 with other organ metastasis. Results: Total eligible patients was89, 41 patients were NSCLC with bone metastasis, 48 patients were NSCLC without bone metastasis. Mean plasma CXCL12 in bone metastasis patients was 2284.49±475.40pg/ml, no bone metastasis was2062.93±717.93pg/ml and local bone invasion was 2995.75±358.85 pg/ml (p=0.048). Plasma CXCL12 was highest in organ metastasis ≥ 3 organ 2349.34 ± 529.35 ,2 organ metastasis 2197.16 ± 617.38pg/ml and 0-1 organ metastasis was lowest plasma CXCL12 2125.57 ± 699.19pg/ml. Patient who had bone metastasis only had plasma CXCL12 2401.95±475.619pg/ml, combinded metastasis 2292.49 ± 501.76pg/ml, metastasis NSCLC but no bone metastasis 1893.91±75688.79 pg/ml (P=0.012). Conclusion: The result showed high plasma CXCL12 in NSCLC patient who had bone metastasis and multiple organ metastases. Subgroup analysis who had merely bone metastasis was highest CXCL12 level andcombinded metastasis higher CXCL12 than who had non bone metastasis.In conclusion, Our results demonstrate a correlation between plasma CXCL12 and bone metastasis in NSCLC patients.Plasma CXCL12 is may be a important cytokine for cancer metastasis.