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Carmela Pepe



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    P1.04 - Immunooncology (Not CME Accredited Session) (ID 936)

    • 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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      P1.04-16 - Comparison of Clinical Response to Checkpoint Inhibitors in Advanced NSCLC with High PD-L1 Expression Tested on Cytology Versus Biopsy Samples (ID 12525)

      16:45 - 18:00  |  Author(s): Carmela Pepe

      • Abstract
      • Slides

      Background

      PD-L1 immunohistochemistry (IHC) expression correlates with clinical response to checkpoint inhibitors in advanced-stage NSCLC. PD-L1 IHC testing is usually performed on tissue blocks from core needle biopsy or surgical resection, but appears to be feasible on cytology cell blocks as well. In this retrospective study, we assessed the clinical response to checkpoint inhibitors in patients with NSCLC and high PDL1 IHC expression on cytology specimens in comparison with tissue biopsy specimens.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between August 2015 and April 2018, 116 patients with NSCLC received immunotherapy at our institution. Only cases with known PD-L1 expression from IHC testing performed on small biopsies or cytology cell blocks were included. A total of 65 consecutive cases were reviewed, including 40 small biopsies and 25 cytology samples. A Tumor Proportion Score (TPS) was categorized as high (≥ 50% tumor cell staining) or low (<50%). Response to treatment was categorized as disease control (DC, including complete and partial response and stable disease) or progression (PD). The primary outcome was the rate of disease control.

      4c3880bb027f159e801041b1021e88e8 Result

      Patients were mostly current or ex-smokers (91%), Caucasians (82%) and non-squamous carcinomas (85 %). High TPS was seen in 44 (68%) cases. Immunotherapy was given in the first line setting in 20 (31%) patients, the second line in 36 (55%), and the third line in 9 (14%). 50 (77%) patients received Pembrolizumab, 10 (15%) Nivolumab and 5 (8%) others received immunotherapies on RCTs. Overall, there was DC in 40 (62%) patients and PD in 17 (26%). There was no significant difference in DC rate between the cytology and the small biopsy groups in high TPS group.

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      8eea62084ca7e541d918e823422bd82e Conclusion

      PD-L1 expression on cytology cell blocks and on small biopsies appears to have similar clinical significance. Further prospective trials are needed to confirm these findings.

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    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • 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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      P2.06-33 - Heterogeneity in Care Pathways for Patients with Malignant Pleural Mesothelioma Presenting at a Quaternary Thoracic Oncology Center in Quebec (ID 14346)

      16:45 - 18:00  |  Author(s): Carmela Pepe

      • Abstract
      • Slides

      Background

      Malignant pleural mesothelioma (MPM) is a rare disease for which diagnostic and therapeutic trajectories are ill-defined. We hypothesize that MPM patients experience delays during their diagnostic and therapeutic trajectory with significant heterogeneity in care pathways. Thus, we evaluated management practices at the MUHC over the past 10 years to address the need for a centralized program and dedicated care team.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a retrospective chart review of MPM cases diagnosed at our center from 2006 to 2016. Clinical, pathologic, and treatment variables were collected. We assessed time from first abnormal imaging to definitive diagnosis, time from definitive diagnosis to first treatment and time from definitive diagnosis to palliative care consult. Overall survival was analyzed by Kaplan Meir method.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 145 patients over a 10-year period and report outcomes on 92 cases with complete data. Demographic data are presented in Table 1. Overall survival was 1.4% at 5-years for all patients, with a median survival of 1 year following a definitive diagnosis. Forty-five percent of patients underwent an investigational PET/CT scan, 89% of patients had M0 status prior to treatment, of whom 20% developed extra-thoracic metastases. Sixty-three percent of patients received some form of treatment. Eight treatment combinations were identified, irrespective of intent, lymph node involvement, and metastatic status. With regards to delays in care pathway, median time from first abnormal imaging to definitive diagnosis was 34 days (IQR 20.5 to 55), definitive diagnosis to first therapeutic intervention was65 days (IQR 35.8 to 163.8), and definitive diagnosis to palliative consult was 289 days (IQR 3 to 1651).

      Table 1. Demographics and treatment characteristics of patients diagnosed with MPM at the McGill University Health Center over a 10-year period.
      Characteristics Overall
      Sample size 92
      Age Number (%)
      Median (IQR) 72 (62-79.5)
      Female Gender, n (%) 19 (20.7)
      Previous or current smoker, n (%) 36 (39.1)
      Asbestos Exposure
      No 20 (21.7)
      Yes 36 (39.1)
      Unknown 36 (39.1)
      Type of MPM
      Biphasic 9 (9.8)
      Desmoplastic 3 (3.3)
      Epitheliod 67 (72.8)
      Sarcomatoid 3 (3.3)
      Not otherwise specified 10 (10.9)
      Treatment
      No 28 (30.4)
      Yes 58 (63.0)
      Unknown 6 (6.5)
      Treatment Course
      Chemotherapy only 8 (13.8)
      Chemo & Radiotherapy 5 (8.6)
      Radiotherapy only 15 (25.9)
      Surgery only 10 (17.2)
      Trimodality therapy 7 (12.1)
      Surgery and Chemo 7 (12.1)
      Surgery and Radiotherapy 4 (6.9)
      Concurrent therapy 2 (3.4)
      Intent at first treatment
      Curative 31 (53.4)
      Palliative 24 (41.4)
      Unknown 3 (5.2)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Overall outcomes for MPM patients presenting at our center are equivalent to historical controls. However, significant heterogeneity and delays exist during the patient trajectory. A centralized approach to diagnosis and treatment may lead to a more efficient and beneficial trajectory for these patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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