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Pengbo Deng
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EP1.14 - Targeted Therapy (ID 204)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.14-37 - Anlotinib-Induced Broncho-Pericardial/Pleural Fistula in Patients Suffering from Lung Cancer (First Report) (Now Available) (ID 374)
08:00 - 18:00 | Presenting Author(s): Pengbo Deng
- Abstract
Background
Anlotinib is an small molecule inhibitor of multiple receptor tyrosine kinases, with inhibitory effects on tumor angiogenesis, and approved in China for treatment of patients with non-small cell lung cancer (NSCLC) who have undergone progression after≥2 lines of chemotherapy. The occurrence of bronchial fistula related to anlotinib has not been reported yet. We presented 2 cases of NSCLC patients with bronchial fistula after treatment with anlotinib.
Method
Case 1: A 69-year-old male diagnosed central squamous cell lung carcinoma(CSCLC) of the left (stage IV) on July 2018, who refused chemotherapy but treated with anlotinib for 3 months, aggravated with short breath, with CT indicating broncho-pericardial fistula. After catheter was set into pericardium and drained for 5 days, CT showed significant reduction of gas and pericardium partially conglutinated.
Case 2: 63-year-old male diagnosed CSCLC of the right (EGFR 19del) in 2016, with a history of diabetes, who successively received 2 lines of chemotherapy, target therapy, radiotherapy, shifted to anlotinib in August 2018 for 4 months, then aggravated with coughing pyohemosputum and fever, with CT indicating broncho-pleural fistula. After performed a closed thoracic drainage and anti-bacterium therapy, the patient improved and drainage decreased.
Result
Two cases developed bronchial fistula during the treatment of anlotinib alone, suggesting that the adverse effects mainly related to the antiangiogenics effect of it and causing ischemic necrosis. Other possible factors include: ①central lung cancer,②squamous cell carcinoma,③cachexia,④multi-line treatment,⑤long diameter of tumor≥5cm) and cavity formation,⑥radiotherapy,⑦accompanied with underlying diseases easy to complicated with infection, such as diabetes.
Conclusion
Although the incidence of bronchial fistula caused by anlotinib in NSCLC is extremely rare, it seriously affects the quality of life and overall survival of patients. Therefore, we need to use it selectively and make a close observation of the high-risk patients.
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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): Pengbo Deng
- Abstract
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.
