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Gabriella Fontanini
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-22 - Primary Epithelial - Myoepithelial Carcinoma of the Lung with Unexpected Aggressive Onset (Now Available) (ID 1110)
08:00 - 18:00 | Author(s): Gabriella Fontanini
- Abstract
Background
Epithelial-myoepithelial carcinoma (EMC) is the rarest sub-type of primary salivary gland type neoplasms of the lung. It usually arises from the salivary glands in the trachea or main bronchi and it is generally classified as a low-grade tumour, but because of its rarity and the unknown malignant potential, the treatment of choice has not been established.
Method
A 50-year old Hispanic woman, with no history of previous malignancies or comorbidities, arrived at our institution with cough and dyspnoea. A chest CT showed a lesion of left upper lobe (LUL) bronchus, associated to complete atelectasis of left lung, pleural effusion and two inhomogeneous pleural masses just over the diaphragm. PET/CT revealed increased FDG uptake in LUL and in pleural lesions. Fiberbronchoscopy showed a mass originating from left upper bronchus that occluded left main bronchus. The biopsy of the neoplasm revealed pulmonary EMC. The cytological examination of pleural effusion was negative for neoplastic cells. After cardio-respiratory complete assessment and tumour board evaluation, the patient underwent left pneumonectomy, systematic lymphadenectomy and removal of two solitary lesions respectively located on parietal pleural and on diaphragm en-block with portion of muscle (repaired with non-absorbable running suture) by thoracotomy
Result
The postoperative course was uneventful (hospitalization: 10 days), however two weeks after discharge the patients was readmitted with pleural effusion and fever. The patient underwent a left thoracentesis (amicrobic, no malignant cells) and a fiberbronchoscopy (regular bronchial suture). After 7 days the patient was discharged. Histopathology confirmed R0 resection of EMC (7x5.5x4 cm), and two solitary metastases on parietal pleura and diaphragm. Ki 67 was <30%. Patient underwent adjuvant chemotherapy, was alive and free of disease 32 months after surgery.
Conclusion
Primary EMC of the lung is an extremely rare neoplasm with an unpredictable biological behaviour. The surgical resection represents the gold standard if a complete resection can be reached
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P1.04 - Immuno-oncology (ID 164)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.04-66 - The Percentage of PD-L1 Besides 50% Positivity Predicts Objective Response to Pembrolizumab in Non-Small Cell Lung Cancer (ID 2340)
09:45 - 18:00 | Author(s): Gabriella Fontanini
- Abstract
Background
Pembrolizumab is the first-line standard of care for advanced Non-Small Cell Lung Cancer (NSCLC) that have a PD-L1 expression level greater than 50%. In this prospective monocentric study, we evaluated how the expression levels of PD-L1 above 50% impact on the objective response rate.
Method
Thirty-four advanced NSCLC patients with a PD-L1 expression level greater than 50% treated with Pembrolizumab in first-line setting between 2017 and 2019 were enrolled in this study. Patient and tumor characteristics were correlated with treatment outcomes. Patients clinical evaluation has been performed every 3 months from the beginning of treatment. Responses were defined according to the Response Evaluation Criteria in the Solid Tumors guidelines, version 1.1. Tumor assessments were performed locally. The mutational status of KRAS, BRAF, NRAS, PIK3CA, ALK, ERBB2, DDR2, MAP2K1, EGFR and RET was determined using a Mass Spectrometry assay. PD-L1 expression levels among the objective response groups were compared by Kruskal-Wallis test. A logistic regression model was used to evaluate the impact of PD-L1 expression levels above 50% on the objective response using mutational status, age, smoking habits, presence of toxicities, performance score and histology as confounders.
Result
Thirteen patients had partial response (PR), 12 stable disease (SD) and nine progression disease (PD). Nine out of 34 tumours harboured KRAS mutations; no alterations were found in the other tested genes. PD-L1 expression levels were different among the objective response groups (P=0.01) with the PR and PD groups having the highest (median 80%, IQ range 80-90%) and the lowest (median 60%, IQ range 60-70%) expression respectively (Figure 1). In the multivariate analysis, PD-L1 level was the only significant predictor of objective response (P=0.03) with an odds ratio of 0.91 (95%CI 0.81-0.98).
Conclusion
In our series, PD-L1 expression above 50% confirmed to be an imperfect biomarker; however, the higher is the expression level the better is the objective response. For this reason, it could be relevant to provide clinicians with the exact PD-L1 percentage. Further investigations are warranted to define the best cut-off to select patients for monotherapy or combination with chemotherapy.
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P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.15-02 - Primary Salivary Gland-Type Lung Tumours, Surgically Treatable Rare Entity Lung Cancer: A Sixteen-Year Experience of a Single Centre (Now Available) (ID 1119)
10:15 - 18:15 | Author(s): Gabriella Fontanini
- Abstract
Background
Primary salivary gland-type lung tumours (PSGT) are uncommon entity, representing 0.09% of overall lung cancer. Due to their rarity, this category of malignancies remain incompletely understood and the role of surgery is poorly known. The primary endpoint of this study was to analyse the impact of surgical treatment on outcome for PSGT lung cancer
Method
A retrospectively analysis of patients who underwent a surgical treatment for PSGT tumours between January 2001 and January 2017 in a single centre was conducted. Overall survival (OS), disease free survival (DFS) and medical records (for age, sex, clinical conditions, location, surgical treatment, histopathology and tumour grade) were analysed
Result
Out of a total of 30 PSGT lung tumours, 26 patients (15 female, 11 male) with an average age of 58.1±12.7 years underwent surgical resection with curative intent. Four patients were excluded from this study because of metastatic disease (2) or unresectable masses that underwent only palliative endoscopic treatment (2).
Adenoid cystic carcinoma was diagnosed in 14 patients, mucoepidermoid carcinoma in 10 patients, and epithelial-myoepithelial carcinoma in 2 patients. Fourteen patients (54%) were current/former smoker. Twelve tumours originated from main bronchus/trachea, 14 from lobar/sublobar bronchus. The surgical procedure included lobectomy (n = 9, 34.6 %), sub-lobar resection (n=5, 19.2%), tracheal resection (n = 4, 15.4%), pneumonectomy (n = 3, 11.5%), sleeve lobectomy (n = 4, 15.4%), and carinal resection (n = 1, 3.8%). No operative mortality or major complications were reported; minor complications (e.g. air leaking, arrhythmias) occurred in five patients (19.2%). Mean dimension of tumours was 3.67±3.24 cm. Three patients underwent adjuvant therapies (2 radiotherapy, 1 chemotherapy). Cancer recurred in 11 patients (42.3%): 3 were surgically treated, 3 underwent chemotherapy, 1 radiotherapy and 4 combined radio-chemotherapy. With a median follow-up of 70 months, the overall survival was 68.8 months and the disease free survival was 56.8 months. The 5-year OS and DFS were 92% and 68% respectively. Adenoid cystic carcinoma was the most favourable subtype with a median OS of 90 months. Only three cancer-related dead occurred
Conclusion
Surgical resection of primary salivary gland-type lung cancer is an effective treatment even in case of large tumours that required extended resections. The long-term survival and the DFS after surgical resection are encouraging and redo surgical procedure with a curative intent can be performed in case of local recurrences
