Browsing Over 443 Presentations
128P - Frequency and types of EGFR mutation in Moroccan patients with non-small cell lung cancer
- M. Sow (Rabat, Morocco)
- M. Sow (Rabat, Morocco)
- H. El Yacoubi1 (rabat, Morocco)
- B. Moukafih (Rabat, Morocco)
- S. Balde (Rabat, Morocco)
- G. Akimana (Rabat, Morocco)
- S. Elkhoyaali (Rabat, Morocco)
- H. Abahssain (Rabat, Morocco)
- H. Mrabti (Rabat, Morocco)
- I. Elghissassi (Rabat, Morocco)
- H. Errihani (Rabat, Morocco)
Abstract
Background
Mutations in the epidermal growth factor receptor (EGFR) gene are commonly observed in non-small-cell lung cancer (NSCLC), particularly in adenocarcinoma histology (aNSCLC). The frequency of EGFR mutations is ethnicity-dependent, with a higher proportion in Asian populations than Caucasian populations. Yet there is a lack of data of these mutations among North African patients. The aim of this study was to report the frequency and types of EGFR mutations in a group of NSCLC Moroccan patients.
Methods
Tumor specimens from Moroccan patients with NSCLC were collected, between November 2010 and December 2017 to determine frequency and types of EGFR mutations. Tumors were tested for EGFR by polymerase chain reaction and sequencing of exons 18, 19, 20, and 21.
Results
A total of 334 patients were consequently enrolled: 242 (72.5%) males and 92 females (27.5%), with a mean age of 61.9 years. 56.9% had a history of smoking, and only the adenocarcinoma histology are considered .EGFR testing of 334 (100%) demonstrated wild typein 261 (78.1%) and mutated EGFR in 73 (21.9%).Mutations were mainly detected in the exon 19 (65.8%), followed by exon 21 L858 (17.8%),exon 21codon (5.5%) and exon 18 (6.8%), whereas mutations in the exon 20 were less frequent(4.1%). In patients with aNSCLC, the detection of EGFR mutation was independently associated with gender (41,3% females Vs.14,5% males; p < 0.001) and smoking status (34.8% non-smokers Vs. 12.9%, p < 0.001).
Conclusions
Our findings confirm the genetic heterogeneity of NSCLC worldwide, reporting frequency of EGFR mutations in NSCLC Moroccan patients intermediate between Asian (50%) and Caucasian (15%) populations. The substantial lack of data from several large geographic regions of the world, notably our region, highlights a potential lack of routine mutation testing and consequent access to EGFR targeted agents, suggesting the need for further research implementations in Morocco.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
170P - Advanced non-small cell lung cancer patients with low tumor mutation burden might derive benefit from anti-programmed cell death (PD)-1 and anti-programmed deathligand 1 (PD-L1) blockade
- W. Nie (Shanghai, China)
- W. Nie (Shanghai, China)
- M. Xu (Shanghai, China)
- L. Gan (Shanghai, China)
- Y. Zhang (Chongqing, China)
- B. Han (Shanghai, China)
Abstract
Background
We aimed to investigate the association between tumor mutation burden (TMB) and survival in non-small cell lung cancer (NSCLC) patients with anti–programmed cell death (PD)-1 and anti--programmed cell deathligand 1 (PD-L1) blockade.
Methods
Five retrospective cohorts using PD1/PDL1 blockades and The Cancer Genome Atlas (TCGA) lung cancer data set were included in this study. The restricted cubic spline (RCS) analysis was used to explore the association between TMB and survival. The cut-off values for TMB were determined by X-tile software. Primary outcomes were overall survival (OS) and progression-free survival (PFS). The associations between TMB and intratumor heterogeneity, number of segments, fraction of genome alterations, aneuploidy score, and T cell populations were also investigated.
Results
TMB showed an inverted J-shaped curve with survival risk in RCS plot. Two cut-off values were determined by X-tile software in each cohort. In addition to high TMB, low TMB was an independent prognostic indicator for OS and PFS in NSCLC patients treated with PD1/PDL1 blockades. Objective response rate (ORR), disease control rate (DCR), and 1-year OS rate in the low TMB group were higher than that in the medium TMB group. In TCGA lung cancer data set, low TMB was also associated with longer OS in comparison with medium TMB. Furthermore, NSCLC patients with low TMB had significantly lower intratumor heterogeneity, number of segments, fraction of genome alterations, aneuploidy score, T helper type 2 (Th2) cells, and CD8+ T cells, but higher levels of Th1 and Th17 cells.
Conclusions
NSCLC patients with low TMB might benefit from anti-PD1/PDL1 immunotherapy.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
62P - External validation of a survival score for limited stage small cell lung cancer treated with chemoradiotherapy
- L. Käsmann (Munich, Germany)
- L. Käsmann (Munich, Germany)
- R. Abdo (München, Germany)
- J. Taugner (München, Germany)
- C. Eze (Munich, Germany)
- M. Dantes (Munich, Germany)
- O. Roengvoraphoj (Munich, Germany)
- C. Belka (Munich, Germany)
- F. Manapov (Munich, Germany)
Abstract
Background
In 2016, a survival score for limited stage small cell lung cancer (LS-SCLC) patients was developed to characterize prognostic sub-groups who underwent multimodal treatment. Herein, we validate the score in an independent external patient cohort.
Methods
We reviewed the medical charts of 78 LS-SCLC patients treated with CRT at our institution. The survival score was calculated by independent prognostic factors: gender, Karnofsky performance status (50-70% vs. 80-100%), Tumor sub-stage (very limited vs. limited disease) and hemoglobin level before the start of radiation (<12 g/dl vs. ≥12 g/dl). Scoring points were derived from 2-year survival rates divided by 10 and the individual values for each prognostic factor were tallied. Three risk subgroups were defined (high, intermediate vs. low-risk: 9-13, 14-18 vs.19-26 points).
Results
Median overall survival in the validation cohort was 17 months (range: 1-123months). The 2-year survival rates were 0% in the high, 35% in the intermediate and 43% in the low-risk subgroup, respectively (p = 0.018). The difference in 2-year survival between the high and intermediate risk subgroups was significant (p = 0.007), whereas the 2yr-OS between the intermediate and low risk was not (p = 0.602). After stratification for the concurrent treatment mode, 2-year survival rates were 0% in the high, 60% in the intermediate and 58% in the low-risk subgroups, respectively (p = 0.004).
Conclusions
The survival score was reproducible to estimate 2-year survival rates of patients with LS-SCLC, especially in the high and intermediate-risk subgroups. In order to better characterize the prognostic difference between intermediate and low-risk patients, the scoring system needs further optimization.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
55O - Radiogenomic signatures of NSCLC brain metastases: A potential non-invasive imaging marker for ALK mutation
- S. Wadhwa (Mumbai, India)
- S. Wadhwa (Mumbai, India)
- G. Krishna.b (Mumbai, India)
- M. Malhotra (Mumbai, India)
- K. Prabhash (Mumbai, India)
- V. Noronha (Mumbai, India)
- A. Joshi (Mumbai, India)
- V. Patil (Mumbai, India)
- A. Mahajan (Mumbai, India)
Abstract
Background
NSCLC harbouring ALK rearrangement has a higher risk of developing brain metastases. Literature on MR Imaging radiogenomics (MRI-R) as predictors of ALK mutation is limited and less investigated. The aim of our study was to evaluate the semantic MRI-R parameters of NSCLC brain metastases and their correlation with ALK status.
Methods
We analyzed clinical data on 75 patients who were tested for ALK mutation and underwent MR imaging at diagnosis. Multiparametric MRI was performed in all cases. The associations between ALK mutation status and clinical features specifically age, sex, smoking, histology, TNM stage and imaging variables of brain metastasis, were analyzed using descriptive analysis (chi-square test) and univariate logistic regression analysis.
Results
There were 46 ALK positive and 29 ALK negative cases that were subjected to MRI-R analysis. ALK positive were predominantly young (83%) and non-smokers (87%) (p < 0.001). Statistically significant difference (p < 0.001) was observed in lesion morphology and its T2W border, fuzzy and infiltrative border with hypointense peripheral solid rim in ALK positive while well defined border and no solid rim in ALK negative. Predominant signal on T1W imaging was hypointense (p < 0.001) in ALK negative, whereas heterogeneity was marker of ALK positive status on T1W (p < 0.001). Lesions in ALK negative group showed central restriction on DW images (p-0.001) and peripheral restriction of the solid rim was characteristic of ALK positive (p < 0.001). ALK positive showed thick ring enhancement while patchy enhancement favoured ALK negative. Incidence of meningeal involvement was significantly higher in ALK positive and was absent in 80% of ALK negative (p-0.02). On univariate logistic regression analysis, statistically significant association was found between age, smoking history, T2W lesion morphology, T2W border, restricted diffusion, enhancement and meningeal positivity (p < 0.05).
Conclusions
ALK positive brain metastases have peculiar MR imaging features that can be non-invasive diagnostic and predictive imaging biomarkers. MR radiogenomics have potential role in individualised management of ALK positive NSCLC brain metastasis.
Legal entity responsible for the study
IEC TMH.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Q&A
Role of monotherapy in first-line NSCLC
- N. Leighl (Toronto, Canada)
- N. Leighl (Toronto, Canada)
171P - Previous exposure to bevacizumab indicated inferior benefits from PD-1/PD-L1 inhibitors in nonsquamous NSCLC
- F. Zhou (Shanghai, China)
- F. Zhou (Shanghai, China)
- Y. Pan (Shanghai, China)
- C. Zhou (Shanghai, China)
Abstract
Background
Bevacizumab is known to enhance the effects of immunotherapy. The landmark IMPOWER150 has demonstrated that the addition of atezolizumab to bevacizumab plus chemotherapy significantly improved survival outcomes among patients with metastatic nonsquamous NSCLC. However, the impact of previous use of bevacizumab on the efficacy of PD-1/PD-L1 inhibitors remained unclear.
Methods
Between Oct 2016 to Sep 2019, 113 patients who were treated with PD-1/PD-L1 inhibitors either as a standard of care or on a clinical trial at Shanghai Pulmonary Hospital were identified. Patients who had prior exposure to immunotherapeutic agents, or death within 4 weeks from the first dose of ICIs treatment were excluded from the analysis. The information regarding previous exposure to bevacizumab was reviewed in electronic medical record.
Results
The median age of enrolled patients was 63 years (range, 29 to 82). Regarding histology, 59.2% (67/113) had nonsquamous NSCLC and 40.8% (46/113) had squamous cell carcinoma. Overall, 16 patients (14.2%) previously received bevacizumab therapy, all of whom had nonsquamous NSCLC. Interestingly, patients who were previous exposure to bevacizumab had shorter PFS than those who were not (1.9 versus 4.3 months, P = 0.017). We then divided patients into 3 groups: arm 1 (16 patients, previous exposure to bevacizumab), arm 2 (51 patients, nonsquamous NSCLC who were not previous exposure to bevacizumab), arm 3 (46 patients, squamous cell carcinoma). The PFS was significantly different between arm 1 and arm 2 (1.9 versus 4.3 months, P = 0.023) or arm 3 (1.9 versus 4.2 months, P = 0.045), but not arm 2 and arm 3 (4.3 versus 4.2 months, P = 0.736). Patients in arm 1 also had inferior ORR (14.3% versus 29.4% versus 29.5%, P = 0.342) and DCR (42.9% versus 70.6% versus 68.2%, P = 0.05) compared with arm 2 and arm 3. Multivariate analysis identified previous exposure to bevacizumab as being independently associated with poorer PFS (HR = 1.9, 95%CI, 1.01-3.59, P = 0.048).
Conclusions
Previous use of bevacizumab indicated inferior benefits from PD-1/PD-L1 inhibitors in nonsquamous NSCLC.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Management of endocrine toxicities: Clinical case
- J. Haanen (Amsterdam, Netherlands)
- J. Haanen (Amsterdam, Netherlands)
Where did we start?
- E. Felip (Barcelona, Spain)
- E. Felip (Barcelona, Spain)
Advanced nursing practices in thoracic surgery: Improving patient outcomes
- M. Culligan (Baltimore, MD, United States of America)
- M. Culligan (Baltimore, MD, United States of America)
Biomarkers are a rapidly changing scenario: How to face it
- E. Smit (Amsterdam, Netherlands)
- E. Smit (Amsterdam, Netherlands)
191P - Assessment of toxicity and clinical outcomes with SBRT in lung metastases: A single institute experience
- V. Pareek (Mumbai, India)
- V. Pareek (Mumbai, India)
Abstract
Background
Stereotactic body radiation therapy (SBRT) can help deliver a high biologically equivalent dose to the tumor volume in a small number of fractions with a steep dose fallout on surrounding healthy tissues. A retrospective analysis was performed on patients treated for lung oligo-metastatic disease from various histopathologies.
Methods
A total of 155 patients were retrospectively assessed who were diagnosed with lung metastases in various primary malignancies. Clinical outcomes in the form of local control (LC), overall survival (OS) and progression free survival (PFS) were assessed. Toxicity was scored according to CTCAE grading. Univariate analysis was performed to correlate various prognostic factors associated with the disease and grade of toxicities associated. Patients were followed up and assessed for late toxicities as per the institution protocol.
Results
The median follow up was 22 months. Colorectal carcinomas formed the major site of primary disease followed by sarcoma and renal cell carcinoma. LC at 1 and 2 years was 94 and 86% respectively. OS at 1 and 2 years was 90, 68.8% respectively. Both OS and L were impacted by the primary histopathology and also the presence of extrapulmonary disease present. PFS at 1 and 2 years was 87% and 62% respectively. Primary histopathology, presence of extrapulmonary disease and age showed a correlation with prognosis at univariate analysis. The treatment follow-up showed no significant late toxicities and Grade 3 and 4 toxicities were not seen in the cohort.
Conclusions
The study suggests the role of SBRT as a treatment option for oligometastases in the lung. However, the factors mostly influencing prognosis were the presence of extra-pulmonary disease and the number of lung lesions. With lower number of metastases to treat, the outcome is found to be better.
Legal entity responsible for the study
V. Pareek.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.