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Michel Van Den Heuvel
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EP1.09 - Pathology (ID 199)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.09-14 - Best Practice Session on Lung Cancer Molecular Diagnostics in the Netherlands to Enhance Testing Proportions Nationwide (Now Available) (ID 1321)
08:00 - 18:00 | Author(s): Michel Van Den Heuvel
- Abstract
Background
Adequate and timely testing for genetic alterations in lung cancer is necessary to consider targeted therapy. Previously, we demonstrated that in the Netherlands molecular testing was suboptimal in 2015, as 25% (EGFR and/or KRAS and ALK) to 50% (ROS1) of patients were not tested according to the guidelines, and notable variation between laboratories was present. Results were fed back to individual laboratories. In a best practice session, we aimed to identify a process for best possible flow and highest possible testing proportions.
Method
We invited pathologists, molecular biologists, pulmonologists, and technicians from six laboratories/hospitals with highest testing proportions to join a best practice session. Ultimately, four laboratories, two academic and two non-academic, joined. Following a questionnaire, we discussed their work flow and why they think their laboratory/hospital performs well.
Result
We identified several stimulatory factors for molecular testing: 1. discuss all metastatic lung cancer patients at multidisciplinary meetings; 2. dedicated/specialized professionals; 3. short communication lines and clear agreements; 4. work culture of critical openness and honesty; 5. awareness and feedback on performance; 6. comprehensive request by the pulmonologist of all genes to be tested; 7. to obtain sufficient tumor tissue: a. perform CT-scan earlier in process, making it possible to collect larger biopsies in case a metastasis is detected, and b. embed cytological material. Costs, without reimbursement, were seen as a prohibitive factor.
Conclusion
Several elementary steps (such as good communication) to improve adequate molecular testing were revealed. Initiatives will be taken to implement the outcomes nationwide, by starting a dialogue with health care professionals at a regional level.
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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
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-115 - Long-Term Effects of Concurrent Chemoradiotherapy on Quality of Life in Locally Advanced Non-Small Cell Lung Cancer Patients (ID 1780)
09:45 - 18:00 | Author(s): Michel Van Den Heuvel
- Abstract
Background
Concurrent chemoradiotherapy imposes beneficial effects on overall survival (OS) in patients with locally advanced non-small cell lung cancer (NSCLC). Currently, it is unknown what the effects on long-term health-related quality of life (HRQOL) are. Therefore, we investigated long-term HRQOL in locally advanced NSCLC patients treated with concurrent chemoradiotherapy, using an accelerated fractionation scheme of 24 x 2.75 Gy +/- Cetuximab.
Method
A 2-armed phase II, multi-center study (NTR2230) was performed with the initial aim to assess the effect of additional Cetuximab to concurrent chemoradiotherapy in locally advanced NSCLC patients. Arm A received high dose accelerated radiotherapy (24 x 2.75 Gy) and concurrent daily low-dose cisplatin (6 mg/m2). Arm B additionally received weekly Cetuximab (400 mg/m2 one-week pre-treatment followed by weekly 250 mg/m2). HRQOL was assessed using the EORTC QLQ-C30 at baseline, 3 months post treatment and after 1 year. The primary endpoints included dyspnea, pain, physical functioning, cognitive functioning and the QLQ-C30 summary score. Following the EORTC guidelines, the scores of the endpoints were linearly transformed to 0–100 scales. Higher scores correspond to improved functioning for the functioning scales and for the summary score while for symptom scales (pain and dyspnea), higher scores indicate more symptoms. Linear mixed-modeling was used to assess differences over time. Standardized effect sizes based on the t-test statistic were calculated: (2*t)/(√degrees of freedom). Effect sizes of 0.2 were considered small, 0.5 moderate and clinically relevant, and 0.8 large.
Result
Between February 2009 and May 2011, 102 patients were randomly allocated in two arms; 51 patients (50%) in arm A and 51 patients (50%) in arm B. Of those, 79 (77%) patients had at least one evaluable questionnaire. Figure 1 shows the development of the HRQOL endpoints over time. Over time, physical functioning (ES 0.48, P-value 0.003), cognitive functioning (ES 0.37, P-value 0.020), dyspnea complaints (ES 0.67, P-value <0.001) and the summary score (ES 0.44, P-value 0.006) significantly worsened. Only pain showed a reversing pattern in which pain was less present at 1 year (ES 0.37, P-value 0.021). No differences between the two arms were found.
Conclusion
In this randomized study of locally advanced NSCLC patients treated with concurrent chemoradiotherapy with or without Cetuximab, a clinically meaningful and long-term decline for all HRQOL endpoints except pain was observed. This analysis suggests that although concurrent chemoradiotherapy improves OS in NSCLC patients, efforts should also be taken to improve long-term HRQOL.
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P1.09 - Pathology (ID 173)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.09-06 - Evaluation of Molecular Testing in a Dutch Cohort of Metastatic Non-Small Cell Lung Cancer Patients from 2017 (ID 1285)
09:45 - 18:00 | Author(s): Michel Van Den Heuvel
- Abstract
Background
Adequate and timely testing for genetic alterations in non-small cell lung cancer (NSCLC) is necessary to consider targeted therapy when a certain genetic alteration is present. Previously, we demonstrated that in the Netherlands molecular testing was suboptimal in 2015, as 25% (EGFR/KRAS and ALK) to 50% (ROS1) of patients were not tested according to the guidelines, and notable variation between laboratories was present. Currently, by analyzing a cohort of metastatic NSCLC from 2017 we aim to assess whether the performance of molecular testing improved.
Method
All fully registered stage IV non-squamous NSCLC with incidence year 2017 from the Netherlands Cancer Registry were matched to the Dutch pathology registry (PALGA). Using information extracted from pathology excerpts, proportions of tumors tested for EGFR and/or KRAS, BRAF, and HER2 mutation, and ALK, ROS1, and RET rearrangement within 3 months after diagnosis were determined, and reason for not testing were assessed.
Result
Of 2596 identified patients, we have currently analyzed 511 (20%). Twenty-three patients were non-eligible after matching, leaving 488 patients. Of these patients, 262 (54%) were male and 413 (88%) had an adenocarcinoma. EGFR and/or KRAS testing was performed within 3 months after diagnosis in 412 patients (84.4%). Of the EGFR/KRAS wildtype tumors (n=184), 167 (90.8%) were tested for BRAF, 158 (85.9%) for HER2, 157 (85.3%) for ALK, 110 (59.8%) for ROS1, and 73 (39.7%) for RET. Insufficient tumor tissue and inappropriate specimen were the most stated reasons for not testing.
Conclusion
These preliminary data show significantly higher testing proportions for EGFR and/or KRAS and ALK as compared to 2015. Further improvement remains possible to identify candidates for targeted therapy. At the WCLC meeting, we expect to present the variation between laboratories for the entire cohort.
