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Ivan Vollmer
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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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EP1.01-41 - Feasibility of EBUS-TBNA Cytologies for an Extensive Assessment of Predictive Biomarkers in Lung Cancer (Now Available) (ID 1640)
08:00 - 18:00 | Author(s): Ivan Vollmer
- Abstract
Background
Clinical guidelines support the determination of several driver genes as well as PD-L1 to drive treatment decisions in non-small cell lung cancer (NSCLC). Endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) cytology specimens are useful for the initial diagnosis of NSCLC, although its capacity to provide enough material for a complete genotyping remains controversial. The aim of this study is to determine the yield of EBUS for a comprehensive multiplex genotyping in patients (pts) with suspected NSCLC.
Method
In this single-center, ongoing, prospective study, samples from mediastinal lymph nodes were obtained from pts undergoing EBUS-TBNA for lung cancer diagnosis/staging. Following malignant confirmation and appropriate cell content by rapid on-site evaluation, the study sample was obtained and formalin-fixed paraffin-embedded (FFPE). Three analytes were evaluated (DNA/RNA/protein). DNA and RNA were extracted and analyzed by Oncomine Solid Tumour panel (22 genes) and a customized nCounter panel (ALK, ROS; RET, NTRK, METDe14). Tumor Proportion Score (TPS) for PD-L1 protein expression was evaluated by an expert pathologist and scored into <1% (negative), 1-49% (weakly positive) and 50% (high).
Result
Twenty-five pts with NSCLC have been included and cytology samples of 20 of them molecularly characterized (5 still in progress). Overall, cytological analysis of EBUS-TBNA yield a complete characterization for the three analytes (DNA/RNA/protein) in 15 pts (75%). EBUS-TBNA sampling was sufficient for both, Nanostring and Oncomine evaluation, in a total of 18 pts (90%): 15 patients (83%) had any alteration detected by oncomine (TP53 61% [11/18],KRAS 44% [8/18], EGFRe 195.5% [1/18], BRAF V600E 5,5% [1/18], DDR2 5.5% [1/18], STK11 11% [2/18]) and 1 pt (5.5 %) by nanostring (METDex14). A total of 19 samples were sufficient for PD-L1 expression scoring (95%). TPS for PD-L1 expression was negative in 8 pts (42%), week in 4 (21%) and high in 7 pts (37%). Overall, half of the pts evaluated (10/20) would be potential candidates for an upfront personalized treatment strategy using targeted agents or immunotherapy.
Conclusion
EBUS-TBNA is a promising alternative source of material for NSCLC genotyping and allows the identification of pts candidates for personalized therapies.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-19 - Radiological and Pathological Response to the Induction of Surgery in the NSCLC Stage III (Now Available) (ID 438)
10:15 - 18:15 | Author(s): Ivan Vollmer
- Abstract
Background
Neoadjuvant treatment (NT) prior to surgical resection is the standard treatment for operable stage III-pN2 NSCLC. Our objective is to compare the response, radiological and pathological, after induction with radio-chemotherapy (RT-Ch) versus chemotherapy alone (Ch).
Method
We develop a retrospective study that included 53 patients from four different centres diagnosed of stage III NSCLC (TNM 8th edition). 34 patients received RT-Ch and 19 received Ch between 2012 and 2018, with a median follow-up of 25 months. The radiological response (RR) was assessed by CT at 3-4 weeks after NT using RECIST criteria. The pathologic response (PR) was evaluated in operated patients (44) through the viable residual cells in the tumor and lymph nodes. pN was taken into account to determine the rate of downstaging. The PR, as well as the surgery, were performed in the same center for all 44 patients
Result
The majority were stage IIIA (33), followed by IIIB (19) and only one was IV (single brain metastasis treated previously with radiosurgery). Comparing the RR in RT-Ch and Ch, we found stable disease and partial response more frequently with a 35.6% vs 52.6% and 61.8% vs 36.9% respectively. A 17.3% and 5.3% of the complete PR was achieved in RT-Ch and Ch respectively. Downstating was feasible in 82.8% of RT-Ch and 40% in Ch. Clinical features and treatment evaluation in Table 1.
Conclusion
In our review we observed that a 45% of the patients treated with Ch had a response of 20% or less in the pN or a local progression after the treatment, in comparison with only a 3.4% in the group of RT-Ch. However, the evaluation of the differences in the PR should be associated with a greater follow-up to assess the impact on overall survival.
