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Prasanta Raghab Mohapatra



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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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      P3.01-06 - Concomitant Plasma-Genotyped T790M Positivity and Small Cell Carcinoma Transformation in EGFR-Mutated NSCLC (ID 14459)

      12:00 - 13:30  |  Author(s): Prasanta Raghab Mohapatra

      • Abstract

      Background

      Patients of non-small cell lung cancer (NSCLC) having epidermal growth factor receptor (EGFR) gene mutation, initially show clinical response to EGFR Tyrosine-Kinase Inhibitors (TKI), but develop resistance after some months. However, the type and timing of TKI-resistance cannot be predicted as it is highly variable. Transformation to small cell lung cancer (SCLC) at progression during TKI-therapy and simultaneous acquisition of T790M EGFR-mutation is uncommonly reported.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Case report: Our patient is a 51 year-male, with stage IV NSCLC of adenocarcinoma subtype (TTF1 positive by IHC). He was initially treated with six cycles of pemetrexed and carboplatin to which he showed good response and was on regular follow up since September 2015. In the meantime, he was detected to have EGFR exon 21-mutation and was treated with Gefitinib for over two years. Patient was doing well and had complete disappearance of the tumour radiologically. After about 26 months of treatment he again became symptomatic. Repeat Computed tomography showed a lobulated mildly enhancing lesion 4.4 × 3 cm in right upper lobe. There were small nodules over bilateral lung fields and subpleural areas in right lower lobe, likely to be metastatic. Lytic lesions were also detected in dorsal (D2) and cervical (C5) vertebral bodies. Liquid biopsy showed T790M EGFR-mutation. Re-biopsy from right upper lobe showed transformation to neuroendocrine carcinoma (SCLC). Gefitinib was stopped and the patient was started on standard platin based doublet regimen for SCLC for the transformation. Patient has received four cycles of platin based chemotherapy and is doing well.

      4c3880bb027f159e801041b1021e88e8 Result

      "Section not applicable"

      8eea62084ca7e541d918e823422bd82e Conclusion

      This case report shows the possible underlying relationship between SCLC transformation and the T790M mutation, and that liquid biopsy approach may help overcome the problem of heterogeneity in acquired resistance to EGFR-tyrosine kinase inhibitors. In advanced NSCLC with EGFR-mutation, delayed onset of TKI-resistance can occur during TKI-treatment. Re-biopsies have increased the chance of detecting a T790M mutation and transformation. “Liquid biopsies” may potentially help identify heterogeneous genetic resistance-mechanisms; however, assessment of mechanisms such as SCLC-transformation needs tissue biopsies.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.13 - Targeted Therapy (Not CME Accredited Session) (ID 979)

    • 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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      P3.13-16 - Concomitant EML4-ALK Rearrangement and EGFR Mutation in Non-Small Cell Lung Cancer Patients: Data from Eastern Indian Hospital. (ID 13867)

      12:00 - 13:30  |  Presenting Author(s): Prasanta Raghab Mohapatra

      • Abstract
      • Slides

      Background

      Clinical guidelines recommend routine testing for genetic mutations in all adenocarcinoma of lung, including ALK EML4 gene rearrangement. The coexistence of EGFR mutations and EML4- ALK rearrangements have been described as extremely rare. Perhaps this is due to its low prevalence and the sensitivity of available diagnostic modalities. All India Institute of Medical Sciences, Bhubaneswar, is an upcoming institute of national importance situated in eastern India. No report on EGFR mutation and EML4- ALK rearrangement has been published so far from this region of India.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively analysed the available data of patients from June 2014 to April 2018. Genetic testing was done from tissue block specimens immediately after establishing the histology. EGFR mutation analysis were done using commercially available Real Time PCR and ALK-positivity was assessed with immunohistochemistry (IHC) by VENTANA ALK (D5F3) CDx Assay. We investigated the course of disease with the efficacy of targeted therapy in EGFR/ ALK co-altered NSCLCs

      4c3880bb027f159e801041b1021e88e8 Result

      Out of 251 NSCLC cases, 198 had adenocarcinoma and only four patients (1.6%) had concomitant EGFR/ALK co-alterations. Of the EGFR mutations, two were positive for Exon 19 and other two were positive for Exon 21. Mean age for Exon 19 and Exon 21 positive patients were 40 and 63 respectively. All four patients were male and had advanced stages of lung cancer. Mutation in all the four patients were detected from initial tissue biopsy and they were negative for ROS1. Three patients had received platinum based doublet regimen followed by EGFR-TKI and one patient received Erlotinib. None had received Crizotinib yet.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The coexistence of EGFR mutations and EML4- ALK rearrangements is low but higher than other geographical areas. Since the two alterations may coexist from the beginning of diagnosis, future perspective in management could be finding potential efficacy of a double inhibition of both ALK and EGFR mutations.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • 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.CR-02 - SBRT of Lung Primary After Complete Resolution of Metastatic Disease in Case of EGFR Mutated Adenocarcinoma Lung: A Case Report (ID 14464)

      12:00 - 13:30  |  Author(s): Prasanta Raghab Mohapatra

      • Abstract

      Background

      Lung cancer accounts for the highest malignancy related mortality among males worldwide. The prognosis of metastatic lung cancer is dismal and as per data from United States of America, the 5-year survival of metastatic lung cancer patients stands at mere 5 percent. Loco-regional management in metastatic lung cancer is not routinely practiced, however exceptions are made in patients who have very good response to systemic treatment. In such cases loco-regional treatment is expected to improve disease free survival.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Section Not applicable

      4c3880bb027f159e801041b1021e88e8 Result

      Fifty-six year old male, known hypothyroid[on thyroxine supplementation] without any significant history of addiction/family history presented with chronic non-productive cough and acute breathlessness. On evaluation left lung upper lobe primary mass [adenocarcinoma on histopathology] and left sided pleural and pericardial effusion[malignant on cytology]as well as multiple cervical lymphadenopathy was found on PET-CT. Hundred percent of the primary tumour tissue was found to harbour EGFR mutation while being negative for ALK mutation. After six cycles of chemotherapy with Carboplatin and Pemetrexed combination chemotherapy regimen, the patient was kept on Erlotinib for 9 months. All the metastatic diseases were found to be resolved and primary was shrunken on assessment PET-CT. Patient was advised for SBRT to primary 50Gy in 5 fractions,10Gy per fraction on alternate days over a period of 10 days following which he has been kept on Tab Erlotinib. The patient has a survival of 18 months calculated from the time of diagnosis till compilation of data and is disease free.

      8eea62084ca7e541d918e823422bd82e Conclusion

      High percentage of EGFR mutation can provide very good response to tyrosine kinase inhibitor therapy in case of metastatic adenocarcinoma lung. Partial response at primary with resolution of metastatic disease throws a challenge for use of loco-regional modality of management in tandem with systemic treatment.

      6f8b794f3246b0c1e1780bb4d4d5dc53