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Marcelo Sanchez

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    MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Screening and Early Detection
    • Presentations: 12
    • Now Available
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      MA10.01 - Invasive Adenocarcinoma in Screen Detected Pure Ground-Glass Nodules (GGN) (Now Available) (ID 2736)

      15:15 - 16:45  |  Presenting Author(s): Renelle Myers  |  Author(s): John English, Sukhinder Kaur Atkar-Khattra, John Mayo, John Yee, Annette Maree McWilliams, Ming Sound Tsao, Stephen Lam

      • Abstract
      • Presentation
      • Slides

      Background

      A major criticism of lung cancer screening initiatives is their propensity to instigate enhanced surveillance and over-treatment of otherwise indolent disease, including adenocarcinoma-in-situ (AIS). These nodules present radiographically as GGN. There are wide variations in the recommendations for surveillance (repeat imaging), diagnosis (biopsy) and therapeutic intervention (resection) for these lesions. To further our understanding of the optimal management of screen detected GGN, we used data from two screening studies in Canada with up to 17 years of follow-up to determine the proportion of persistent GGN that are invasive adenocarcinomas.

      Method

      Two lung cancer screening studies data sets were reviewed: the BC Lung Health Study (BCLHS) with 1365 participants and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan) with 2537 participants. BCLHS enrolled ever smokers 45-74 years of age with >30-year smoking history. The median follow-up in this cohort was 12 years (0.1-17.6) The PanCan study screened participants age 50-75 years with a PLCOm2008 6-year lung cancer risk > 2%. The median follow-up was 5.5 years (3.2-6.1). The nodules were followed until they resolved, demonstrated stability for >2 yrs or were surgically resected. All pure GGO resected were re-reviewed and classified by two pulmonary pathologists according to the revised 2015 World Health Organization classification of lung tumours. Cancers were staged using the 8th edition of the AJCC/UICC cancer staging manual.

      Result

      A total of 18,589 nodules in 3902 participants were reviewed. 2392 (13% of all nodules) were classified as pure GGN. 1073 of the 2392 were > 5mm at the baseline scan. Of these 1073 GGN, 156 (15%) resolved, 879 (82%) remained pure GGN, 38 (3.5%) became part-solid or solid. 32(3%) of the GGN from 29 patients that demonstrated growth were resected. The median size prior to resection was 16 mm (range 7 to 33 mm). The histopathology distribution included: 19 invasive adenocarcinomas, 7 minimally invasive adenocarcinomas, 6 adenocarcinoma-in-situ. The TNM stage distribution and average size of the GGN on the CT prior to resection are listed in Table 1. Sixty-one percent of the invasive cancers (Stage IA1 to IIIA) were less than 20 mm. Eleven percent of the invasive adenocarcinomas had lymph node metastasis.

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      Conclusion

      A high proportion of pure GGN that demonstrate growth are invasive cancers. The majority were < 20mm in size when they were resected. This has significant implication in the development of recommendations to manage screen detected GGN.

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      MA10.02 - Deep Learning with Radiomics May Predict High-Grade Lung Adenocarcinoma Based on Histological Patterns in Ground Glass Opacity Lesions (Now Available) (ID 128)

      15:15 - 16:45  |  Presenting Author(s): Xing Wang  |  Author(s): Li Zhang, Lei Tang, Xin Yang, Quanzheng Li, Nan Wu

      • Abstract
      • Presentation
      • Slides

      Background

      Adenocarcinoma (ADC) is the most c­­­­­­­ommon histological subtype of lung cancers in non small cell lung cancer (NSCLC) in which ground glass opacifications (GGOs) found on computed tomography (CT) scans are the most common lesions. These lesions are usually treated with limited lung resection. However, the presence of a micropapillary or solid component is identified as an independent predictor of prognosis, indicating a more extensive resection. The accurate classification of subtypes still remains difficult in radiology or in frozen pathological analysis, even with the help of classical radiomics. The purpose of our study is to explore imaging phenotyping using a novel method combining radiomics with deep learning (RDL) to predict high-grade patterns within lung ADC.

      Method

      Included in this study were 111 patients differentiated as having GGOs and pathologically confirmed ADC. Four different methods were compared to classify the GGOs for the prediction of the pathological subtypes of high-grade lung ADCs, including classic machine learning, radiomics, deep learning method, and a proposed novel method referred as RDL. A four-fold cross-validation approach was used to evaluate the performance of such methods.

      Result

      We analyzed 32 patients with high-grade patterns and 79 without such patterns. The proposed RDL has achieved an overall accuracy of 0.888, which significantly outperforms classic machine learning, radiomics, and deep learning alone (p< 0.001, paired t-test).


      figure1.pngfigure2.png

      Conclusion

      High-grade lung ADC based on histologic pattern spectrum in GGO lesions might be predicted by a novel framework combining radiomics with deep learning, which reveals a significant advantage over traditional methods.

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      MA10.03 - Quantitative Computed Tomography (CT) Based Texture Analysis; Could We Predict the Future Growth of the Pure Ground Glass Nodules? (ID 229)

      15:15 - 16:45  |  Presenting Author(s): Joosung Sun  |  Author(s): Hye Lin Kim, SeulGi You, Youngin Choi, Young Gi Min, Kyung Joo Park

      • Abstract
      • Slides

      Background

      To evaluate whether the quantitative computed tomography based texture analysis (QTA) could predict the future growth of the pure ground glass opacity nodule (GGN) or not.

      Method

      We retrieved CT images of 9284 patients who underwent chest CT in 2013 from the picture archiving and communication system (PACS). We queried the database of PACS to filter reports of chest CT containing one of these key words, as follows; “ground-glass”, ground glass”, or “GGO(s)”. 78 patients were finally included [5 patients (5GGNs) who underwent operation due to growth of GGN during follow-up and 73 patients who had 3-year-follow-up CT]. Total 90 GGNs from 78 patients were analyzed by QTA. The parameters of QTA were mean HU value, standard deviation (SD), entropy, mean positive pixels (MPP), skewness, and kurtosis. QTA was performed with image filtration step to remove photon noise, filtration technique enhanced features of different sizes based on the spatial scale filter (SSF) value varying from fine-texture (SSF2), medium-texture (SSF3), and coarse-texture (SSF4). We focused on the change of volume% of GGNs [(follow-up volume of GGN/initial volume of GGN)*100%], and assessed the differences of QTA parameters’ value according to the change of volume % for three cut-off levels (150%, 170%, and 200%); group 1a (≤130%), group 1b (>130%);group 2a (≤150%), group 2b (>150%);group 3a (≤170%), group 3b (>170%).

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      Result

      r.png

      Only entropy was a variable that showed statistically significant difference between group 3a and 3b with all the filtrations (SSF2, 3, 4) applied or without filtration (SSF0). The mean, SD, MPP, kurtosis and skewness, showed no significant difference according to the cut-off value of volume % change (130%, 150%). There was no significant difference in QTA parameters in group2a vs 2b, group3a vs 3b.

      Conclusion

      The initial entropy parameter of texture analysis for GGNs may have the potential to predict the GGNs growth.

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      MA10.04 - Discussant - MA10.01, MA10.02, MA10.03 (Now Available) (ID 3750)

      15:15 - 16:45  |  Presenting Author(s): Marcelo Sanchez

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA10.05 - Breath Analysis: New Key-Challenges for Early Detection of Lung and Pleural Neoplasms (Now Available) (ID 959)

      15:15 - 16:45  |  Presenting Author(s): Annamaria Catino  |  Author(s): Gianluigi De Gennaro, Alessia Di Gilio, Laura Facchini, Domenico Galetta, Teresa Mongelli, Jolanda Palmisani, Francesca Porcelli, Niccolò Varesano, Pamela Pizzutilo, Michele Montrone, Vito Longo, Gabriella Del Bene, Angelica Mastrandrea, Francesco Pesola, Donata Ricci, Patrizia Petrillo, Antonella Zacheo

      • Abstract
      • Presentation
      • Slides

      Background

      The growing interest about breath analysis relies on the need of tools to get an early diagnosis of respiratory pathologies with high mortality rate such as lung cancer (LC) and malignant pleural mesothelioma (MPM). Nowadays the key-challenge of the scientific community is the search for non-invasive diagnostic biomarkers able to identify patients at risk of developing cancer or with early stage cancer. A diagnostic progress would be crucial to improve the survival outcome of these neoplasms, generally detected at an advanced stage. The analysis of Volatile Organic Compounds (VOCs) pattern in human breath for early detection and follow-up of diseases such as cancer is low-cost, non-invasive and promising alternative to traditional exams (i.e., colonoscopy, biopsy).

      Method

      This study is based on the development and validation of a methodological approach aimed to the identification of VOCs breath pattern to discriminate between patients affected by both LC and MPM, and healthy controls (CTRL). A total of 80 breath samples from 36 patients with LC, 14 patients with MPM and 30 CTRL have been collected into inert Tedlar bags, transferred to sorbent tubes (biomonitoring, Markes) and analysed by TD-GC/MS (TD Markes Unity 2 - GC Agilent 7890/MS Agilent 5975).

      Result

      Non parametric test as Wilcoxon/Kruskal Wallis tests (R version 3.5.1) allowed to identify the most weighting variables in discrimination between LC, MPM and HC breath samples. On the basis of p-values lower than 0.05 (selection between CTRL and LC, and between CTRL and MPM) and current knowledge on metabolic processes, a multivariate statistics (Principal Components Analyses (PCA) -PAST 3.20) has been applied on breath samples, considering only selected variables. The preliminary statistical elaboration by PCA of data collected from the analysis of LC and CTRL samples have shown two principal components: PC1 characterized by higher loadings of benzoic acid, methylcyclohexane and hexanal, and PC2 characterized by high loadings for dimethyldecane, pentane and pentanal. Similar results were obtained by PCA applied to MPM and CTRL breath samples considering 2-methylpentane, cyclopentane, hexane and 2-butanone as discriminant variables.

      Conclusion

      PCA was able to discriminate between LC and CTRL and between MPM and CTRL breath samples. Leave-one-out cross-validation method was applied to calculate the prediction accuracy obtaining good sensitivity (88%), accuracy (86%) and specificity (92%).

      Further investigation about breath analysis is strongly warranted, due to the need of biomarkers potentially useful both for the screening of high-risk subjects and for the early diagnosis of lung and pleural neoplasms.

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      MA10.06 - Randomized Clinical Trial with Computer Assisted Diagnosis (CAD) Versus Radiologist as First Reader of Lung Screening LDCT (Now Available) (ID 2102)

      15:15 - 16:45  |  Presenting Author(s): Ren Yuan  |  Author(s): John Mayo, Isaac Streit, Sukhinder Kaur Atkar-Khattra, Renelle Myers, John Yee, Stephen Lam

      • Abstract
      • Presentation
      • Slides

      Background

      CAD has been studied extensively in lung nodule detection while its value in lung cancer screening has not been tested in a prospective randomized clinical study. We aim to evaluate the value of a CAD in radiologist work-flow and for quality assurance in reading and reporting lung cancer screening LDCT.

      Method

      Between August 2016 and February 2019, 1386 ever smokers were enrolled in the BC Lung Screen Trial. The median follow-up was 10 months. Their chest CTs were randomized to CAD reading first arm using a CAD system (Philips IntelliSpace Portal) (n=741), or Radiologist reading first (RAD) arm (n=645). In CAD-1st arm, a radiologist read CTs with the CAD findings displayed concurrently, accepting, rejecting and adding nodule(s). Radiologist’s reading time was recorded, and management recommendation was made using the automatically generated PanCan lung nodule risk score (N Engl J Med 2013; 369:910-919). In Rad-1st arm, the radiologist read the CT without using CAD, gave the management recommendation using Lung-RADS, and the reading time was recorded. Then the radiologist turned on CAD annotations to accept, reject and add nodule(s). The PanCan nodule risk scores were generated. Nodule management was categorized into 3 groups: I: Scheduled follow-up CT ≥1yr for those with no or very low risk lung nodules; II: Early recall CT <1 yr; or III: Referral to clinical diagnostic pathway for suspicious malignancy.

      Result

      Radiologist’s reading time was shorter in CAD-1st than Radiologist-1st arm (9±3 vs. 10±3 minutes, p<0.01). The time saved was greatest for Group I scans (85% of workload) (8±3 vs. 10±3 minutes, p<0.01). In 20/741 (2.7%) participants in CAD-1st arm, the additional nodule added by the radiologist upgraded the patient’s management; 5 of 20 were later confirmed to be malignant. Two of 5 were >3cm masses, the other three included a 19 mm GGO and two solid ones abutting vessels. In 1/645 (0.15%) participants in Radiologist-1st arm, the additional nodule detected by CAD upgraded the patient’s management from Group I to II. Over 31-months of follow-up, 29 cancers (2.1%) have been detected, and 1 of 29 (3.4%), a 5 mm solid nodule in the left lower lobe abutting the fissure and vessels, was missed by both radiologist and CAD.

      Conclusion

      CAD saves radiologist’s time in reading large numbers of screening LDCT especially in those with no or very low risk lung nodules. However, reading by experienced radiologist is still needed.

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      MA10.07 - Integrative Analysis of Epistasis Involving Oncogenesis-Related Genes in Lung Cancer Risk Development (Now Available) (ID 2502)

      15:15 - 16:45  |  Presenting Author(s): Yafang Li  |  Author(s): Xiangjun Xiao, Yohan Bossé, Younghun Han, Christopher Ian Amos

      • Abstract
      • Presentation
      • Slides

      Background

      Our previous study identified significant genetic interactions within oncogenesis-related genes in lung cancer risk development. More genetic interactions may exist between oncogenesis-related genes and outside regions in the genome. A functional annotation and pathway analysis of the identified epistasis-related genes will advance our understanding about the complicated biological mechanisms underlying lung tumorigenesis.

      Method

      The genotypes from two independent lung cancer GWAS studies including a total of 23,351 lung cancer patients and 19,657 health controls with European ancestry were collected for the analysis. Pairwise epistasis was conducted between 27,722 SNPs, from 2,027 oncogenesis-related genes, and 317,624 SNPs from the rest of the genome. A two-stage study design including discovery and replication studies, and stringent Bonferroni correction for multiple statistical analysis were applied in the analysis, Additional genotyping and gene expression data from 409 independent individuals with Caucasian ancestry were used to evaluate the effect of identified epistasis on gene expression levels. The epistasis-involved genes, were submitted to DAVID, Reactome, and GeneMANIA for gene functional annotation and pathway analysis.

      Result

      Significant genetic interactions were identified between SNPs in gene pairs ATR-GALNT18 (Interaction OR=0.76, p value=7.98x10-13) and MET-DPF3 (Interaction OR=0.76, p value=1.62x10-12) in lung adenocarcinoma; and PICALM-PDZRN4 (Interaction OR=1.47, p value=1.67x10-12) in lung squamous carcinoma. None of these genes have been identified from previous main effect association studies in lung cancer. Further eQTL gene expression analysis revealed the significant association in expression levels between joint genotypes at rs637304:rs285581 and the PICALM gene expression (p=0.009). A total of 12 unique genes, from six significant interactions, including those from within oncogenesis-related genes and between oncogenesis-related genes and outside variants, were submitted to functional annotation and pathway analysis. Three of them (ATR, MET and FHIT) are shown to be related with lung cancer, and six of them (RAD51B, FHIT, CALNT18, RGL1, SYNE1 and TSPAN8) are involved in tobacco-use disorders. The top 10 pathways include TP53 regulates transcription of DNA repair genes (FDR=1.67x10-2), homologous DNA pairing and strand exchange (FDR=2.57x10-2), and Meiotic synapsis (3.08x10-2), etc. GeneMANIA predicted one gene network harboring all the 12 candidate genes, supporting the epistasis at 3 genes pairs and indirect interactions at 3 gene pairs.

      Conclusion

      We identified novel genes involved in lung cancer risk development by interacting with other genetic variants. The study provides evidence that epistasis explains part of the missing heritability in lung cancer; and complex gene network and pathways contribute to lung carcinogenesis.

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      MA10.08 - Discussant - MA10.05, MA10.06, MA10.07 (Now Available) (ID 3751)

      15:15 - 16:45  |  Presenting Author(s): Fabrizio Bianchi

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA10.09 - Evaluation of the Clinical Utility of the PanCan, EU-NELSON and Lung-RADS Protocols for Management of Screen Detected Lung Nodules at Baseline (Now Available) (ID 2137)

      15:15 - 16:45  |  Presenting Author(s): Renelle Myers  |  Author(s): John Mayo, Martin Tammemagi, Sukhinder Kaur Atkar-Khattra, Ren Yuan, John Yee, John English, Kyle Grant, Alexandar Lee, Anna McGuire, Annette Maree McWilliams, Fraser Brims, Lin Mo, Stephen Lam

      • Abstract
      • Presentation
      • Slides

      Background

      Several protocols are available to guide management of lung nodules identified by the first (baseline) low-dose screening CT. It is important to objectively assess their clinical utility, health care resource utilization and potential harms. We aim to compare the PanCan (NEJM 2013;369:908 & J Thorac Oncol 2018; 13(10): S362-S363), EU-NELSON (Lancet Oncol. 2017 Dec;18(12):e754-e766 & Lung Cancer 2006;54:177-184) and Lung-RADS(https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-Rads) lung nodule management protocols on our data set from two sites of the International Lung Screen Trial (ILST), in Vancouver, Canada and Perth, Western Australia.

      Method

      Ever smokers age 55 to 80 years were enrolled into ILST if they had a ≥30 pack-years smoking history and smoked within 15 years or if their PLCO m2012 6 year lung cancer risk was ≥1.51%. The participants were managed via the PanCan lung nodule risk based protocol. The NELSON and Lung-RADS nodule protocols were applied to the ILST data set. The potential difference in the proportion of the participants having an early recall CT scan (< 1 year) or referral to a clinical diagnostic pathway was compared between the PanCan, NELSON, Lung-RADS protocols. The participants were divided into 3 groups: Group 1 (next scheduled annual/biennial CT) included PanCan CAT 1, 2, NELSON NODCAT I, II, Lung-RADS CAT 1, 2. Group 2 (early recall CT <1 year) included PanCan CAT 3, NELSON NODCAT III, Lung-RADS CAT 3, 4A and Group 3 (Diagnostic Pathway) included PanCan CAT 4, 5, NELSON NODCAT IV (solid nodule), Lung-RADS CAT 4B, 4X. The number of participants and the lung cancer rate in each group was compared between the three protocols.

      Result

      A total of 1386 participants with a median follow-up of 10 months (ranging from 4-31 mos) were evaluated. The results are shown in Table 1.

      PanCan selected the fewest individuals to early recall (Group 2 & 3) versus NELSON p=0.004 and detected the same number of lung cancers as did the NELSON and more than by Lung-RADS.

      In addition, 81% of the PanCan group 1 participants were triaged to biennial repeat screening instead of annual screening in the NELSON and Lung-RADS protocols, which has substantial resource utilization and radiation exposure implications.

      presentation2.jpg

      Conclusion

      The personalized risk-based PanCan Protocol may decrease resource utilization and potentially minimize risk of screening for participants.

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      MA10.10 - Uptake in Lung Cancer Screening – Does CT Location Matter? A Pilot Study Comparison of a Mobile and Hospital Based CT Scanner (Now Available) (ID 2165)

      15:15 - 16:45  |  Presenting Author(s): Emily Bartlett  |  Author(s): Samuel Kemp, Sujal Desai, Saeed Mirsadraee, Carole Ridge, Jaymin Morjaria, Pallav Shah, Katie Morris, Jane Derbyshire, Michelle Chen, Christine Peacock, Natallia Ivashniova, Maria Martins, James Addis, Simon Padley, Anand Devaraj

      • Abstract
      • Presentation
      • Slides

      Background

      Community based lung cancer screening has been proposed as a method of increasing uptake for lung cancer screening by reducing barriers to participation. We report baseline statistics for a lung cancer screening pilot study in which patients were scanned on either a community based mobile CT unit or on a University Hospital based fixed-site CT scanner.

      Method

      Ever smokers aged 60-75 registered at 17 participating general practitioner practices (GP) in West London were invited for a lung health check at either a mobile unit situated in a supermarket car park or in a hospital site. The location offered was based upon proximity to the participant’s home address. On attendance a lung health check, assessing lung cancer risk, was undertaken. Participants with a LLPv2 score of ≥2.0% and/or PLCOM2012 score of ≥1.51% were offered a same day low dose CT (LDCT) scan. Uptake, attendance and non-attendance (DNA) rates were compared using Chi-squared (χ2) test.

      Result

      8366 potentially eligible participants were invited for a lung health check appointment; 5135 (61.4%) to the hospital site, and 3231 (38.6%) to the mobile site. 1749/8366 (20.9%) participants responded (males n=954/1749 (54.5%)). 1047/5135 (20.4%) were booked an appointment at the hospital site and 702/3231 (21.7%) at the mobile site (p=0.14). No difference was observed in lung cancer risk between participants at the two sites. Patients at the mobile site were more likely to be ex-smokers (p=0.048). The DNA rate at the hospital site was 96/1047 (9.2%) and at the mobile site was 48/702 (6.8%) (p=0.08). On attendance, 63 patients were ineligible for screening; 52/1749 (3.0%) did not meet the entry criteria and 11/1749 (0.6%) were acutely unwell. Therefore 1542 patients attended and had a risk score calculated and of these 1145/1542 (74.3%) underwent CT. Median [range] risk scores for scanned patients were 1.97 [0-25.34] for PLCOM2012 and 4.71 [0.94-35.92] for LLPv2. Lung cancer was confirmed in 17/1145 (1.5%) participants at baseline. A further 151/1145 (13.2%) participants will undergo interval CT for indeterminate nodules.

      Conclusion

      There was a small but non-significant increase in participant response rates for the community based mobile site compared to the hospital site CT scanner, but no difference in DNA rates. While community based mobile scanners may provide valuable additional capacity to lung screening programmes, the magnitude of any benefit to participant uptake needs to be balanced against the additional complexity of setting up these stand-alone facilities. Further work is ongoing to understand the interaction between CT location and other factors that influence recruitment, with a view to using effective methods to increase uptake at all sites for future screening invitations.

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      MA10.11 - Sensitivity and Optimal Clinicopathological Features of Genetic Targeted Liquid Biopsy in pN0M0 Lung Adenocarcinoma (Now Available) (ID 788)

      15:15 - 16:45  |  Presenting Author(s): Masaoki Ito  |  Author(s): Yoshihiro Miyata, Shoko Hirano, Fumiko Irisuna, Naoto Kishi, Yasuhiro Tsutani, Rafael Rosell, Morihito Okada

      • Abstract
      • Presentation
      • Slides

      Background

      Liquid biopsy for diagnosis of early-stage lung cancer is still challenging. The optimal marker and methodology has not been established. In Asia, almost 40-50% of lung adenocarcinomas harbor the EGFR mutation and L858R is a representative of a somatic EGFR mutation. We evaluated the usefulness of the EGFR somatic mutation in liquid biopsy using droplet digital PCR (ddPCR), which is a sensitivity device to detect several types of genetic mutations.

      Method

      We examined weather L858R could be detected from preoperative ctDNA by ddPCR. Cases without EGFR mutation (wild type) were utilized as negative control. All involved cases underwent surgical resection after preoperative HRCT and PET-CT. Serum for ctDNA extraction was collected before the operation. L858R in the primary site was confirmed by resected surgical specimen. Clinicopathological features (e.g.: whole and invasive tumor size on HRCT, SUV max on PET-CT, histological subtype) were also explored for an optimal liquid biopsy candidate.

      Result

      Forty-five pN0M0 lung adenocarcinoma patients harboring L858R were enrolled. Twenty-one and 24 cases showed part-solid and pure solid appearance on HRCT, respectively. Median whole and invasive tumor size on HRCT was 21 and 19 mm, respectively. 91.1% (41/45) cases were clinical stage IA1-IB and 97.8% (44/45) cases were pathological stage IA1-IB. In wild type cases, positive droplet for L858R was almost completely undetectable. Whereas, L858R was significantly detected in 7 EGFR mutant cases (sensitivity is 15.56%, 7/45). Among 7 positive cases, 6 cases showed pure solid appearance in preoperative HRCT. Except for pure solid appearance, there was no significant features related to the positive result. If cases are limited to pure solid appearance, 25.0% (6/24) of cases could be diagnosed by liquid biopsy. Even small-sized tumors (1.1 cm in diameter) or tumors with slight accumulation on PET-CT (SUV max 0.5) could be detected if it showed pure solid appearance on HRCT.

      Conclusion

      L858R can be a definitive marker for liquid biopsy using ddPCR in pN0M0 lung adenocarcinoma. 15.56% (7/45) of cases were diagnosed in pN0M0 cases. Limited to pure solid tumor, 25.0% (6/24) could be detected. Liquid biopsy can be a useful diagnostic option, especially for tumors with pure solid appearance.

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      MA10.12 - Discussant - MA10.09, MA10.10, MA10.11 (Now Available) (ID 3752)

      15:15 - 16:45  |  Presenting Author(s): Christine Dorothy Berg

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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Author of

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    MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      MA10.04 - Discussant - MA10.01, MA10.02, MA10.03 (Now Available) (ID 3750)

      15:15 - 16:45  |  Presenting Author(s): Marcelo Sanchez

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P2.04 - Immuno-oncology (ID 167)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.04-61 - Preliminary Report of a Multidisciplinary Task Group for the Study of Immune-Mediated Pulmonary Toxicity (ID 1647)

      10:15 - 18:15  |  Author(s): Marcelo Sanchez

      • Abstract

      Background

      Immunotherapy (IO) is now the standard of care for many tumor types. However, it is not free of risks, being pulmonary toxicity one of the most relevant immune-related adverse event due to its severity. Differential diagnosis with other pulmonary complications such as infections or tumor dissemination further complicates its management.

      Method

      In order to raise awareness, gather information, and to discuss early management strategies in patients (pts) with immune-related interstitial lung disease (irILD), in 2017 we created a multidisciplinary task group comprised of pneumologists, pathologists, oncologists and radiologists. We herein report the main features of the first series of pts treated with IO who subsequently developed ILD, prospectively identified from a tertiary University Hospital over a period of two years (2017-2019), focusing on clinical presentation, radiological patterns, outcomes and therapeutic intervention.

      Result

      We identified a total of 23 pts with suspicion of irILD. Patients mainly received programmed cell death-1 (PD-L1) inhibitors (61%). Main characteristics are summarized in Table 1. ILD occurred more often in males, and former or current smokers (91%), with a median age of 62 years. The most common radiological pattern was the presence of ground-glass opacities (87%), followed by consolidations (61%). Forty-eight percent of the cases had grade 3 severity according to the Common Terminology Criteria for Adverse Events (CTCAE). Thirteen of the patients (57%) underwent a fibrobronchoscopy during the diagnostic period and a specific microorganism was isolated from BAL in three cases (13%) (Aspergillus fumigatus, cytomegalovirus and herpes type 1 virus). Ten pts (43%) underwent transbronchial biopsies being focal organizing pneumonia and desquamative changes the most common pathological patterns observed. Twenty patients (87%) received prednisone (1mg/kg/day) and thirteen of them (57%) also received antibiotic treatment.

      Patients (%)

      Mean age (years)

      61.63 ± 12.35

      Gender

      Male

      19 (83%)

      Female

      4 (17%)

      Smoking history

      Current

      2 (9%)

      Never

      7 (30%)

      Former

      14 (61%)

      Type of cancer

      Lung

      8 (35%)

      Kidney

      5 (22%)

      Skin

      4 (17%)

      Others*

      6 (26%)

      * Others: haemathologic, bladder, liver, sigma, urothelial, timic.

      Immunotherapy

      Nivolumab

      8 (35%)

      Pembrolizumab

      6 (26%)

      Durvalumab

      2 (9%)

      Others*

      7 (30%)

      * Others: Atezolizumab, Nivolumab+Ipilimumab, Atezolizumab+Daratumumab, Atezolumab+Bevacizumab, CX-072, Nivolumab/Nivolumab+Ipilipumab, Avelumab.

      Conclusion

      Immuno-mediated pulmonary toxicity is a rare but severe complication that carries a significant mortality. Due to their complexity, multidisciplinary approach is required to provide an adequate treatment and to guarantee early intervention.