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Ana Vivancos
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ES25 - Liquid Biopsy (ID 27)
- Event: WCLC 2019
- Type: Educational Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:Max Diehn, Lucia Milla Collado
- Coordinates: 9/10/2019, 14:30 - 16:00, Colorado Springs (1994)
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ES25.04 - Liquid Biopsy: Utility for Early Detection (Now Available) (ID 3290)
14:30 - 16:00 | Presenting Author(s): Ana Vivancos
- Abstract
- Presentation
Abstract
Personalized treatment according to molecular profile is standard of care in advanced NSCLC patients. Epidermal Growth Factor Receptor (EGFR) activating mutations predict sensitivity to first- and second-generation anti-EGFR tyrosine kinase inhibitors (TKIs) in patients with non-small cell lung cancer (NSCLC). However, obtaining a tissue biopsy remains a limitation in NSCLC patients. Liquid biopsy is a non-invasive method that allows the detection and quantification of tumor somatic mutations in plasma, although around 20% of all tumors don’t appear to shed DNA into the bloodstream. Here, we aimed to correlate the presence and amounts of ctDNA in plasma of NSCLC patients with several clinical parameters, as well as obtaining serial data on non-shedding patients throughout their course of illness.
We collected 280 serial blood samples of 40 patients with NSCLC diagnosis harboring EGFR sensitizing mutations in their tumor biopsy. Extracted ctDNA was tested for five common EGFR mutations (exon 19 deletion, L858R, L861Q, T790M and C797S) by highly sensitive and quantitative Droplet Digital PCR (ddPCRTM; Bio-Rad), at a limit of detection between 0.1-0.5% and quantified the percentage of mutant alleles of EGFR. Of these patients, 16 provided one plasma sample (32%) and the other 34 (68%) provided multiple blood collections with an average of 5 follow-up plasma samples. All patients received targeted TKI therapy before or during the study. Lines of treatment, Progression free survival (PFS) and overall survival (OS) were annotated for each patient in the cohort.
Out of the 40 patients evaluated, we detected presence of baseline ctDNA in 32 patients (80%). Such parameter was independent of the sensitizing mutation; tumors harboring exon 19 or exon 21 mutation tend to equally shed DNA into the bloodstream (78% and 80%, respectively). After a median follow up of 36.1 months, and immature survival data, the PFS and OS are higher among patients with baseline ctDNA positive compared to patients without ctDNA detected: 22 months vs. 13.6 months and 35 vs. 24 months, respectively. T790M and C797S resistance mutations were detected at different prevalences, depending on the TKI treatment regimen, and were always subclonal in plasma as compared to the clonal EGFR mutation (indel 19/L858R). We observed that, for the whole period analyzed in non-shedding patients, ctDNA was never detected.
In our series, sensitizing EGFR mutations in plasma were identified in 80% of the patients by ddPCR. Acquired resistance mutations in EGFR appeared to be subclonal, which might impact detection in liquid biopsy. Shedding is a complex biological entity that warrants further research in order to improve our understanding on its impact in prognosis.
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MA09 - EGFR & MET (ID 128)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:Jordi Remon, Juergen Wolf
- Coordinates: 9/08/2019, 15:15 - 16:45, Melbourne (1991)
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MA09.08 - Discussant - MA09.05, MA09.06, MA09.07 (Now Available) (ID 3748)
15:15 - 16:45 | Presenting Author(s): Ana Vivancos
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-05 - Incidence and Outcome of Multiple Primary Cancers (MPC) in a Series of Lung Cancer (LC) Patients (ID 1030)
09:45 - 18:00 | Author(s): Ana Vivancos
- Abstract
Background
The number of cancer survivors has increased as a result of significant progress in prevention, diagnosis and treatment of malignant tumors. The risk of developing a second neoplasm, after treatment of an initial primary cancer, is increasing and indeed lung cancer represents a commonly diagnosed second primary malignancy. This study investigates the co-occurrence of MPC among patients (p) diagnosed with lung cancer (LC).
Method
Review of clinical data of all consecutive patients with histologically confirmed LC visited at our institution between October 2017 and August 2018
Result
Out of 1386 p with LC, two primary cancers occurred in 206 cases (15%), including 41 p (3%) with three primary cancers. Patients with MPC were predominantly males (67%), smokers (88%), statin users (40%) and 28% had known family history. Second cancer was detected in a routine follow-up in 62%, whereas 27% were symptomatic patients. Median age at the first tumor diagnosis was 61 years (27-85). LC occurred as first neoplasm in 34% of the cases, as subsequent neoplasm in 41% and as two consecutive primary neoplasm in 25%. The most common primary cancer was LC in 34%, followed by breast (16%), colorectal (15%), prostate (9%), bladder (8%) and head and neck (6%). Treatment received for the first cancer included surgery in 80%, chemotherapy in 47% and radiotherapy in 32%. As a second tumor LC represented 41%, followed by bladder (19%), colorectal (10%), prostate (9%) and breast (7%). Surgery was performed in 70% of the cases with a second cancer. Regarding only patients with LC as two primary tumours (first and second tumour), 25 pts (89%) were not metastatic at second tumour, surgery was performed in 82% and 7 pts (24%) developed a third tumour. Overall, median time of diagnosis between the first and the second neoplasm was 4.2 years (CI95% 3.2-5.2), without significant differences if primary tumor was LC or another neoplasm (p=0.82). Smoking was associated with a shorter time of the second neoplasm diagnosis (3.8 years vs 7.9 years for non-smokers, p=0.09), whereas taking statins exhibited longer time of diagnosis of the second neoplasm (5.1 vs 3.3 year, p=0.05). With a median follow up of 7.3 years after diagnosis of the first neoplasm, the 5-year survival rate was 97.2% (94.8-99.7%).
Conclusion
In our series, the frequency of the MPC co-occurrence among LC p is 15%, indicating that surveillance strategies are recommended. Many p are treated with curative intent. Moreover, smoking and taking statins influences the time interval between tumors
