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Liming Cao



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    EP1.12 - Small Cell Lung Cancer/NET (ID 202)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.12-10 - Molecular Characterization of NSCLC-Like and SCLC-Like Subsets in Chinese Pulmonary Large-Cell Neuroendocrine Carcinoma (LCNEC) (Now Available) (ID 1341)

      08:00 - 18:00  |  Author(s): Liming Cao

      • Abstract
      • Slides

      Background

      LCNEC is an aggressive, biologically heterogenous carcinoma which can be molecularly characterized as SCLC-like and NSCLC-like. Accurate distinction of molecular subset is of major clinical relevance since it may guide treatment choices in LCNEC. Here we determined the genomic characteristics of the two LCNEC subsets in a Chinese cohort to clarify their correlations with traditional lung cancer histologies.

      Method

      FFPE samples from 31 LCNECs were sequenced using a 520-cancer-related gene panel, with an average sequencing depth of 1385X. Comparative mutational analysis was conducted between NSCLC-like LCNECs from our cohort and adenocarcinomas from TCGA dataset

      Result

      Despite similar clinical features in terms of stage and age at diagnosis, NSCLC-like (42%, 13/31) and SCLC-like (32%, 10/31) subsets from LCNEC displayed distinct molecular characteristics. NSCLC-like subset harbored significant higher mutation frequencies of STK11, KEAP1 and FAT3 (53.8%, 38.5% and 38.5%, p=.007, .046 and .046), while SCLC-like subset was characterized by highly mutated RB1 (100%, p<.001) and PTEN (50%, p=.007). Compared with TCGA adenocarcinomas, NSCLC-like LCNEC displayed more frequent mutations in TP53, STK11, APC, KMT2D and SMARCA4 (76.9%, 53.8%, 30.8%, 30.8% and 23.1%; p=.043, .004, .045, .005 and .049). In addition, potential targetable alterations were present in 46.2% (6/13) pts of NSCLC-like subset. For those advanced stage pts, 2/5 NSCLC-like and 5/5 SCLC-like pts received relevant chemotherapy according to their molecular characteristics. The clinical outcomes of these pts are still under follow-up.

      Conclusion

      This study demonstrates the distinct molecular features between NSCLC-like and SCLC-like subsets, and highlights the predominant genomic similarity and separate entities between NSCLC-like LCNEC with adenocarcinoma. Given the evidence that genomic profiling may aid in informing treatment decisions for pts with LCNEC, our study indicates that, based on accurate molecular typing, 46.2% NSCLC-like pts may benefit from potential targeted therapy and the rest of them may be more suitable to receive NSCLC-chemotherapy

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    OA03 - Systemic Therapies for SCLC: Novel Targets and Patients' Selection (ID 121)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
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      OA03.05 - Characterization of Genomic Alterations in Chinese LCNEC and SCLC via Comprehensive Genomic Profiling (Now Available) (ID 1486)

      13:30 - 15:00  |  Author(s): Liming Cao

      • Abstract
      • Presentation
      • Slides

      Background

      LCNEC and SCLC are aggressive neuroendocrine carcinomas with overlap in clinical, histopathologic, morphologic and genomic features. Differential molecular features between the two subtypes have not been well elucidated, contributing the uncertainty for optimal clinical strategy for each subtype. Here we interrogated the genomic characteristics in LCNEC as compared to SCLC along with their histologically related subtypes: carcinoids and atypical carcinoids via comprehensive genomic profiling.

      Method

      FFPE samples from 31 LCNECs, 35 SCLCs, 14 carcinoids and 22 atypical carcinoids were sequenced in a CLIA-certified sequencing laboratory using 520-cancer-related gene panel, with an average sequencing depth of 1385X.

      Result

      Comparative mutational analysis revealed that both LCNEC and SCLC sub-cohorts displayed higher rate of TP53 alterations than that of carcinoid (p<0.001, p<0.001). SCLC patients harbored more RB1 and PIK3CA mutations than LCNECs (p<0.001, p=0.014) and carcinoids (p<0.001, p=0.018). In addition, mutation frequencies of LRP1B, FAT1, PRKDC, PIK3CA, NOTCH1, SPTA1 and EPHA3 in SCLC were significantly higher than that in carcinoid. Mutations in TP53 and RB1 occurred concurrently in 83% (29/35) SCLC patients, whereas in only 32.3% (10/31) LCNECs.(Fig.1) We further investigated the distribution of mutations across KEGG pathways and found that mutation frequencies in both HIF-1 and Notch signaling pathways were lower in LCNEC than SCLC (p=0.032, p=0.025). Copy number variation (CNV) analysis revealed that LCNEC and SCLC had comparable CNVs which were significantly higher than carcinoid (p<0.001, p<0.001) and atypical carcinoid (p=0.010, p=0.028). TMB analysis also revealed a comparable TMB status of LCNEC (12.7/Mb) and SCLC (11.9/Mb), and relatively lower TMB in both carcinoid (2.4/Mb, p<0.001, p<0.001) and atypical carcinoid (5.6/Mb, p=0.003, p=0.009) than LCNEC and SCLC.

      wclc lcnec figure 1.jpg

      Conclusion

      We demonstrated the differential genomic characteristics in the four subtypes of neuroendocrine carcinomas. Compared with SCLC, LCNEC has lower mutation frequencies in RB1, PIK3CA, as well as HIF-1 and Notch signaling pathways. In addition, LCNEC and SCLC had comparable CNV and TMB status, which significantly higher than that of carcinoids and atypical carcinoid.

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-21 - Sputum Can Serve as an Alternative Source for Liquid Biopsy in Patients with Lung Cancer (Now Available) (ID 1579)

      09:45 - 18:00  |  Author(s): Liming Cao

      • Abstract
      • Slides

      Background

      With the advancements in the development of targeted therapy, the detection of actionable mutations has become routine practice in diagnosing lung cancer, especially in non-small cell lung cancer (NSCLC). Due to its non-invasiveness and great accessibility, plasma-based mutation profiling, with a sensitivity of approximately 70%, is widely used in clinical settings. Profiling using other body fluids have been actively explored. In this study, we investigated the potential of sputum obtained from non-small cell lung cancer (NSCLC) patients for mutation profiling.

      Method

      We performed capture-based ultra-deep targeted sequencing on matched Falin-Fixed Paraffin-Embedded (FFPE), plasma and sputum samples of 11 treatment-naïve NSCLC patients using a panel consisting of 168 lung cancer-related genes. Among the 11 patients, with a median age of 57, 8 were diagnosed with adenocarcinoma and 3 with squamous cell carcinoma. In addition, 4 patients were classified with central types and the other 7 were classified with peripheral types. Five of them were non-smokers and the remaining were smokers. Three of them were females and 8 were males. All patients were diagnosed with advanced disease (stage III or IV).

      Result

      Collectively, we identified 52, 40 and 33 mutations from FFPE, plasma and sputum samples, respectively. Using FFPE samples as a reference, both plasma and sputum had an overall concordance rate of 61.5%. If only actionable classic driver mutations were considered, the concordance rate increased to 91% for sputum and 82% for plasma. Profiling of sputum revealed 8 patients with classic lung cancer driver genes: 4 patients with EGFR mutation, 1 with ALK rearrangements, 2 with KRAS mutation, and 1 with ERBB2 mutation. The ERBB2 mutation revealed by sputum was not detected from the corresponding plasma sample. Furthermore, our study revealed that the allelic fractions (AFs) from sputum were significantly higher than AFs from plasma samples (p=0.039). For smokers, the difference of AFs between sputum and plasma was more significant (p<0.001). Furthermore, among the mutations which were detected from both sputum and plasma, 92% mutations had higher AF in sputum. In contrast, for non-smokers, only 29% of mutations had higher AF in sputum. Our data revealed for non-smokers, two media had comparable AFs (p=0.273).

      Conclusion

      Our study demonstrated that sputum from advanced stage NSCLC patients is an alternative media for mutation profiling. Potentially, it may serve as a better source for mutation profiling than plasma in smokers. Larger studies are needed to confirm our findings.

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