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S. Reu



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    P1.03 - Poster Session with Presenters Present (ID 455)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P1.03-027 - Clinical and Histological Features Associated with SUV in FDG-PET-CT in Patients with Adenocarcinoma of the Lung (ID 4783)

      14:30 - 15:45  |  Author(s): S. Reu

      • Abstract

      Background:
      FDG-PET-CT is increasingly used for staging and treatment monitoring in NSCLC. The prognostic and possibly predictive value of the standardized-uptake-value (SUV), and the clinical, molecular and pathological features contributing to SUV levels have not been well described.

      Methods:
      We retrospectively reviewed the records of patients staged with FDG-PET-CT and correlated SUV values before and during treatment with clinical and pathological features of the tumour including CRP as a marker of systemic inflammation, adenocarcinoma subtype (solid, lepidic etc.), and Ki67, as a marker of tumour proliferation.

      Results:
      190 patients with adenocarcinoma of the lung were identified. 110 had FDG-PET-CT staging and were included in this analysis. Tumour subtypes were as follows: 50.0% solid, 16.4% acinar, 9.1% papillary, 7.3% lepidic, 1.8% micropapillary, 15.4% other. 70 patients received systemic treatment and 40 were treated surgically. The mean primary-tumour-SUV for all patients was 11.1 (for patients treated medically, 13.5, and for those treated surgically, 8.6). Ki67 expression in the tumour was lowest in the group with SUV < 10 (38.6%) and highest in the group with SUV > 20 (56.0). The group with SUV 11-19 had a moderate Ki67 expression (47.9%). In patients with surgical tumour samples there was a trend towards higher SUV in patients with tumours showing 30% or more solid growth pattern (mean SUV 11.4) and lower SUV in patients with any lepidic growth (mean SUV 4.0) (p=0.002). Systemic markers of inflammation were significantly higher in patients whose tumours had SUV>10 (mean CRP, 2.3 mg/dl; mean leukocytes, 9.7 G/L) than in patients with low-SUV tumours (<5) (mean CRP, 0.4 mg/dl, p=0.0186; mean leukocytes, 7.2 G/L, p=0.014).

      Conclusion:
      Multiple factors appear to be associated with higher or lower SUV values, including adenocarcinoma subtype, proliferation index of the tumour and systemic inflammation. These factors should be taken into account when interpreting FDG-PET-CT SUV values in clinical practice. The correlation of FDG-PET-CT SUV values with inflamed tumour phenotypes, and the possible predictive value of SUV for response to immune therapies, should be further investigated.

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    P1.06 - Poster Session with Presenters Present (ID 458)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P1.06-035 - Frequency and Clinical Relevance of EGFR-Mutations and EML4-ALK-Translocations in Octagenarians with NSCLC (ID 5923)

      14:30 - 15:45  |  Author(s): S. Reu

      • Abstract

      Background:
      Novel therapies targeting genetic alterations have improved response rates and overall survival for some patients with NSCLC; however, only a minority of caucasian patients with lung cancer benefit from these treatments. Testing for EGFR mutation and ALK translocation is recommended for all patients with advanced adenocarcinoma, but the highest occurance of these driver mutations has been described in younger patients, females, and those with little or no smoking history. The frequency of driver mutations in elderly and very elderly patients has not been described.

      Methods:
      We reviewed the charts of all patients over age 70 treated at our centre in 2015 and assessed the frequency of EGFR and ALK testing. We report the frequency of EGFR and ALK alterations in patients aged 70-74 , 75-79 and >80 years.

      Results:
      Out of 179 patients diagnosed at our centre in 2015, 15 were 80 years or older at the time of first diagnosis and 7 of 15 had non-squamous histology. Among these very elderly patients, 3 patients were found to have EML4-ALK translocations and 2 patients were found to have EGFR mutation (1 Del19, 1 L858R). This represents a 71% frequency of treatable driver mutations in octagenarians with non-squamous NSCLC. Rates of genetic drivers were somewhat lower, but still clinically relevant, in non-squamous NSCLC patients aged 70-74 (27.0%) and 75-79 (26.7%).

      Conclusion:
      Very elderly patients (>80 years of age) with non-squamous NSCLC were found to have high rates of the driver alterations EGFR mutation and ALK translocation. This is clinically relevant, as this often frail and comorbid population may not be suitable for treatment with cytotoxic chemotherapy and may benefit from first line treatment with a targeted tyrosine kinase inhibitor. Testing for these genetic alterations should not be restricted to younger patients. The biology of lung cancer in the very elderly may differ from that of moderately elderly patients, as the longevity of these patients may select for individuals more resistant to, or with little exposure to, environmental carcinogens.