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Martin Gutierrez
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P1.09 - Pathology (Not CME Accredited Session) (ID 941)
- 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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P1.09-40 - Metastatic Endometrial Sarcoma Presenting as a Spontaneous Pneumothorax and Masquerading as a Pulmonary Blastoma. (ID 14400)
16:45 - 18:00 | Author(s): Martin Gutierrez
- Abstract
Background
For the proper evaluation of pulmonary cavitary lesions, it is essential to obtain an adequate assessment of the patient’s clinical history. Imaging studies can be equivocal and adequate pathological diagnosis can also be challenging. This is particularly important in the case of metastatic lung tumors with extra-thoracic origin, such as certain gynecologic malignancies, which—owing to their late metastatic potential—can be noted years after removal of the primary tumor, causing a misdiagnosis.
a9ded1e5ce5d75814730bb4caaf49419 Method
We illustrate this scenario with an interesting case of an endometrial stromal sarcoma which presented as a cavitary lesion causing a spontaneous pneumothorax and initially diagnosed as a pulmonary blastoma.
4c3880bb027f159e801041b1021e88e8 Result
44 year old woman presented with a one day history of left sided chest pain and shortness of breath. The pain was sudden, sharp and associated with dyspnea. The patient denied any fevers, chills, cough, hemoptysis, weight loss, recent travel, sick contacts or tuberculosis. A chest X-ray demonstrated a large left-sided pneumothorax and a chest CT showed a left upper lobe cavitary lesion (Figure 1). Subsequently, a left upper lobe and lingual wedge resection were performe and biopsies of the cavitary lesion were sent. The initial pathological impression was that this was a pulmonary blastoma with heterologous leiomyosarcomatous differentiation. However, further history revealed that the patient had chronic anemia and menometrorrhagia secondary to uterine fibromas and had a total abdominal hysterectomy one year prior to presentation. This finding prompted a review of the pathological specimen and positive immunoreactivity to estrogen/progesterone receptors (ER+/PR+), and CD10+ provided the alternate diagnosis of a metastatic low-grade stromal sarcoma of endometrial origin. Patient followed with medical oncology and gynecology and is currently undergoing hormonal therapy.
8eea62084ca7e541d918e823422bd82e Conclusion
This case highlights the importance of a proper correlation of clinical history alongside imaging studies and immunohistochemical findings in the diagnosis of certain lung lesions, in particular thoracic gynecological malignancies.
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.01-42 - Impact of Tobacco Smoking on Outcomes in Patients with Metastatic Non-Small Cell Lung Cancer in the Era of Targeted Therapy (ID 13849)
16:45 - 18:00 | Presenting Author(s): Martin Gutierrez
- Abstract
Background
Prior epidemiological studies have noted differences in the demographic and clinical characteristics among patients with metastatic non-small cell lung cancer (NSCLC) between those with and without exposure to tobacco smoke. Most notably never smokers are more likely to harbor genomic driver mutations and (in the era of targeted therapy) improved survival. Observational databases, capturing real world diagnostic and treatment patterns, can provide insights on outcomes of NSCLC based on smoking history.
a9ded1e5ce5d75814730bb4caaf49419 Method
The electronic health records (EHR) of patients with de novo stage IV NSCLC diagnosed between January 2013 and December 2016 from 30 cancer centers, contributing to the Cota Observational Cancer Database, from 184 oncologists were reviewed.
4c3880bb027f159e801041b1021e88e8 Result
1716 NSCLC pts were identified including 243 (14.2%) never tobacco smokers, 405 (23.6%) active smokers, 1026 (59.8%) former smokers, 7 (0.4%) passive smokers, and 29 (1.7%) not reporting. Never Smokers (NS) were more likely than smokers (S=active and former smokers combined) to be female (NS: 67.4%; S: 47.2%; p<0.0001) with similar ages (NS: 66 yrs; S: 67 yrs), but included more Asians pts (7.4% vs 1%, p<0.0001). Histologic subtypes differed: Squamous NS: 9%; S: 17.8%: (p<0.0001), AdenoCA NS: 73.2%; S: 68% (p=0.1), NOS N: 5.3%; S: 6.1% (p=0.8). Genomic profiling for EGFR/ALK was more common and identified more mutations in the NS cohort. In the non-squamous histologies EGFR testing was NS: 87% with 45.9% mutated; S: 70% with 10.4% mutated (tested p<0.0001; mutated p<0.0001). In the non-squamous histologies ALK testing was NS: 74% with 5.4% translocated ; S: 67% with 1.4% translocated (tested p=0.04; translocated p<0.001). As first line therapy 40% of NS received targeted therapy (11% receiving targeted 2nd line) whereas 4.8% S received 1st line and 1.5% 2nd line targeted therapy. The median overall survival for the NS cohort was 21 months compared to 11 months among S (log-rank p<0.05); with PFS of 9 vs 6 months (p<0.05). Excluding use of targeted therapy in 1st or 2nd line, the median OS for NS was 17 mo; for S was 10 mo (p<0.05).
8eea62084ca7e541d918e823422bd82e Conclusion
This real world observational study confirms a higher rate of targetable genomic driver mutations among never smoker NSCLC. Despite guidelines recommending universal genomic testing, never smokers are tested at a higher frequency. In the era of targeted therapy (but before the widespread use of immunotherapy) never smoker NSCLC patients experienced improved overall survival with and without targeted treatment compared to individuals with tobacco exposure.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.11-22 - Use of Electronic Medical Records for Tobacco Use and Lung Cancer Screening Documentation in a Large Urban Academic Medicine Practice (ID 11196)
16:45 - 18:00 | Author(s): Martin Gutierrez
- Abstract
Background
There is sufficient evidence to support lung cancer screening with low-dose computed tomography (LDCT) in high-risk current and former adult smokers. However, guidelines have not been fully translated into clinical practice. Electronic Medical Records (EMRs) efficiently collect data that can identify high-risk patients (pts) and monitor key metrics for lung cancer screening and smoking cessation efforts. In this study, we evaluated compliance with USPTF lung cancer screening guidelines and the use of EMRs for the documentation of tobacco use.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively reviewed data from consults in a large urban, academic, outpatient clinic between January 2017 and June 2017. We evaluated documentation in the built-in functions in a well-established EMR system (Epic) and in medical visit notes for each pt.
4c3880bb027f159e801041b1021e88e8 Result
A total of 1,124 pt charts were reviewed. 63% of pts were female and the median age was 61 years. 39% of pts were African American, 32% Hispanic, 5% Caucasian, 1% Asian, and 23% other. All charts had documentation of smoking status in the EMR social history flowsheet. 34% (379/1124) of pts had a history of tobacco use, out of which 39% (146/379) were current smokers. For current smokers, tobacco use disorder was documented as an active issue in the EMR medical problem flowsheet in only 37% (54/146) of cases. In 66% (96/146) of cases, smoking cessation was addressed in the physician’s note and smoking cessation counseling or medications were offered during the consult. 18% of smokers (69/379) met USPTF criteria, of whom 44/69 (64%) were referred for LDCT. For pts that were not referred for LDCT, 92% (23/25) had a prior CT of the chest in the last year. 82% (36/44) of pts underwent the LDCT screening test and 100% had LDCT results documented in the EMR. 47% (17/36) of screened pts had pulmonary nodules and/or findings suspicious for lung malignancy. 76% (13/17) of pts had follow-up imaging studies and 11% (2/17) of pts subsequently underwent biopsy that yielded a diagnosis of lung cancer.
8eea62084ca7e541d918e823422bd82e Conclusion
Our data showed suboptimal compliance with the LDCT lung cancer screening guidelines in clinical practice. Current EMR-centered databases are being well implemented for the acquisition of critical information that is integrated with care delivery. However, there are instances of poor documentation and underutilization of existing built-in flowsheets in EMR systems that could help identify active smokers, better address smoking cessation efforts, and more efficiently monitor high-risk pts in need of future screening.
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