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Anja C. Roden
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MA15 - Usage of Computer and Molecular Analysis in Treatment Selection and Disease Prognostication (ID 141)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:John Le Quesne, Noriko Motoi
- Coordinates: 9/09/2019, 15:45 - 17:15, Tokyo (1982)
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MA15.04 - Discussant - MA15.01, MA15.02, MA15.03 (Now Available) (ID 3780)
15:45 - 17:15 | Presenting Author(s): Anja C. Roden
- Abstract
- Presentation
Abstract not provided
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MA23 - Preclinical Models and Genetics of Malignant Pleural Mesothelioma (ID 353)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:Ramon Palmero Sánchez, Raphael Bueno
- Coordinates: 9/10/2019, 14:30 - 16:00, Copenhagen (1980)
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MA23.07 - Loss of Expression of BAP1 and/or MTAP Aids in the Diagnosis of Malignant Mesothelioma Metastatic to Lymph Nodes (Now Available) (ID 1121)
14:30 - 16:00 | Presenting Author(s): Anja C. Roden
- Abstract
- Presentation
Background
Stage and histology are the strongest prognostic parameters in malignant pleural mesothelioma and aid management of patients. However, the distinction between reactive intranodal mesothelial cells and metastatic malignant mesothelioma (MM) can be challenging. Loss of BRCA1 associated protein-1 (BAP1) and/or methylthioadenosine phosphorylase (MTAP) expression has been identified in a subset of MM but not in reactive mesothelial proliferation. We investigated the value of these markers in the distinction between reactive mesothelial cells and metastatic MM in lymph nodes.
Method
Surgical files of Mayo Clinic Rochester (1996-2018) were searched for metastatic MM in lymph nodes. All cases and if available corresponding primary MM were reviewed by a thoracic pathologist (ACR) to confirm the diagnosis. Primary MM and lymph nodes were stained with BAP1 (clone C-4) and MTAP (2G4). Absence of nuclear staining of BAP1 and absence of nuclear and cytoplasmic staining of MTAP in essentially all tumor cells was considered as loss of expression.
Result
Forty-four patients (25 males, 56.8%) had a median age of 64 years (range, 24-75) at time of surgery. Tissue was available from nodal metastases in all cases, either paired with the primary MM at time of nodal sampling (N=37) or at a different time (N=4) (time between tissue collections, range, 1day- 4 years, respectively), or without paired primary MM (N=3). Thirty-seven pleural, 6 peritoneal and 1 pericardial MM were of epithelioid (N=39) or biphasic (N=5) subtype. Patients underwent extrapleural pneumonectomy (N=17), pleurectomy (N=7), resection (N=9), debulking (N=2), biopsy (N=8), or autopsy (N=1). In nodal metastases, BAP1 and/or MTAP expression was lost in 29 (of 43, 67.4%) cases; specifically, BAP1 expression was lost in 28 (of 44, 63.6%), MTAP was lost in 14 (of 43, 32.6%), and both were lost in 12 (of 43, 27.9%) cases. Agreement in expression/loss of expression of BAP1 and/or MTAP in primary and metastatic MM occurred in all cases. During a median follow up of patients who underwent extrapleural pneumonectomy or pleurectomy (available in N=23) of 14.8 months (range, 1-119) 17 patients died within a median time of 16 months.
Conclusion
BAP1 and MTAP immunostains are helpful in the distinction between metastatic MM and reactive mesothelial cells in lymph nodes when one or both markers lost expression in the mesothelial cells. Expression of both markers does not exclude the possibility of metastatic MM.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.06 - Mesothelioma (ID 169)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.06-22 - Pathologic and Imaging Response Correlations in Patients Treated with Neoadjuvant Chemotherapy for Mesothelioma (ID 846)
09:45 - 18:00 | Author(s): Anja C. Roden
- Abstract
Background
In light of the emergence of neoadjuvant immunotherapy for the treatment of non-small cell lung cancer, there has been interest in developing neoadjuvant therapies with immune-checkpoint inhibitors for mesothelioma. Neoadjuvant trials allow the incorporation of pathologic responses as endpoints which have not been validated for mesothelioma. We sought to assess the correlation between pathologic and imaging responses in the neoadjuvant setting in patients with mesothelioma.
Method
We identified patients with mesothelioma who were treated with neoadjuvant chemotherapy and underwent subsequent resection at Mayo Clinic Rochester, MN from 2000-2017. We used modified Response Evaluation Criteria in Solid Tumors (RECIST) to determine radiographic responses. Imaging response was defined utilizing modified-RECIST criteria, with response defined as either complete (disappearance of all pleural and non-pleural disease) or partial (>30% decrease) response and imaging non-response was defined as either progressive (increase in size by 20% and 5 mm from nadir) or stable (meeting criteria for neither) disease. All cases were reviewed by a thoracic pathologist (ACR) to confirm the diagnosis and to define the pathologic response, which was performed blinded to the imaging response. For the purpose of this exploratory study we defined pathologic response as percent viable tumor 50% or less and non-response as >50%.
Result
We identified 22 patients with sufficient data and tissue available for inclusion in our study. The median age was 65 (range 48-74). There were 20 patients with epithelioid, 2 with biphasic and 0 with sarcomatoid subtypes of mesothelioma. There were 12 (55%) patients with radiographic responses and 9 (41%) with pathologic responses. Five patients had both a pathologic and imaging responses, 7 patients did not have a pathologic response but had an imaging response, 4 patients had a pathologic response without an imaging response, and 6 patients had neither a pathologic nor imaging response (χ2= 0.0063, p=0.937).
Conclusion
Since neoadjuvant trials have the potential to improve survival, and may be used to assess drug efficacy and accelerate drug approvals, it is important to have a unified and effective strategy to determine responsiveness of drug therapy. In our single institution, retrospective series we did not identify a significant correlation between imaging and pathologic responses which might be, at least in part, to the fact that mesotheliomas often have large areas of necrosis even without neoadjuvant therapy. Larger studies will be needed to define appropriate pathologic response endpoints in neoadjuvant trials for mesothelioma.
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P2.09 - Pathology (ID 174)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.09-24 - IASLC Global Survey for Pathologists on PD-L1 Testing for Non-Small Cell Lung Cancer (ID 906)
10:15 - 18:15 | Author(s): Anja C. Roden
- Abstract
Background
PD-L1 immunohistochemistry (IHC) is now performed for advanced non-small cell lung cancer (NSCLC) patients to examine their eligibility for pembrolizumab treatment, as well as in Europe for durvalumab therapy after chemoradiation for stage III NSCLC patients. Four PD-L1 clinical trial validated assays (commercial assays) have been FDA/EMA approved or are in vitro diagnostic tests in multiple countries, but high running costs have limited their use; thus, many laboratories utilize laboratory-developed tests (LDTs). Overall, the PD-L1 testing seems to be diversely implemented across different countries as well as across different laboratories.
Method
The Immune biomarker working group of the IASLC international pathology panel conducted an international online survey for pathologists on PD-L1 IHC testing for NSCLC patients from 2/1/2019 to 5/31/2019. The goal of the survey was to assess the current prevalence and practice of the PD-L1 testing and to identify issues to improve the practice globally. The survey included more than 20 questions on pre-analytical, analytical and post-analytical aspects of the PDL1 IHC testing, including the availability/type of PD-L1 IHC assay(s) as well as the attendance at a training course(s) and participation in a quality assurance program(s).
Result
344 pathologists from 310 institutions in 64 countries participated in the survey. Of those, 38% were from Europe (France 13%), 23% from North America (US 17%) and 17% from Asia. 53% practice thoracic pathology and 36%, cytopathology. 11 pathologists from 10 countries do not perform PD-L1 IHC and 7.6% send out to outside facility. Cell blocks are used by 75% of the participants and cytology smear by 9.9% along with biopsies and surgical specimens. Pre-analytical conditions are not recorded in 45% of the institutions. Clone 22C3 is the most frequently used (61.5%) (59% with the commercial assay; 41% with LDT) followed by clone SP263 (45%) (71% with the commercial assay; 29% with LDT). Overall, one or several LDTs are used by 57% of the participants. A half of the participants reported turnaround time as 2 days or less, while 13% reported it as 5 days or more. Importantly, 20% of the participants reported no quality assessment, 15%, no formal training session for PD-L1interpretation and 14%, no standardized reporting system.
Conclusion
There is marked heterogeneity in PD-L1 testing practice across individual laboratories. In addition, the significant minority reported a lack of quality assurance, formal training and/or standardized reporting system that need to be established to improve the PD-L1 testing practice globally.
