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Liliana Fernandez-Trujillo



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    EP1.04 - Immuno-oncology (ID 194)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-37 - Biomarkers in Non-Small Cell Lung Cancer: Expression of PD-L1 Protein and p16 in Squamous Cell Carcinoma Histologic Subtype (ID 2773)

      08:00 - 18:00  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Squamous cell carcinoma(SCC), 30% of Non-Small Cell Lung Cancer(NSCLC), cigarette is its mayor etiology. >50% NSCLC are diagnosed in advanced/stage, 10–15%EIIIB, 40%E-IV. In terms of survival, NSCLC is heterogeneous and variable. Survival at 5 years is <15%, treatment is not curative.

      In cancer, the evasion of the immune system and the uncontrolled tumor proliferation is important. The programmed-cell-death-ligand(PD-L1) is a lymphocyteT protein. The union PD-1/PD-L1 inhibits the lymphocyteT’s activity. Overexpression of PD/L1 in CD8+lymphocytes inhibits apoptosis, reduces survival. In NSCLC, PD-L1 is a predictor of successful immunotherapy. Inhibition PD:PD-L1 is an effective antitumoral therapy.

      The p16INK4a intervenes in pulmonary carcinogenesis, localized in chromosome 9p21(locus CDKN2A), its codes suppressor/tumoral proteins:p16INK4a-p14ARF. P16 inhibits D1-dependent quinases4-6(CDK4/6,ciclinaD1) which regulate the retinoblastoma protein through phosphorylation. Dysfunctional p16 inactivates Rb through hyperphosphorilation and progression of the cell cycle. Its expression contributes to the therapeutic response and to survival in NSCLC. We describe the clinical, pathological and survival characteristics in SCC based in expression of PD-L1/p16.

      Method

      Descriptive study, 24 patients with SCC, 2009–2013. PD–L1 studied with antibody 22C3 pharmDxkit(Agilent,Santa-Clara,CA,USA) in Autostainer Link/48DAKO®with murine monoclonal antibody(Clone/E6H4™) in BenchMark/Autostainer(Ventana®). PD-L1 was classified with TPS(Tumor/Proportion/Score), high expression TPS>50%, low expression TPS1-49%, or negative TPS=0%. P16(+) with expression >70% in nuclei, tumoral membranes.

      STATAv.14®, ShapiroWilk, Chi squared, Fisher, t-Student or U/Mann/Whitney were used. Survival with Kaplan-Meier.

      Result

      Age 67+14, 63%men. 54% of smokers, 7% had COPD. E-IV54%, E-IIIA25%, E-IIIB13%, E-IIB y E-IIA4%. PD-L1(+) more in smokers (85%)p=0.001. Treatment: palliative/care(25%), chemotherapy/surgery(17%); chemotherapy/radiotherapy/surgery(12%); radiotherapy/surgery(8%), only surgery(4%). PD-L1, high-expression survival 33m, low expression/negative 66m (log-rank test p=0.0041), Figure1: p16(+) in 10(41.6%), survival 36.2m, p16(-) survival 66.8m, p16/PD-L1(-) survival 66.8m, p16/PD-L1(+) survival 36.2m.

      Conclusion

      SCC with PD-L1 TPS>=50%, p16(+), smokers with high/tumor/burden had lower survival rates.

      Immunotherapy against programmed cell death(PD-1) is a promising alternative impacting survival in advanced/metastatic NSCLC.

      pd-l1 y p16 iaslc 2019.png

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    EP1.05 - Interventional Diagnostics/Pulmonology (ID 195)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 4
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.05-02 - Endobronchial Ultrasound and Transbronchial Needle Aspiration EBUS-TBNA: In a University Hospital in Latin America (ID 2729)

      08:00 - 18:00  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Endobronchial Ultrasound and Transbronchial Needle Aspiration (EBUS-TBNA) nowadays it has a primordial role in the workup of malignant and nonmalignant pulmonary disease. It’s the most important advancement in pulmonary medicine in the last 20 years.EBUS-TBNA is a minimally invasive technique, well tolerated, cost efficient, for real time visualization of the airways with ultrasound and for sampling the mediastinum and hilum. Its indications: diagnosis, staging, restaging of lung cancer, evaluation of metastatic lesions and non-malignant diseases. It requires multidisciplinary evaluation with image analysis, general condition of the patient, risks and benefits, also close work with pathology, performing a Rapid On-Site Evaluation (ROSE) to improve the diagnostic performance.

      We describe the EBUS-TBNA in Fundación Valle del Lili a University Hospital of Reference in Latin America.

      Method

      Prospective, descriptive study, period June/2015-June/2018. The indications were staging and restaging of lung tumors, diagnosis of lung or mediastinal masses, abnormal ganglia in CT or PET/CT equal or greater than 1cm. 108 patients were evaluated under general IV anesthesia, with a standardized protocol in the endoscopy room. The equipment used was Olympus® bronchoscope + US probe + 22G FNA.

      Result

      Average age of 63,5 +/- 12,9, women 53(49%), men 55(50,9%)
      The quality of the sample was adequate in 105 (97,22%), positive of malignity 63(60%) negative 42(40%), inadequate samples 2(1,8%) and in one case a complete evaluation of the mediastinum was made without evidence of lesions, so no samples were taken. The ganglionary stations most frequently evaluated were 7 40(37%), 11R 22(20,3%), 11L 14(12,9%) and mediastinal mases 11(10,1%).

      The malignant lesions were non-small cell pulmonary carcinoma (NSCLC) 26(41,2%), metastasis head and neck tumors 10(15,8%), small cell pulmonary carcinoma 9(14,28%).

      97,22% of the smears with Diff-Quick staining presented lesion, 5 dips were performed in each station, and immunohistochemistry was made in cellblocks as well as DNA extraction for EGFR mutation studies and EML4/ALK gene rearrangements in 50% of cases of NSCLC and PDL1 in 19,2% of these cases. 10(9,26%) of the series was taken to mediastinoscopy with a 100% correlation with the results of EBUS-TBNA.

      Conclusion

      EBUS-TBNA is the recommended technique for lung cancer mediastinal staging. Our results adjust to international results; it is safe, minimally invasive, in many cases an outpatient procedure and a good performance when accompanied with ROSE.

      table 1 ebus-tbna.png

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      EP1.05-03 - Therapeutic Bronchoscopy in Multimodal Therapy for the Management of Central Airway Obstruction (ID 2799)

      08:00 - 18:00  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Central airway obstruction may be due to malignant and non-malignant causes. The malignant obstruction of the airway is an important cause of morbidity and mortality in lung cancer. Intervention with therapeutic bronchoscopy decreases symptoms and allows time to employ treatments like surgery/radiotherapy or quimotherapy. In benign pathology prior intubation or complications related to lung/transplantation are common. Patients usually have cough and dyspnea that can progress to respiratory failure. Therapy should be oriented to secure and restore the airway. Best technique choice depends on etiology, type and severity of lesion, technological availability and operators skills. Nowadays, a multimodal therapy is implemented, including different intervention methods for the management. We aimed to describe therapeutic bronchoscopy in Fundación Valle del Lili a University Hospital in Latin America.

      Method

      Descriptive retrospective study, April-2013/June-2018. 151 procedures were performed. Symptoms, etiology, localization, severity, diagnosis, type of anesthesia, interventions and complications were analyzed. The device was a therapeutic flexible and rigid bronchoscope Olympus® and specific intervention instruments.

      Result

      56.9+/-16.9-years. 58(38%)women and 93(61,5%)men. Malignant lesions were found in 91(60.26%). Symptoms were cough 122(80.8%), dyspnea 122(80.8%), hemoptysis 51(33.8%) and chest pain 41(27.2%). General anesthesia was used in 147(97.35%), the most common approach was the use of laryngeal mask 112(74,17%) then an endotracheal tube 22(14.57%). In 108(71,52%) a severe airway obstruction was present. 93(61,59%) had an endobronchial mass and 36(23,84%) external compression. Lesion location was: left-stem bronchi 73(48,34%) right-stem bronchi 64(42,38%), trachea inferior 23(15,23%), trachea superior 18(11,92%), carina 18(11,92%), trachea media 11(7,28%) and intermediate bronchus 11(7,28%). Most common malignant etiology was non-small cell lung cancer 39(42,85%), followed by typical/atypical carcinoid tumor 11(12,08%), sarcoma 9(9,89%) and metastatic tumors of gastrointestinal origin 8(8,79%) and head and neck tumors 6(6,59%) among others. Benign pathology was found in 60(39,7%) included granuloma 11(18,33%), stenosis 41(68,3%) which are related in most with airway complications after lung/transplantation and foreign bodies were found in 6(10%). Procedures were debridement 104(68,87%), electrocoagulation 95(62,91%), argon plasma 39(25,83%), stent colocation 5(3,31%), balloon/dilatation 42(27,81%) and cryoprobe 29(19,21%). Multiple interventions were made in various patients. Obstruction resolution was complete for 56(37,09%) and there was residual stenosis in 42(27,81%) or residual mass in 53(35,1). Complications included mild hemoptysis in 8(5,38%) and scaling in the attention room in two cases. No reported deaths associated with the procedure.

      Conclusion

      Central airway obstruction is a complex situation that requires multidisciplinary approach. Currently, multimodal therapy is recommended combining different options of intervention, through flexible or rigid bronchoscopy, to achieve optimal results.

      figure 1. therapeutic bronchoscopy.png

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      EP1.05-09 - Well-Differentiated Liposarcoma Causing Endobronchial Occlusion: A Case Report (ID 2812)

      08:00 - 18:00  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Endobronchial well-differentiated liposarcoma(WDL) is an uncommon benign entity which corresponds to 0,1-0,5% neoplasms affecting the bronchial tree. 60% patients are men with a median age of presentation of 60-years-old. Smoking and obesity are known risk factors. Its treatment implies resection of the tumor only or part of the lung too. Endobronchial WDL is associated with favorable prognosis, particularly when distant compromise from the lungs is absent. In consequence, timely diagnosis is pivotal. We present the case of a endobronchial occlusion due to WDL.

      Method

      Review of the Clinical History.

      Result

      74-years-old man former smoker of 54.8 packs-year, with COPD and family history of gastric and bladder cancer. Attends medical assistance with constant expectorant cough and repeated pneumonias without dyspnea. Chest-CT evidence a great size, exophytic tumoral lesion in left main bronchus, complete ipsilateral atelectasis and mediastinal lymphadenopathies.

      Bronchoscopy is performed, revealing a mass of tumoral appearance from the left inferior lobe. Mass resection is performed in two times with electrocoagulation and cryoprobe under general anesthesia, leaving permeable the lumen of the main left bronchus and all its segments without complications.

      Histopathological studies with hematoxylin-eosin stain showed a lesion of mesenchymal origin, compound by different size adipose tissue and fibrous stroma covered by respiratory epithelium.

      Immunohistochemistry expressed vimentin, within fibrous septa nuclear marker CDK4 was expressed, KI67 of 2% without evidence of mitosis according to pHH3 assessment. Morphological pattern and immunophenotypic expression profile. compatible with WDL. Periodic follow-up evaluations of the airway with bronchoscopy were recommended.

      Conclusion

      WDL is a benign but uncommon neoplasm arising at the tracheobronchial tree. Despite its benignity, endoluminal polypoid growth can cause endobronchial occlusion and destruction of distal parenchyma. Cough, progressive dyspnea, hemoptysis and recurrent pneumonia are common clinical manifestations, yet bronchoscopy and histopathologic assessment are essential to confirm diagnosis and avoid irreversible parenchymal changes.

      liposarcoma iaslc 2019.png

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      EP1.05-10 - Metastasis from a Primary Melanoma of the Sinonasal Cavity: A Case Report (ID 2881)

      08:00 - 18:00  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Metastatic extension to tracheobronchial tree from non-lung primary neoplasms is a common clinical problem. Endoluminal compromise is estimated to be present in 2-28% of metastatic disease cases. Melanoma’s high metastatic potential can affect lung in 71% of cases, turning it into a frequent cause of relapse, however, endobronchial metastases by this entity corresponds to 4,5% of all metastatic lesions from the tracheobronchial tree.
      Mucosal melanoma (MM) is a rare entity that encompasses 1.3% from all cases of melanoma. Sinonasal cavity and conjunctiva are the most frequent locations. Liver metastasis from primary sinonasal MM has been described but endoluminal airway spread is extremely uncommon. We report the case of primary MM from sinonasal cavity with endotracheal metastasis and severe obstruction of the central airway.

      Method

      Review of the Cinic History.

      Result

      47-year-old man with previous diagnosis of nasal melanoma attended the hospital for a FBC indicated due to one month of dyspnea and chest discomfort. His medical history included surgical resection from inferior turbinate lesion with positive borders, followed by adjuvant radiotherapy as part of the therapeutic management for his melanoma. Subsequent PET-CT scan evidenced hypermetabolic lesion in VII hepatic segment and pre-cava adenopathy. On the FBC, a 1-cm tumoral lesion in right nasal fossa was observed in addition to a complex mass located in the fourth tracheal ring, obstructing 90% of the lumen. ICU hospitalization was indicated due to respiratory failure high risk. Complete lesion resection was performed via therapeutic FBC with electrocautery and cryoprobe under general anesthesia. Pathological report: Neoplastic lesion compatible with metastasis of MM with non-mutated BRAF. Chemotherapywasinitiated.

      Conclusion

      Primary MM is an uncommon tumor. Although endoluminal airway metastases are extremely rare from primary sinonasal MM, they are a differential diagnosis to consider in a patient with respiratory symptoms within the context of this primary neoplasia.

      figure1 melanoma.png

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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
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-17 - Giant Thymolipoma in a Young Woman: A Case Report (ID 2825)

      08:00 - 18:00  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Thymolipoma is a benign mediastinal tumor composed by adipose tissue and thymic tissue. It is a rare mediastinal tumor, presenting predominantly between 20-40 years, without predilection for a specific gender. Its clinical presentation is variable, from asymptomatic cases to thoracic pain and recurrent respiratory infections. We describe the case of a young female, asymptomatic, with an incidental finding of a mediastinal mass posteriorly diagnosedas a thymolipoma.

      Method

      Review of the Clinic History.

      Result

      A 21-year-old female, previously healthy, presents with a recent history of community acquired pneumonia with radiological alterations in x-rays. She denies respiratory or systemic symptoms; physical exam she has decreased breaths sounds in the bases. Chest CT-scan: a large mass in the anterior mediastinum, extending to the left hemi-thorax, with adipose tissue, surrounding the cardiomediastinum without infiltrating it. Surgical excision is performed describing a large (39x22x8cm) lobulated mass weighing 3378grs with a fatty appearance, encapsulated and with scarce hemorrhagic areas, collapsing the left lung. Histopathology: a mesenchymal lesion composed of mature adipose and thymic tissue, with Hassall´s corpuscles and immunohistochemistry compatible with an encapsulated thymolipoma.

      Conclusion

      Thymolipomas are identified typically in the management of other medical conditions. They are associated with chromosomal alterations such as rearrangement of the cytogenetic bands, loss of chromosomal material or supra-numeric chromosomes. Four categories have been proposed for its classification: lipoma with thymic tissue combined adipose and thymic neoplasm, adipose tissue replacement of a thymoma and replacement of a hyperplasic thymus; being the first type the one we found on our patient.

      Surgical excision is curative, without complications and there are no descriptions of malignant transformation. A few case reports on the literature have associated it with myasthenia gravis, particularly in elderly patients with small masses. Within the differential diagnosis the lipoma, the liposarcoma and the thymic hyperplasia have to be taken into account.

      figure 1 timolipoma.png

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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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      P2.04-70 - PD-L1 Expression in a Population with Non-Small Cell Lung Cancer in a Reference Healthcare Center in Latin-America (ID 2792)

      10:15 - 18:15  |  Presenting Author(s): Liliana Fernandez-Trujillo

      • Abstract
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) is the most common type among malignancies of the lung, and among its histological subtypes, different mutations and protein expressions have been object of study for the past years. Epidermal growth factor receptor (EGFR) mutations and EML4-ALK fusion as driver mutations have been reported to upregulate programmed death-ligand 1 (PD-L1) expression. Despite therapeutic significance of these associations has not been yet completely elucidated, studying the prevalence and correlation of these features becomes more important with time.

      Method

      Clinical and mutational features were described in 114 patients diagnosed with NSCLC between 2013 and 2016 at a reference health care center in Colombia. Among the patients in whom PD-L1 expression was tested, we reported its prevalence and distribution in patients positive for EGFR and ALK.

      Result

      The mean age was 65±12 years. 72.8%(n=83) were classified as stage IV. Adenocarcinoma was the most frequent (80.7%; n=92). The prevalence for EGFR mutations was 27% (n=30) and for EML4-ALK fusion gene was 15.8% (n=9). PD-L1 expression was tested in 57 patients from which 35% (n=20) came positive, 5 were also positive for EGFR and 4 for ALK. From all PD-L1 positives, 60% (n=12) with high expression. No association was found between gender and PD-L1 expression, and being a non-smoker was associated with a lower expression of the protein.

      Conclusion

      The prevalence of EGFR mutations was similar to that reported worldwide, and fusions in the EML4-ALK gene were higher than expected, as well as PD-L1 expression. Smoking has already been reported to be associated with a higher expression of PD-L1, as found in this study. More studies must be done regarding expression of the protein in patients with driver mutations to stablish reliable associations and elucidate the clinical significance of blocking PD-1/PD-L1 in EGFR and ALK-mutant NSCLC treated with TKIs.

      pdl1 iaslc 2019.png

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