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Francesco Pesola
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-56 - Co-Presentation of Adenocarcinoma and Squamous Cell Lung Carcinoma Harbouring ALK Rearrangement in Different Sites (Now Available) (ID 1416)
08:00 - 18:00 | Author(s): Francesco Pesola
- Abstract
Background
Approximately 4% to 9 % of NonSmallCellLungCarcinoma (NSCLC) contain mixed adenomatous on squamous pathologies (adenosquamous cell carcinoma). The lung ADC to SCC transdifferentiation as a drug-resistance mechanism has been recently described. While the histological transformation mainly described in ALK-positive patients is from NSCLC entity to SCLC, only one case of histologic transformation of ALK rearranged ADC to SCC after treatment with an ALK inhibitor has been reported. Importantly, transformed samples retain the initial genomic alteration, supporting the lineage transition as a novel resistance mechanism.We describe an unique case of co-presentation of ADC and SCC in two different disease sites, both harbouring ALK rearrangement.
Method
A 57-year-old male never smoker presented with a left adrenal mass. CT Scan showed a right superior lobe mass, bilateral pulmonary nodules (Fig. 1 A), and bone metastases. The lung biopsy documented ADC with moderate differentiation and ALK rearrangement by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC).
Result
The patient was treated with Crizotinib but, after 4 months, the CT showed a near complete response of the pulmonary disease (Fig. 1 B), while a progression of the left adrenal metastasis was observed. (Fig. 2 A, Fig. 2B). A left adrenal biopsy showed a SCC histology, with ALK rearrangement confirmed both by IHC and FISH. The treatment was switched to alectinib without respoinse so the patient received chemotherapy.
Conclusion
The absence of an initial biopsy of the adrenal mass doesn't allow to distinguish between a lung ADC to SCC transdifferentiation with a consequence of the treatment-induced selection pressure, so a preexisting SCC at the time of diagnosis would exhibit tumor dominance after elimination of the ADC. However, the presence of the ALK rearrangement in the adrenal biopsy suggest a possible ADC to SCC transdifferentiation in the early phase of metastases development as a new potential mechanism of drug resistance
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EP1.04 - Immuno-oncology (ID 194)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-38 - A Case of Lichenoid Reaction as Late and Uncommon Immune-Related Skin Toxicity During Nivolumab Treatment (Now Available) (ID 1408)
08:00 - 18:00 | Author(s): Francesco Pesola
- Abstract
Background
Immune-checkpoint inhibitors have shown remarkable activity in advanced Non-small cell lung cancer (NSCLC).
An increasing number of immune-related skin toxicities has been reported , also heterogeneous and unusual. So, these reports could be useful to manage such events.
Lichenoid dermatitis (LD) identifies a group of dermatoses clinically and histologically reminiscent of idiopathic lichen planus (LP). Pharmacologycal, chemical and viral causes agents can induce skin lichenoid reactions.
Method
Result
We report the case of a 81-years-old man with stage IV non-small cell lung cancer treated with Nivolumab developing a hitchy, recurrent and polymorphous lichenoid eruption after 36 cycles of treatment (Figure 1).
A skin biopsy (Figure 2) showed an area of parakeratosis associated to a dense lympho-histiocytic infiltrate of the papillary derma that obscures the basal membrane and causes vacuolization of the basal layer of the epidermidis with an isolated Civattes body (red arrow), (40
X, H&E).The temporary interruption of Nivolumab , together with short and low-dose cycles of corticosteroids repeated for several times due to the wave evolution of the lichenoid reaction, allowed for the partial recovery of the skin toxicity and the resumption of treatment.
Conclusion
Unlike the classic appearance of lichenoid reactions, this patient showed a more polymorphous lesions as compared to the classic forms .
The correct and early recognition of these uncommon effects is useful to optimally manage and safely continue a treatment while achieving a therapeutical response of neoplastic disease
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MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:Fabrizio Bianchi, Marcelo Sanchez
- Coordinates: 9/08/2019, 15:15 - 16:45, Dublin (1997)
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MA10.05 - Breath Analysis: New Key-Challenges for Early Detection of Lung and Pleural Neoplasms (Now Available) (ID 959)
15:15 - 16:45 | Author(s): Francesco Pesola
- Abstract
- Presentation
Background
The growing interest about breath analysis relies on the need of tools to get an early diagnosis of respiratory pathologies with high mortality rate such as lung cancer (LC) and malignant pleural mesothelioma (MPM). Nowadays the key-challenge of the scientific community is the search for non-invasive diagnostic biomarkers able to identify patients at risk of developing cancer or with early stage cancer. A diagnostic progress would be crucial to improve the survival outcome of these neoplasms, generally detected at an advanced stage. The analysis of Volatile Organic Compounds (VOCs) pattern in human breath for early detection and follow-up of diseases such as cancer is low-cost, non-invasive and promising alternative to traditional exams (i.e., colonoscopy, biopsy).
Method
This study is based on the development and validation of a methodological approach aimed to the identification of VOCs breath pattern to discriminate between patients affected by both LC and MPM, and healthy controls (CTRL). A total of 80 breath samples from 36 patients with LC, 14 patients with MPM and 30 CTRL have been collected into inert Tedlar bags, transferred to sorbent tubes (biomonitoring, Markes) and analysed by TD-GC/MS (TD Markes Unity 2 - GC Agilent 7890/MS Agilent 5975).
Result
Non parametric test as Wilcoxon/Kruskal Wallis tests (R version 3.5.1) allowed to identify the most weighting variables in discrimination between LC, MPM and HC breath samples. On the basis of p-values lower than 0.05 (selection between CTRL and LC, and between CTRL and MPM) and current knowledge on metabolic processes, a multivariate statistics (Principal Components Analyses (PCA) -PAST 3.20) has been applied on breath samples, considering only selected variables. The preliminary statistical elaboration by PCA of data collected from the analysis of LC and CTRL samples have shown two principal components: PC1 characterized by higher loadings of benzoic acid, methylcyclohexane and hexanal, and PC2 characterized by high loadings for dimethyldecane, pentane and pentanal. Similar results were obtained by PCA applied to MPM and CTRL breath samples considering 2-methylpentane, cyclopentane, hexane and 2-butanone as discriminant variables.
Conclusion
PCA was able to discriminate between LC and CTRL and between MPM and CTRL breath samples. Leave-one-out cross-validation method was applied to calculate the prediction accuracy obtaining good sensitivity (88%), accuracy (86%) and specificity (92%).
Further investigation about breath analysis is strongly warranted, due to the need of biomarkers potentially useful both for the screening of high-risk subjects and for the early diagnosis of lung and pleural neoplasms.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-74 - Clinical-Pathological Features and Outcome of Patients with Oral Metastases from Lung Cancer: A Multicenter Retrospective Study (ID 2701)
10:15 - 18:15 | Author(s): Francesco Pesola
- Abstract
Background
Oral metastases are a rare event, accounting to less than 1% of all oral malignancies, sometimes being the first manifestation of a wide-spread disease. Regardless of the site of the primary tumor, patients with oral metastases have a poor prognosis, with a reported median overall survival (mOS) of 6 months. Lung cancer, particularly small cell lung cancer (SCLC) and poorly differentiated carcinoma, represents the main source of oral metastases, even if large datasets still lack. We conducted a multicenter retrospective study investigating incidence, clinical-pathological features and outcome of patients with oral metastases from lung cancer.
Method
Between January 2014 and December 2018 we collected data from all consecutive patients diagnosed with lung cancer in four oncological Italian centers. Clinical-pathological features of those patients with oral metastases involving jaw or/and soft tissues were described.
Result
Among 4,082 consecutive lung cancer patients, the incidence of oral cavity metastases was 0.15% (6 out of 4,082 patients,). Patients were more frequently male (5 out of 6, 83%), current or former smokers (5 out of 6, 83%), with a median age at diagnosis of 61 years (range 53-69) [table 1]. Four different histotypes of lung cancer were detected. Five patients (83%) were stage IV ab initio, with synchronous histologically confirmed oral metastases. All these patients had distant metastases other than in the oral cavity (median of 5 different metastatic sites). The mOS since the diagnosis of oral metastases was 67 days (range 36-166).
Table 1. Patient characteristics
Gender
Age (years)
Smoke
Histotype
N° metastatic sites
Site of oral lesion
Time between stage IV diagnosis and oral lesion occurrence
Local radiotherapy
Median OS from oral lesion occurrence (days)
M
69
Current
Poorly differentiated
4
Jaw
Syncronous
Yes
57
M
61
Current
Sarcomatoid
5
Jaw
Syncronous
Yes
107
M
61
Former
Adenocarcinoma
3
Gum
11 months
Yes
77
M
53
Former
Poorly differentiated
4
Gum
Syncronous
No
44
M
59
Current
SCLC
5
Gum
Syncronous
No
36
F
66
Unknown
Squamous (mut ex 19 EGFR)
5
Gum
Syncronous
No
166
Conclusion
To our knowledge, this is the largest study assessing the incidence of oral metastases in lung cancer patients. Oral involvement, usually diagnosed at an advanced stage, seems to be associated with a very poor prognosis, with a mOS of about 2 months. Further confirmatory datasets are warranted.
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P2.10 - Prevention and Tobacco Control (ID 176)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Prevention and Tobacco Control
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.10-06 - Smoking Prevalence and Perceptions Among Healthcare Professionals: A Survey in an Italian Clinical Cancer Centre (Now Available) (ID 840)
10:15 - 18:15 | Author(s): Francesco Pesola
- Abstract
Background
A survey has been conducted on employees of our Clinical Cancer Centre about the smoking prevalence and knowledge of the smoking-related harms. The results have been compared to those emerged from a previous survey when the current smoke-free-hospital policies (national and internal) were not yet active.
Method
In June 2017, during two weeks, 400 subjects received an anonymous questionnaire (36items) investigating demographics, smoking-habits, secondhand-smoke exposure, knowledge of Italian smoke-free legislation.
Result
104 subjects (26%) returned the self-completed form (M=45.34years, SD=10.5; 67.3%women). 17,8%of responders were smokers, 26,2%former smokers, 56% no smokers, while in 23,8% the data were missing. Among the former smokers, the mean age of smoking cessation was 33,3 years (sd=10,2), without drugs in 77,3% of cases, for the following reasons: preventive health purposes (29,6%),a child birth (26%),suggestions from family members (3,%); no one stopped on medical advice. The ex-or never smokers share the working room with one (23,2%) or more (8,5%) smokers, pointing out the smoke exposure in hospital (30%), and feeling intense uneasiness (46,8%). The smoke-free-hospitals policy is not fully accepted, indeed only 40% declared that the smoking ban is observed and 63,2% said to smoke during the working-time.Regarding the policies that prohibit smoking inside and outside the hospital, the responders perceived it as a good way to protect the health (65,4%), to reduce the prevalence of smokers in hospital (20%), to protect non-smokers (46,1%) and to decrease tobacco-related disorders (37,5%) (p<0,001). The implementation of Italian smoke-free policies has favoured the reduction of the number of smoked cigarettes (55%), but did not increase the desire of a complete cessation (63%). A comparison of the surveys conducted in 2014 and 2017 is showed in Figure.
Conclusion
The adopted strategies are partially efficient; among personnel there is a large prevalence of smokers and interventions aimed at the development of a culture of health promotion are needed.
