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Antonio Calles Blanco
Moderator of
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YI01 - First Time Attendee Session (ID 107)
- Event: WCLC 2019
- Type: Young Investigator Session
- Track: Young Investigators
- Presentations: 4
- Now Available
- Moderators:Antonio Calles Blanco, Alan D Sihoe
- Coordinates: 9/07/2019, 07:00 - 08:30, Dublin (1997)
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YI01.01 - Planning an Academic Career in Lung Cancer (Now Available) (ID 3690)
07:00 - 08:30 | Presenting Author(s): David R Gandara
- Abstract
- Presentation
Abstract
Planning an Academic Career in Thoracic Malignancies
David R Gandara, MD
University of California, Davis Comprehensive Cancer Center
Sacramento, CA
For those graduating from training in oncologist specialties worldwide in 2019, never have there been so many and such diverse opportunities, including Industry-related and Governmental positions. While the term “private practice” has specific connotations for oncologists in the USA that may no be applicable elsewhere in the world, the requisites for a career in academic medicine are uniform on a global basis. For example, it is often stated that that for clinical investigators a career in academic medicine is like a 3 legged stool, supported equally by clinical care, research and teaching. Some would add that administration is the fourth leg of an academic career, since it is often a significant component of time-spent. For those in a purely laboratory-based academic career, clinical care may be replaced by other activities. Assuming that you choose to be an academic physician with clinical care responsibilities, there are 3 broad categories of effort: clinical educator/administrator, clinical investigator and clinician-scientist.
Making the decision on which career pathway to follow is often not easy, and may be influenced by your country of origin and associated opportunities and challenges for different specialties in oncology where you intend to work. In fact, changing the decision between academic and non-academic career pathways have never been easier. There are many examples today of oncologists moving back and forth between academics and industry, with equal success in both venues.
This presentation will give a “personalized” approach to career planning taken from my own and other shared experiences. Since the ratio of pros/cons for academic medicine are largely applicable on an individual basis, this presentation mode will hopefully provide young investigators attending WCLC 2019 with personal insight and position them well for making this career-defining decision.
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YI01.02 - Why to Become a Member of the IASLC (Now Available) (ID 3691)
07:00 - 08:30 | Presenting Author(s): Giorgio Vittorio Scagliotti
- Abstract
- Presentation
Abstract
Since the 1970s, the International Association for the Study of Lung Cancer (IASLC) has promoted research and education into all aspects of lung cancer and other thoracic malignancies, as well as encouraged worldwide cancer prevention efforts.
According to its mission statement the International Association for the Study of Lung Cancer (IASLC) must embrace the study of the etiology, epidemiology, prevention, diagnosis, treatment and all other aspects of lung cancer and other thoracic malignancies; provide education and information about lung cancer and other thoracic malignancies to IASLC members, to the medical community at large, and to the public; use all available means to eliminate lung cancer and other thoracic malignancies as a health threat for the individual patient and throughout the world.
In the last ten years those goals have been embraced by a growing number of members worldwide and now the association counts on approximately 7.000 members with a large portfolio of scientific and educational activities, being now IASLC the premiere society in the field of thoracic oncology.
Beyond this bold statement the really question here is why me? While IASLC in the context of many other offers coming from other scientific organizations? The answer comes from one of our members “Being a member helped me in many, many ways. First coming to the IASLC World Conference on Lung Cancer. I was a resident and presenting in front of 100 people [….] that helped me secure my fellowship position. The IASLC helped me with great networking opportunities to interact with many members of the lung cancer community”.
That is really the key message. Inclusivity and multidisciplinary. The composition of our Board and committees reflect this sense of inclusivity. We want all the players in the thoracic oncology arena to have the appropriate voice, and the younger generation at the foremost.
IASLC mentors and support younger people in the context of several activities within the organization. IASLC has a wide range of fellowships that support people to travel and present at meetings, to get involved in research, and more importantly to get a research grant to make your ideas a reality, and to meet people who can help you further in boosting your career.
Our annual meeting is a reference meeting and every year the most relevant scientific research results have been constantly presented. The targeted therapy meeting held every year at the end of February in Santa Monica remains a unique forum of scientific exchange between researchers and pharma not paired by any other type of meeting throughout the world. Equally relevant are the regional meetings that are mainly educational but are also offering the opportunity to report about your own research.
One of the main duties of a membership association is to provide value to its members, through high quality and relevant offerings and deeper, more efficient mechanisms for engagement. Creating a robust experience for IASLC members and honoring our commitment to geographic and discipline diversity is our goal
The most challenging part for any scientific society is to understand the differences in generational needs. We need to identify the best new talents, the rising stars in our field, who will not only disrupt conventional thinking; they will lead the IASLC in the future. Specific actions will be considered and others are already in place to convince younger generations to see themselves in the IASLC mission.
We want you joining us in the fight against tobacco, we want you to be the ambassadors of our organization for the present and, more importantly, the future of our patients with the ultimate goal to be part of a dream : the eradication of thoracic malignancies
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YI01.03 - Making the Most of WCLC: A Guide for First Time Attendees (Now Available) (ID 3692)
07:00 - 08:30 | Presenting Author(s): Heather A Wakelee | Author(s): Becky Bunn
- Abstract
- Presentation
Abstract
Congratulations on making the decision to attend the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer (WCLC)! This is the largest meeting in the world focused entirely on thoracic malignancies and is truly an international and multidisciplinary event. However, it is possible to get lost with so many concurrent sessions and in the sea of thousands of delegates. So having a game plan is critical. You will want to have a roadmap and plan for each day but also allow time for networking and to have some fun. With the virtual meeting available afterwards do not worry too much if you want to be in two places at once. You can be… “virtually.”
Check out the “First Time WCLC Attendees” tab on the IASLC WCLC2019 conference website for great guidance from Dr. Anne-Marie Baird. To paraphrase her:
#1 Prepare
#2 Attend the Young Investigators Symposium
#3 Check out the Posters
#4 Network
#5 Engage with Social Media.
These are all outstanding suggestions! To help you prepare be sure to look at the program in advance and get a sense of the conference center layout. Each morning there is a Plenary session highlighting key topics with talks given by world leaders. These can be amazing! The top abstracts of the meeting will be presented in the Presidential symposium on Monday morning Sept 9. The conference app (available a week or so before the start of WCLC2019) is a great way to keep track of everything. With so many concurrent sessions it will be important to have the info at your fingertips.
There is a daily press conference that you can attend or review in the press and media section of the WCLC website. Highlights of the day (HOD) will be presented Mon Sept 9 and Tues Sept 10 from 10:30-12 of the conference and also included in emails and on the website. Checkout the daily newspaper (WCLC Daily News) for more highlights. Also you may want to follow everything that is happening on social media!
IASLC is active on: Twitter, Facebook, LinkedIn, YouTube, Instagram
Important Hashtags for lung cancer #LungCancer, #CureMESO, #NSCLC, #SCLC, #CancerResearch, #Oncology, #clinicaltrials
IASLC 2019 World Conference on Lung Cancer – Social Details:
Official Conference Hashtag: #WCLC19
Official Hashtag of Lung Cancer Social Media Community: #LCSM
The IASLC operates a social media booth at each WCLC for new users to learn about social media, get a tip-sheet and take photos with special branded backdrop (which is really fun)!
As you look at the program you will see there is a great mix of education sessions, workshops and new data presentations. You will likely want to attend a mix of all of these. The education sessions may be a focus since those will include global experts summarizing particular topics and future predictions. It can be a bit tricky to understand the significance of some of the new data without knowing the background and the education sessions will help with that knowledge. It is also great to go to some of the mini-orals (MA) and oral (O) sessions to hear the latest research, particularly in your areas of interest. The mini-orals can be tricky as each one goes by fast so be ready! Again, plan in advance.
As Dr. Baird points out, the poster/networking sessions are really wonderful. A lot of critical data that might not be as “flashy” is buried in the posters and you are likely to learn a lot. Even more importantly you will have a chance to network and find out who around the world is focusing in the same areas where you have interests. There are 2 poster sessions each day. The poster sessions are particularly great because you actually get to interact with people. If you see someone you want to talk to at the poster session do not be intimidated if they happen to be a “name” you have read multiple times in key papers. Everyone is excited to meet eager people working to help fight lung cancer!
The importance of networking cannot be over-emphasized. Getting to know the field and others who share your passion for fighting lung cancer and other thoracic malignancies can make a tremendous impact on your future academic career. Branch out and meet people in other disciplines and from other parts of the world. Having a common interest in fighting lung cancer can lead to some strong connections and it is incredibly fun to attend future conferences knowing that you will get to connect with friends you met at your first IASLC WCLC. Important collaborations can also be started including international efforts. If you are still in training this networking time is also critical to your future job hunting!
Remember to have FUN! Sign up and attend the IASLC social events. These involve good food, great music and sometimes dancing and most importantly a real opportunity to network.
Saturday – Opening Ceremony and Welcome Reception
Monday - IASLC Foundation Road to Hope gala
Tuesday - Closing Ceremony
After running around at the conference there will be times you just want to sit and relax. Fortunately there is an IASLC membership lounge in the exhibit hall open during exhibit hours. All members are invited to use the space for meetings, to sit for a few minutes, and to learn more about the IASLC and its committees. More details can be found here: https://wclc2019.iaslc.org/networking_opportunities/
Also, make some time before or after the conference to be a tourist in the local region. Most convention centers are fairly similar, but thinking about the last 3 IASLC WCLC conferences you can imagine how Yokohama, Toronto and Barcelona are all very different and fabulous places to explore.
Enjoy your first IASLC WCLC and hopefully you will plan to make it an annual event!
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YI01.04 - Congratulations, Your Abstract Has Been Accepted, and Now? - Tips and Tricks to Prepare a Presentation for WCLC (Now Available) (ID 3693)
07:00 - 08:30 | Presenting Author(s): Benjamin J Solomon
- Abstract
- Presentation
Abstract
This presentation will provide a practical guide about how to prepare and deliver an effective and engaging presentation at WCLC. Tips and suggestions will be provided for oral presentations, miniorals, posters and E-posters.
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Author of
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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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EP1.01-92 - Effectiveness of Second-Line Treatment with Nintedanib + Docetaxel (ND) in Patients with Metastatic Lung Adenocarcinoma (Now Available) (ID 1815)
08:00 - 18:00 | Author(s): Antonio Calles Blanco
- Abstract
Background
Nintedanib is an oral angiokinase inhibitor directed against VEGFR 3, FGFR 1-3, and PDGFR alpha and beta. It is approved by the European Medicines Agency in combination with docetaxel for the treatment of metastatic lung adenocarcinoma previously treated with platinum-doublet chemotherapy. Given the efficacy of checkpoint inhibitors in the second-line treatment of advanced lung cancer, we evaluated the outcomes of ND in this setting
Method
Patients diagnosed with advanced lung cancer between July 2015 to October 2017 at the University Hospital Arnau de Vilanova (Lleida, Spain) and treated with ND were included. The clinical history, tumor pathology, tumor biologic characteristics, treatments prior and posterior to ND were reviewed. Statistical analysis was realized using IBM SPSS Statistics 23.0 software. Overall survival (OS) was calculated by Kaplan-Meier curve, determining a median OS with 95% confidence interval and estimated mortality rates during each year of follow-up
Result
Thirteen of 357 patients with advanced lung cancer during the time period specified were treated with ND and included in the analysis. Median follow-up was 14.4 months (range: 7.3 – 41.2 months). Median age at diagnosis was 62.1 years (range: 46-73 years). Never-smokers comprised 15.4% of the patients, ex-smokers 46.2% and active smokers 38.5%. Bone metastases were present in 23.1% of patients, while 15.4% and 15.3% had central nervous system and hepatic metastases, respectively. The majority, 69.2%, received a platinum-doublet first-line and 46.2% received pemetrexed maintenance. The median number of ND cycles was four. Responses to ND were 53.8% partial response (PR), 23.2% stable disease (SD), and 23% progressive disease, with a disease control rate (DCR) of 77%. 53.8% of patients continued with nintedanib maintenance with the following responses: 43% PR, 14.3% SD, and 42.7% progressive disease (DCR 57.3%). There were no grade 2 or greater toxicities in the nintedanib maintenance group. Fifty-four percent of ND patients received third-line therapy: 50% atezolizumab, 16.7% carboplatin + vinorelbine, 16.7% nivolumab, and 16.7% oral vinorelbine. Eleven percent of patients received fourth-line therapy. Median OS was 14.4 months (CI 95%: 11.7 – 17.1 months). OS rates at 2 and 3 years were 69.2% (CI 95%: 44,1% - 94,3%) and 23.1% (CI 95%: 0,2 - 46%), respectively
Conclusion
ND is an effective second-line treatment for patients with advanced lung adenocarcinoma. In this descriptive analysis, the median OS associated with ND was superior to the results of Lume-Lung 1 and Checkmate 057, although the study is limited by sample size
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MS05 - Novel Biological Pathways and Druggable Targets (ID 68)
- Event: WCLC 2019
- Type: Mini Symposium
- Track: Biology
- Presentations: 1
- Now Available
- Moderators:Jin Jen, Marisol Arroyo-Hernandez
- Coordinates: 9/09/2019, 11:00 - 12:30, Vancouver (2003)
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MS05.04 - Innate Immune Mediators in Lung Cancer (Now Available) (ID 3464)
11:00 - 12:30 | Presenting Author(s): Antonio Calles Blanco
- Abstract
- Presentation
Abstract
Non-small-cell lung cancer (NSCLC) accounts for about 85% of total lung cancer cases. The major types of NSCLC—squamous cell carcinoma and adenocarcinoma—harbor distinct histopathologies, biomarker expression, genomic alterations, and response to therapy [1,2]. Recent studies have shown that there are also differences in their tumor immune microenvironments [3–6]. Specifically, adenocarcinomas have increased infiltration of tumor-associated macrophages, while squamous lung tumors exhibit an enrichment in tumor-associated neutrophils (TANs) in both mouse and human lung tumors. The two major subtypes of NSCLC are also associated with distinct lineage-specific master regulators: SOX2 is commonly amplified and up-regulated in the vast majority of squamous tumors anddrives the squamous fate, whereas NKX2-1 is highly expressed in adenocarcinoma and governs adenocarcinoma fate [2]. We developed novel genetically engineered mouse models (GEMMs) of squamous lung cancer on the basis of overexpression of the transcription factor Sox2 and loss of the tumor suppressor Lkb1 (SL mice) (Mukhopadhyay et al, Cell Rep, 2014 [7]). SL tumors recapitulated gene expression and immune infiltrate features of human squamous NSCLC, including an enrichment of TANs and a decrease in expression of NKX2-1. Deletion of Nkx2-1in SL mice (SNL) revealed that NKX2-1 suppresses SOX2-driven squamous tumorigenesis by repressing adeno-to-squamous transdifferentiation. We further employed multiple GEMMs to elucidate the role of SOX2 and NKX2-1 in tumor cell fate and TAN recruitment. In Kras-driven adenocarcinomas,mis-expression of Sox2 or loss of Nkx2-1 led to TANrecruitment. SOX2 recruits, whereas NKX2-1 suppresses, TANs at least partly through inverse regulation of the chemokineCxcl5. Tumor-derived CXCL5 is sufficient to recruit TANs. Single cell RNA sequencing (scRNA-seq) revealed that TANs exhibit tumor-promoting features, including production of reactive oxygen species (ROS), and distinct gene expression profiles compared to blood neutrophils (Mollaoglu et al, Immunity, 2018 [8]). Depletion of TANs through LY6G blocking antibodies or CXCR2 inhibitors in SNL mice reduced squamous tumors, suggesting that TANs foster squamous cell fate. Furthermore, TAN depletion coupled with scRNA-seq suggests that TANs regulate distinct aspects of tumor cell fate. Together, these data suggest that lineage-defining transcription factors determine the tumor immune microenvironment, which in turn can impact the nature of the tumor.
References
1 Langer, C.J. et al. (2016) Incremental Innovation and Progress in Advanced Squamous Cell Lung Cancer: Current Status and Future Impact of Treatment. J. Thorac. Oncol.11, 2066–2081.
2 Campbell, J.D.et al. (2016) Distinct patterns of somatic genome alterations in lung adenocarcinomas and squamous cell carcinomas. Nat. Genet.48, 607–616.
3 Kargl, J. et al. (2017) Neutrophils dominate the immune cell composition in non-small cell lung cancer. Nat. Commun.8, 14381
4 Nagaraj, A.S. et al. (2017) Cell of Origin Links Histotype Spectrum to Immune Microenvironment Diversity in Non-small-Cell Lung Cancer Driven by Mutant Kras and Loss of Lkb1. Cell Reports 18, 673–684.
5 Xu, C. et al. (2014) Loss of Lkb1 and Pten Leads to Lung Squamous Cell Carcinoma with Elevated PD-L1 Expression. Cancer Cell 25, 590–604.
6 Ferone G., et al. SOX2 Is the Determining Oncogenic Switch in Promoting Lung Squamous Cell Carcinoma from Different Cells of Origin. Cancer Cell. 2016;30(4):519-532. doi:10.1016/J.CCELL.2016.09.001.
7 Mukhopadhyay, A. et al. (2014) Sox2 Cooperates with Lkb1 Loss in a Mouse Model of Squamous Cell Lung Cancer. Cell Reports 8, 40–49.
8 Mollaoglu, G. et al. (2018) The Lineage-Defining Transcription Factors SOX2 and NKX2-1 Determine Lung Cancer Cell Fate and Shape the Tumor Immune Microenvironment. Immunity 49, 764-779.e9.
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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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P1.16-09 - Post-Progression Outcomes After Pembrolizumab in Patients with NSCLC and High PD-L1 Expression: Real-World Data from a European Cohort (ID 2749)
09:45 - 18:00 | Author(s): Antonio Calles Blanco
- Abstract
Background
Real-world data regarding treatment patterns and clinical outcomes after progression on first-line pembrolizumab (pembro) monotherapy among NSCLC patients are lacking.
Method
A comprehensive clinicopathological database of 173 consecutive patients with NSCLC and PD-L1>50% treated with first-line pembro in 14 centers in Italy, Spain, Greece and Switzerland was retrospectively created and post-progression patterns and outcomes were recorded. Analysis was performed using the SAS 9.3 software.
Result
Main clinicopathological features are summarized in Table 1. Median TPS score for PD-L1 expression was 70%. Median duration of pembro treatment was 6.1 months (range: 0.2-20.8). Thirty patients (17.4%) received pembro despite having non-metastatic disease (stage I-IIIC), as deemed medically inoperable or ineligible for definite chemo-radiotherapy. At data cut-off (10th April 2019), 100 patients (58%) had stopped treatment due to disease progression, 9 (5%) due to toxicity, 3 (2%) for other reasons and 61 (35%) were still on treatment. Best response to pembro was CR, PR, SD and PD in 2%, 34%, 20% and 24% respectively, while in 11.6% death occurred in the absence of documented PD. Among patients who progressed (N=100), in 18 cases pembro was continued beyond progression, as considered to confer clinical benefit. Among patients who discontinued pembro (N=94), 47% received any second-line chemotherapy and 53% received no further treatment. Main chemotherapy regimens were carboplatin with either pemetrexed (16%) or gemcitabine (9%) or paclitaxel (7%), cisplatin-pemetrexed (7%) and gemcitabine monotherapy (9%). Best response to chemotherapy was CR, PR, SD and PD in 2%, 30%, 11% and 32% respectively. After a median follow-up of 11.2 months, median OS was 13.5 months (range: 0.16-25.8+).
Table 1: Main clinicopathological characteristics of the patient cohort.
N=173
%
COUNTRY OF ORIGIN
Italy
98
56.7
Greece
32
18.5
Switzerland
27
15.6
Spain
16
9.2
SEX
Male
112
64.7
Female
61
35.3
AGE Median (Range) yrs
68 (19-86)
SMOKING STATUS
Current
66
38.2
Former
86
49.7
Never
18
10.4
Unknown
3
1,7
PERFORMANCE STATUS
0
50
28.9
1
80
46.2
2
41
23.7
3
2
1.2
HISTOLOGY
Adeno
116
67.1
Squamous
37
21.4
Large Cell
2
1.2
Pleiomorphic
3
1.7
Sarcomatoid
7
4.0
Poorly differentiated/
Undifferentiated
8
4.6
SITE OF METASTASIS
Bone
74
49.7
Intrapulmonary/Contralateral Lung
72
48.3
Adrenal
43
28.9
Brain
30
20.1
Liver
23
15.4
Other
63
36.4
TNM STAGE AT DIAGNOSIS (AJCCC v.8)
I
2
1.2
II
2
1.2
III
26
15.0
IV
142
82.1
Unknown
1
0.5
STEROID USE
Yes
48
27.7
No
105
60.7
Unknown
20
11.6
Conclusion
Real-world data in a large retrospective cohort, indirectly compared to Keynote 024, suggest that: 1) Due to it’s favorable toxicity profile, pembro is also an option in earlier stages in frail (PS=2 or medically inoperable stage I-III) patients, 2) One in five patients continues pembro beyond progression due to clinical benefit and 3) More than half of patients who progress do not receive any second-line treatment, mainly due to clinical deterioration.
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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
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-10 - Real Clinical Practice Study to Evaluate 2 Line Treatment Based on Comprenhensive Genomic Profiling in NSCLC. LungONE Study (Now Available) (ID 1558)
10:15 - 18:15 | Author(s): Antonio Calles Blanco
- Abstract
Background
Cancer is a genomic disease and molecular-targeted therapy plays an increasingly important role in the treatment of advanced NSCLC. The current standard of care (SoC) indication for NSCLC is defined by genomic biomarkers to classify the tumor as a carrier of a therapeutic approved target. However, the current standard of practice for molecular testing in NSCLC in Spain is highly heterogeneous, depending on several factors such as hospital size, resources, laboratory equipment and experience. In addition, there are several other markers and/or genomic signatures which are not determined due to the current lack of scientific evidence, i.e. MSI, TMB, KRAS, BRAF, RET, MET, HER2 and NTKR, which could guide physician second line treatment choice, including clinical trial options. The aim of this study is to evaluate the impact on decision making in the 2nd line treatment using a comprehensive genomic profiling (CGP) in advanced/metastatic NSCLC with adenocarcinoma histology.
Method
Section not applicable
Result
Section not applicable
Conclusion
This is a multicenter, prospective, single-cohort study to describe the clinical management of the 2nd line SoC treatment in patients with locally advanced/metastatic NSCLC with adenocarcinoma histology, when a comprehensive genomic profile based on FoundationOne®CDx or FoundationOne® Liquid test, is provided. 12 academic institutions in Spain were selected and 180 patients were planned to be recruited. The principal objective is to evaluate if there is any change in planned 2nd line treatment decisions after receiving the CGP report. Secondary objectives for this study are:1) to identify non-previously detected actionable molecular aberrations by conventional molecular assays; 2) to evaluate the economic impact in terms of use of healthcare resources of the CGP vs. standard diagnostic panels; and 3) to describe each patient’s status 2 years after the inclusion of the last patient in the study. Patients will follow usual clinical pathways for biomarker analysis and a comprehensive genomic profiling in the remaining tissue through FoundationOne® CDx, will be conducted or liquid biopsy with FoundationOne® Liquid, if exhausted. To be enrolled in the study, patients must have an ECOG between 0 and 2 and biomarkers ALK, EGFR, ROS1 must have been assayed (negative or unknown results). Enrolment begun on October 2018 and, to date, a total of 110 patients have been included.
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P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.14-29 - Clinical Impact of Next-Generation Sequencing (NGS) in Blood Liquid Biopsies for Treatment Decisions in Advanced NSCLC (ID 2803)
10:15 - 18:15 | Presenting Author(s): Antonio Calles Blanco
- Abstract
Background
Blood-based NGS is emerging as either complementary or alternative to standard tissue genotyping in metastatic non-small-cell lung cancer (NSCLC). In cases where tissue is not enough to complete standard EGFR, ALK, and ROS1 testing, or when patients are tested as triple-negative for these genetic alterations, additional tumor genotyping can lead to the detection of further actionable mutations. Moreover, NGS provides valuable genomic information that could be used to select for immunotherapy in metastatic NSCLC.
We aimed to describe the molecular findings obtained by liquid biopsy of a cohort of advanced NSCLC patients with unknown/negative EGFR, ALK and ROS1 and how the results modified treatment decisions.
Method
We performed a retrospective study of advanced NSCLC patients that were analyzed with NGS as part of a molecular pre-screening for clinicals trials in our institution in Madrid (Spain) between October 2016 and March 2019. Patients >18 years-old, PS ECOG 0-2, stage IIIC-IV NSCLC were routinely tested for EGFR, ALK, and ROS1, in addition to PD-L1 (22C3). Those wild-type for EGFR, ALK, or ROS1, or without enough tissue to perform the triple testing were considered for blood-based NGS. The different diagnostic assays for ctDNA NGS used depended on clinical trial molecular pre-screening protocol: Foundation One® Liquid or Guardant360®.
We analyzed the frequency of oncogenic drivers, the proportion of patients treated with genotype-directed therapy, and survival.
Result
We analyzed 95 NSCLC pts with valid NGS results from ctDNA (blood sample).
We detected 14 oncogenic driver mutations (15%): 5 EGFR (5.2%), 1 ALK fusion (1%), 1 BRAF V600E (1%), 2 METex14 (2.1%), 2 RET fusion (2.1%) and 3 HER2 mutations (3.2%). We also found 16 KRAS mutations (16.8%), and genetic alterations in tumor suppressor genes: 39 TP53 (41%), and 6 NF1 mutations (6.3%).
So far 8/14 patients were treated with genotype-directed therapy (8.4%), 2 of them under clinical trial: 5 pts were treated with an anti-EGFR treatment, 2 pts received alectinib (1 pt for ALK rearrangement, 1 pt for RET rearrangement) and 1 pt with tepotinib (MET splice mutation)
Of the 6 patients with NF1 mutations, 4 pts were women (66%), 5 pts were current smokers (83%), median age at diagnosis was 69 years (66-80), and 5 pts had non-squamous histology (83%). PDL1 tumor expression was determined in 4 patients: 2 pts >50%, 1 pt 10%, and 1 pt 0%. NF1 was co-mutated in 4 pts with RAS (66%), 1 with both RAS and TP53, and 1 HER2 A775:G776insYVMA.
3/6 NF1 mutant patients were treated with single agent ICI: 2 pts with first-line pembrolizumab, and 1 pt second-line pembrolizumab. In addition, one patient with germline NF1 mutation was treated with 2nd line atezolizumab. All 3 pts obtained responded to ICI (1 pt with atypical response). We will present updated data on PFS and OS.
Conclusion
Blood-based NGS can guide treatment decisions in metastatic NSCLC, with special interest in those patients without enough tumor tissue, or wild-type to standard-tissue diagnostic tests. NF1 mutations in NSCLC could predict responses to immune-checkpoint inhibitors, and warrants further evaluation.
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SH02 - Highlight of the Previous Day (ID 99)
- Event: WCLC 2019
- Type: Highlight of the Previous Day Session
- Track:
- Presentations: 1
- Now Available
- Moderators:Grace Yang, Debora Gil
- Coordinates: 9/10/2019, 11:30 - 13:00, Melbourne (1991)
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SH02.05 - SCLC/NET (Now Available) (ID 3666)
11:30 - 13:00 | Presenting Author(s): Antonio Calles Blanco
- Abstract
- Presentation
Abstract not provided
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