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Angela Botticella
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OA09 - Prevention and Cessation (ID 909)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 BD
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OA09.06 - Molecular Alterations and Estimated Indoor Radon in NSCLC Patients from the French National Cancer Institute Registry: Radon France Study (ID 14168)
16:10 - 16:20 | Author(s): Angela Botticella
- Abstract
- Presentation
Background
Radon is a radioactive gas, considered the leading cause of lung cancer in non-smokers. We assessed the correlation between the radon exposure areas in France and the molecular alterations nationally registered in non-small cell lung cancer (NSCLC) patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively collected all NSCLC tested for EGFR, BRAF, HER2 and KRAS mutations (m) and ALK and ROS1 rearrangements (r) on the 28 French Plateform led by INCa (French National Cancer Institute). The prevalence of molecular alterations by region was correlated to the indoor radon risk area based on the official French (Institut de Radioprotection et de Sûreté Nucléaire, INSN, France). Paris and its region Ile-de-France were not included in this analysis due to its high rate of patients that are native from other regions.
4c3880bb027f159e801041b1021e88e8 Result
116.424 NSCLC were included. Overall, KRAS was positive in 27,7% (27.314/98.522), EGFR in 11,27% (13.125/116.424), ALK in 3,2% (2.928/91.291), BRAF in 2,3% (2.419/105.919), ROS1 in 1,12% (373/33.222) and HER2 in 0,8% (816/97.749) of all cases.
We stratified the French regions in 3 areas based on their exposure to radon: high (Auvergne-Rhône-Alpes, Bretagne, Normandie, Pays de la Loire), intermediate (Bourgogne-Franche-Comté, Nouvelle Aquitaine, Occitanie, Provence-Alpes-Cote-d'Azur) and low explosure (Centre Val-de-Loire, Grand Est, Hauts de France). The prevalence of driver alterations (EGFR, BRAF, HER2 and ROS1 were significantly higher in high exposure area. The prevalence of KRAS mutations was significantly higher in low exposure area.
8eea62084ca7e541d918e823422bd82e ConclusionLow risk
Intermediate
High
P
EGFR mutation
1962 (10%)
4338 (11%)
4176 (11.4%)
<0.0001
ALK rearrangement
577 (3.3%)
1019 (3%)
896 (3%)
0.35
BRAF mutation
327 (1.8%)
830 (2.4%)
692 (2.4%)
0.0001
HER2 mutation
109 (0.6%)
266 (0.9%)
252 (0.8%)
0.01
ROS1 rearrangement
61 (0.9%)
133 (0.9%)
126 (1.3%)
0.005
KRAS mutation
4717 (29.8%)
9215 (28.2%)
7895 (27%)
<0.0001
Molecular drivers*
3037 (3.9%)
6587 (4.4%)
6142 (4.4%)
<0.0001
* EGFR, BRAF & HER2 mutations, ALK & ROS1 rearrangements; KRAS mutation excluded.
NSCLC molecular alterations that are linked to low tobacco consumption were higher in the French region with high radon exposure. Role of the radon in lung cancer carcinogenesis of specific molecular subtypes should be further explored.
6f8b794f3246b0c1e1780bb4d4d5dc53Information from this presentation has been removed upon request of the author.
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P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.01-07 - Immune-Related Pneumonitis in NSCLC Patients Treated with Immune Checkpoint Inhibitors (ICI): Impact of Previous Thoracic Radiotherapy (ID 12805)
16:45 - 18:00 | Presenting Author(s): Angela Botticella
- Abstract
Background
Pneumonitis is a potentially lethal side effect of immune checkpoint inhibitors (ICI), occurring in 1–5% of patients enrolled in clinical trials. Little is known about the interactions between ICI and previous thoracic radiation. This is the aim of the present study.
a9ded1e5ce5d75814730bb4caaf49419 Method
Between December 2012 and November 2017, 318 consecutive non-small cell lung cancer (NSCLC) patients received ICI in our Institution and their charts were retrospectively analyzed. Primary endpoint was to determine whether previous radiotherapy had an effect on pulmonary toxicity. Pulmonary toxicity was retrospectively assessed by Common Terminology Criteria for Adverse Events version 4.0.
4c3880bb027f159e801041b1021e88e8 Result
Median follow-up was 32.8 months [95%CI: 5-190]. Median age at the start of ICI was 63 years. 205 patients (64,5%) were males, 103 (32,4%) smokers and 250 (78,6%) with PS ≤1; 206 (64,8%) had adenocarcinoma and 76 (23,9%) squamous; 79 (24,8%) were KRAS mutated, 18 (5,5%) EGFR mutated and 5 (1,6%) ALK positive. PDL1 was ≥ 1% by immunohistochemistry in 86 (27%), negative in 37 (11,6%) and unknown in 196 (61,3%) patients. ICI treatment was median 3rd line (range: 1-12), 89,4% monotherapy PD-(L)1 inhibition.
72 patients (22,6%) received a thoracic RT: 62 out of the 72 RT patients (87,5%) were irradiated with a curative intent. 53 patients (73,6% of the RT patients) received thoracic 3D-conformal RT or intensity modulated RT (normo- or mildly hypofractionated), whereas 9 received SBRT.
16,7% of the RT patients (12/72) showed a G1-4 immune-related pneumonitis (with a G=>3 of 11,1%), whereas for never-irradiated patients the G1-3 rate of immune-related pneumonitis was 2,4% (6/246), with only 1 G3 toxicity observed and no G>4 (t-test, p 0,001).
Median interval between the onset of the immune-related pneumonitis and the end of the RT was 22,4 months.
8eea62084ca7e541d918e823422bd82e Conclusion
NSCLC patients treated with ICI may be at higher risk of developing immune-related pneumonitis when previously treated with curative-intent thoracic RT.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.14-04 - Stereotactic Body Radiation Therapy for Pleural Recurrences of Thymoma (ID 14075)
16:45 - 18:00 | Author(s): Angela Botticella
- Abstract
Background
Pleural recurrences are not uncommon as a result of thymoma evolution; yet there is no therapeutic standard for their treatment. The purpose of this study was to evaluate the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of pleural metastasis.
a9ded1e5ce5d75814730bb4caaf49419 Method
A single institution retrospective study of the patients treated with SBRT using Novalis and VMAT, with doses of 30Gy in 5 fractions or 40Gy in 10 fractions. Treatment responses were evaluated using TDM and/or TEP TDM
4c3880bb027f159e801041b1021e88e8 Result
In the period 2014-2017, 10 patients (6 women, 4 men) with a median age of 51 and a total of 21 pleural recurrences were treated with SBRT. Initial Masaoka-Koga stages were: 1 I, 3 IIb, 3 III, 2 IVa and 1 unknown. Nine of them had previously been treated for other pleural recurrences (7 had surgery, 2 conformational RT and 3 chemotherapy).
All patients were treated for one to three recurrence locations, either successively or at the same time. At the time of last follow-up, only one patient had died following the metastatic evolution of their thymoma.
With a median follow-up for the lesions of 20 months, local control was very good, since all lesions were reduced to a smaller, non-progressive mass or in complete metabolic response.
No patient developed Grade 3 or higher acute or late toxicity.
8eea62084ca7e541d918e823422bd82e Conclusion
Treatment of pleural recurrences of thymoma using SBRT with moderate doses allowed for good local control without increased toxicity, constituting a good alternative to surgery. This treatment could furthermore delay the use of chemotherapy.
6f8b794f3246b0c1e1780bb4d4d5dc53
