Author of

• 20039

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  Poster Display Session (ID 63)

  • Event: ELCC 2017
  • Type: Poster Display Session
  • Track:
  • Presentations: 2
  • Moderators:
  • Coordinates: 5/07/2017, 12:30 - 13:00, Hall 1

  • 19882

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    126P - The clinical impact of multiplex ctDNA gene analysis in lung cancer (ID 476)

    12:30 - 13:00  |  Author(s): N. Peled
    • Abstract

    Background:
    Next-generation sequencing (NGS) of cell-free circulating tumor DNA (ctDNA) enables a non-invasive option for comprehensive genomic analysis of lung cancer patients. In this study, we evaluated the clinical utility of ctDNA sequencing on treatment strategy.
    
    Methods:
    In this retrospective study, data was collected from files of 109 NSCLC patients at the Thoracic Cancer Unit at Rabin Medical Center, Israel, between 2014-2017. Plasma samples from advanced non-small cell lung cancer (NSCLC) patients were analyzed by a commercial test (Guardant 360[TM]), using massively parallel paired-end synthesis to sequence a targeted gene panel. This test allows the detection of somatic alterations such as point mutations, indels, fusions and copy number amplifications.
    
    Results:
    109 consecutive NSCLC patients were included in this study. Median age at diagnosis was 63 years, 81% had adenocarcinoma. 39% (43/109) performed ctDNA analysis before 1[st] line therapy (Group A) and 61% (66/109) on progression (Group B), among them 42% (28/66) after progression on EGFR TKI (Group B1). ctDNA analysis yielded lung cancer related actionable mutations in 40% (44/109) of the patients; 32% (14/43) in group A and 45% (30/66) in group B; 71% (20/28) in group B1. Treatment decision was taken toward targeted therapy subsequent to NGS analysis in 27% of patients. 68 individual actionable genomic alterations were found (table).rnTable: 126PGenetic alterations frequencies among groups A, B and B1rn

    rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn

    Group A: Upfront NGS (n = 43, 19 individual mutations)		Group B: NGS on progression (n = 66, 49 individual mutations)		Group B1: NGS on progression on EGFR TKIs (n = 28, 34 individual mutations)
    EGFR Sensitizing	52% (10/19)	EGFR Sensitizing	45% (22/49)	EGFR Sensitizing	59% (20/34)
    MET	16% (3/19)	MET	25% (12/49)	EGFR T790M	23% (8/34)
    ERBB2	10.5% (2/19)	EGFR T790M	16% (8/49)	MET	12% (4/34)
    BRAF V600E	10.5% (2/19)	RET	6% (3/49)	ERBB2	3% (1/34)
    RET	10.5% (2/19)	ERBB2	6% (3/49)	ALK	3% (1/34)
    rn	rn	ALK	2% (1/49)	rn	rn

    rnrnResponse assessment (RECIST) for 20 patients with evaluable response to targeted therapy showed complete response in 5% (1/20), partial response in 35% (7/20), stable disease in 25% (5/20) and progressive disease in 35% (7/20). Response rate was 20% (1/5) for group A, 47% (7/15) for group B, among them 67% (6/9) for group B1. Total objective response rate (ORR) was 40%.
    
    Conclusions:
    Comprehensive ctDNA testing revealed possible treatment options for 40% of patients analyzed. The highest impact was seen in the progressors on EGFR therapy. These positive results emphasize the utility of liquid biopsy analysis to guide clinicians to select the right therapy for the right patient.
    
    Clinical trial identification:
    
    
    Legal entity responsible for the study:
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.
    
    Funding:
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.
    
    Disclosure:
    S. Geva: Travel grant from Teva Pharmaceuticals. Honorarium from Guardant Health, Inc. T. Twito, A. Dvir, L. Soussan-Gutman: Employee of Oncotest (subsidiary of Teva pharmaceuticals), the distributor of Guardant360 in Israel. E. Dudnik: Consultant of BI. Honorary lectures for BI, Roche, AstraZeneca and MSD. R.B. Lanman: Employee with stock ownership in Guardant Health, Inc. N. Peled: Consultant for Pfizer, BI, Roche, AZ, MSD, BMS, Lilly, Novartis, and NovellusDx. All other authors have declared no conflicts of interest.
    
    

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    68P - Circulating tumor cells spillage after lung nodule biopsy (ID 497)

    12:30 - 13:00  |  Author(s): N. Peled
    • Abstract

    Background:
    Lung cancer has high recurrence rate even when diagnosed at an early stage. Biopsy is currently the procedure of choice for the investigation of pulmonary lesions, yet it is unclear whether the biopsy itself releases tumor cells into the circulation and attributes to the late distal recurrence. Studies of various malignancies show the ability to identify circulating tumor cells (CTC) even in early stage cancer. The number of CTC correlates with disease outcome. The aim of this study was to quantify the spillage of tumor cells after nodule biopsy in early lung cancer.
    
    Methods:
    Patients with pulmonary nodules undergoing computed tomography biopsy enrolled into this study. CellCollector[TM] (GILUPI, Germany) was used for CTC detection before and after the procedure. This filtration device isolates CTC in-vivo through a standard cannula inserted to the cubbital vein for thirty minutes via epithelial cell adhesion molecule antibodies. Patients served as their own controls. Trans thoracic biopsy was done by a 19G needle with a standard procedure of one pass. The study was approved by the institutions' ethics committee.
    
    Results:
    13 patients were enrolled to between 02/2016 and 08/2016. Five patients were excluded due to partial procedure. Eight patients were eligible for analysis. Three had benign diseases (Granuloma, Interstitial pneumonitis. and five had lung cancer (Adenocarcinoma -4; Squamous-1); 3 had an elevation of the CTC count (0->2, 0->3, 2->8) and 2 had a depletion (8->2, 5->2). All 5 patients were male, with a median age of 65 years (range 54-72), four of them were past smokers and one never smoker. No adverse events were reported.
    
    Conclusions:
    With the limitation of low number of participants, this preliminary data shows that trans thoracic biopsy may increase CTC in some patients with lung cancer. The study is ongoing and the enlarged cohort will be presented.
    
    Clinical trial identification:
    
    
    Legal entity responsible for the study:
    Rabin Medical Center Ethics Comittee
    
    Funding:
    GILUPI
    
    Disclosure:
    J. Pfannkuche: Managing director at GILUPI, which provided the kits for this study. C. Chudak: Marketing & Sales Manager at GILUPI, which provided the kits for this study. All other authors have declared no conflicts of interest.