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Anne Van Lindert
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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): Anne Van Lindert
- 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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P1.09 - 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): Anne Van Lindert
- 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.
