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Sunil Kumar
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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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P1.09-11 - Immunohistochemical Assessment of BRCA1 Associated Protein-1 (BAP1) in Pulmonary Mucoepidermoid Carcinomas (ID 11322)
16:45 - 18:00 | Author(s): Sunil Kumar
- Abstract
Background
Primary pulmonary mucoepidermoid carcinomas (PMEC) are rare tumors that account for <1% of all lung carcinomas. They are presumed to originate from the minor salivary glands lining the tracheobronchial tree. PMEC are the most common malignant salivary gland tumors of tracheobronchial tree. Despite recent advances in diagnosis and treatment, there has not been much improvement in the outcome of patients with MECs, thus necessitating the identification of novel targeted therapeutic agents. Comprehensive genomic profiling has recently revealed genomic aberrations in BRCA1 associated protein-1 (BAP1) gene in a subset of their non-pulmonary salivary gland counterparts. We conducted this study to identify loss of BAP1 by immunohistochemistry (IHC) in a cohort of PMECs.
a9ded1e5ce5d75814730bb4caaf49419 Method
Cases of PMECs were retrieved from the departmental archives. Hematoxylin and eosin stained sections were reviewed. Immunohistochemistry for BAP1 was performed on formalin fixed paraffin-embedded tumor sections.
4c3880bb027f159e801041b1021e88e8 Result
Twenty-five PMEC cases were retrieved, out of which sufficient tumor tissue for IHC was available only in 15 PMECs. Thirteen (86.7%) tumors were tracheobronchial in location, while two (13.3%) were intraparenchymal. All were low grade MECs. On immunohistochemistry, BAP1 nuclear staining was retained in all cases (100%), irrespective of tumor location or grade.
8eea62084ca7e541d918e823422bd82e Conclusion
Identification of easily applicable techniques to detect BAP1 loss in PMECs is needed for therapeutic decisions. Using IHC, loss of BAP1 staining was not seen in any of our cases, suggesting either the extreme rarity of BAP1 loss in PMEC or insensitivity of BAP1 IHC to detect aberrations at genomic level. Analysis of aberrations in BAP1 gene by genomic approaches in PMECs may be done before excluding the possibility of BAP1 gene as a predictive biomarker for targeted therapies.
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: 2
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.14-13 - PD-L1 Immuno-Expression Assay in Thymomas: A Study from India (ID 11244)
16:45 - 18:00 | Author(s): Sunil Kumar
- Abstract
Background
Programmed death ligand 1 (PD-L1), an immune check point inhibitor, is known to be expressed in several malignancies and is being considered as a prognostic factor and a potential immunotherapeutic target. Recent development of anti-PD-1/L1 antibodies has demonstrated anticancer activity of these agents in various neoplasms. The aim of this study was to characterize PD-L1 expression in thymomas and to determine whether PD-L1 represents a therapeutic target in unresectable thymomas. A correlation with clinicopathological features and previously published studies in the literature was established.
a9ded1e5ce5d75814730bb4caaf49419 Method
Tissue microarrays were prepared from selected blocks of thymomas and immunohistochemistry (IHC) using SP263 clone of PD-L1 was performed. Cases were considered as PD-L1 positive or negative based on percentage of stained thymic epithelial cells; if these were <25 or >25 percent. Results were compared clinically and with previously published studies using Google and Pubmed search engines.
4c3880bb027f159e801041b1021e88e8 Result
Of 84 cases of thymoma, 69 (82.1%) revealed PD-L1 positivity in more than 25% cells. 94.23% of type B thymoma subtypes (B1/B2/B3) were PD-L1 positive (P<.001). There was no correlation of PD-L1 with age, gender, myasthenia gravis, the tumor size or stage of disease. So far, 9 studies of PD-L1 expression in thymic epithelial tumors are available in the literature; most of which showed PD-L1 expression in higher stage and B histotype however percentage positivity varied from 53.7% to over 90%.
8eea62084ca7e541d918e823422bd82e Conclusion
PD-L1 expression is frequent in type B (B1/B2/B3) thymomas. It can be easily evaluated by IHC even on small biopsies in unresectable cases. PD-L1 immunoassay will serve as a potential indicator for benefit from anti-PD-L1 antibody immunotherapy in thymomas thereby enabling improved clinical evaluation as well as prognostic stratification of patients.
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P1.14-14 - Histotyping of Indian Thymomas: A Comprehensive Clinicopathologic Study (ID 11242)
16:45 - 18:00 | Author(s): Sunil Kumar
- Abstract
Background
Thymomas are rare, but most common anterior mediastinal lesions. The WHO 2015 classification has defined criteria of classifying these into various subtypes. The histomorphologic spectrum of thymic epithelial tumors (TET) in Indian population has not been explored. We aimed to study the histomorphology of TETs in the Indian patients with clinico-pathological correlation.
a9ded1e5ce5d75814730bb4caaf49419 Method
It was a retrospective, tertiary referral centre, study. All cases of morphologically confirmed, surgically resected specimens and small biopsies diagnosed as TETs since 2009 were included. Clinical details and histology slides were reviewed using the Modified Masaoka-Koga staging system and WHO 2015 classification. Clinico-pathological correlation and survival analysis was done. Comparative review from other published Indian studies was performed.
4c3880bb027f159e801041b1021e88e8 Result
We identified 219 cases of TETs (138 resections and 81 biopsies). Most common histo-morphologic type was B2 and most frequent stage was I. Clinically, higher stage tumors were found mostly in men (P=.008) and these were type B thymomas (P=.01). Association of myasthenia gravis was prevalent in women (P=.02) and in lower stages (P=.04). Survival analysis revealed significant association between recurrence and tumor stage. Although thymic carcinoma was diagnosed on biopsy, no resectable case was identified.
8eea62084ca7e541d918e823422bd82e Conclusion
Literature lacks detailed histotyping of TETs from India. Indian thymomas are most commonly stage I tumors of B2 and AB histotypes. Resected thymic carcinomas are conspicuously absent in Indian cohort. We hope that broadening the spectrum of recognized pathologic manifestations of Indian thymomas will help global database for future studies.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.01-51 - Outcomes with Systemic Chemotherapy in Advanced NSCLC Patients with Performance Status 2 and Above and without Driver Mutation (ID 14433)
12:00 - 13:30 | Author(s): Sunil Kumar
- Abstract
Background
Platinum-based combination chemotherapy is recommended as the standard treatment for patients with advanced NSCLC, but its benefit is limited to patients with performance status (PS) of 0 or 1. However, it is not clear whether these benefits apply to patients with poor performance status ((PS 2 and above)). These patients have inferior outcomes and have been excluded from clinical trials. This population accounts for a significant portion (up to 30%) of patients of our practice and some of them have been treated with systemic chemotherapy based on clinician’s discretion. We have analyzed the outcome of these patients who have been treated with chemotherapy despite poor performance status.
a9ded1e5ce5d75814730bb4caaf49419 Method
We performed a retrospective analysis of patients of advanced NSCLC with poor PS (ECOG PS 2 or more) registered at our lung cancer clinic between January 2016 and September 2017 and treated with systemic chemotherapy. Patients with driver mutations who were treated with first line TKIs were excluded. Hospital case records were reviewed for baseline characteristics, treatment details and outcome data.
4c3880bb027f159e801041b1021e88e8 Result
A total of 78 patients were found to be eligible for this analysis. Median age was 60 years (33-77 years) including 15% patients 70 years or above. At presentation out of these 78 patients, 48 (62.5%) were smokers, 24 patients (30 %) had pleural effusion, 8 patients (10%) had brain metastasis and 30 patients (38%) had bone metastasis. Majority patients had ECOG PS 2 but 35 % had PS 3 or 4 also and 38(48 %) had one or more associated comorbidities. The most common chemotherapy regimen used was weekly paclitaxel and carboplatin (50 %) followed by pemetrexed and carboplatin (23 %). Majority (61.5 %) patients could complete 4 or more cycles of chemotherapy however 10 patients (13%) could receive only one cycle and 21 (27%) patients even received maintenance chemotherapy. Chemotherapy was interrupted or stopped due to toxicity in 33% patients. At least one point improvement in ECOG PS from baseline was observed in 44 patients (56%) after 2 cycles of chemotherapy. Objective response and disease control rates were 21 % and 48.6 % respectively. After a median follows up of 8.6 months, median progression free survival was 5.8 months.
8eea62084ca7e541d918e823422bd82e Conclusion
Systemic chemotherapy in modified doses and schedules in advanced NSCLC patients with PS 2 and above is feasible and may be associated with better symptom palliation with clinical benefit and improvement in survival. Further studies addressing this neglected subgroup are indicated.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.09 - Pathology (Not CME Accredited Session) (ID 975)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.09-22 - Correlation Between Maximum Tumour Diameter Measurement on CT-Scan and Histopathological Specimen: An Indian Experience (ID 13431)
12:00 - 13:30 | Author(s): Sunil Kumar
- Abstract
Background
Lung cancer is staged according to TNM classification, which encodes the anatomic extent of the disease. This is the most important prognostic factor in patients diagnosed with lung cancer. CT scan is a basic imaging modality used for pre-treatment tumour staging (T staging). Each centimetre increase in size leads to worsening of prognosis. Adjuvant treatment decisions are based upon the final histopathological tumour size. Accurate clinical and pathologic correlation has been an important focus of research in many cancers. The objective of our study is to see for any discordance with respect to tumour size calculated by CT scan and final histopathological specimen in patients of carcinoma lung undergoing upfront surgery.
a9ded1e5ce5d75814730bb4caaf49419 Method
All patients of lung cancer operated upfront between 2012 to 2017 were included in the study. Any patient with chest wall involvement, significant pleural effusion and tumours of main bronchus were excluded. CT scans were acquired from the supraclavicular region through the adrenal glands using a 1.25 mm slice thickness with 1.25 mm spacing following deep inspiration. Based on tumour perimeter maximum tumour size was calculated. The largest diameter of resected lung tumour was recorded using a standard ruler by the pathologist. A mean, median and range for both the CT diameter and pathology diameter were obtained. A paired t-test was used to examine the measurement difference between CT and pathology.
4c3880bb027f159e801041b1021e88e8 Result
A total of 109 patients were included in the study. Most common histology was Squamous cell carcinoma (n=40,36%), followed by Adenocarcinoma (n=32,29.3%), Neuroendocrine tumour(n=27,24.77%) and other histologies(n=10,9.17%). Among these patients, 22 tumours were located in right upper lobe (20.18%), 10: right middle lobe(9.17%), 25:right lower lobe(22.93%), 31: left upper lobe(28.44%) and 21: left lower lobe(19.26%). The mean size of tumour on CT scan is 4.92cm (SD=1.852cm, range:1-10 cm) and mean size on grossing is 4.5cm(SD=1.774cm,range:0.5-9.5cm)(p<0.05). The difference between the CT diameter and histopathological size is statistically significant. Tumour location and histology did not add any difference to tumour shrinkage.
8eea62084ca7e541d918e823422bd82e Conclusion
Our study demonstrates that there is a statistically significant difference between tumour diameter as measured by CT and its pathologic size. These differences could have implications in the treatment and prognosis of patients with lung cancer.
6f8b794f3246b0c1e1780bb4d4d5dc53
