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Chih-Hung Lin



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    EP1.14 - Targeted Therapy (ID 204)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.14-06 - Clinical Application of an Appropriate Size NGS Panel in Advanced Non-Small Cell Lung Cancer Management: Personal Experience (ID 684)

      08:00 - 18:00  |  Author(s): Chih-Hung Lin

      • Abstract
      • Slides

      Background

      Precision medicine plays an important role in patients with advanced non-small cell lung cancer (NSCLC). The targeted genes, EGFR, BRAF, ALK, and ROS1, have become as a standard genetic test in NSCLC. Using multi-gene next-generation sequencing (NGS) technology is an efficient approach compared with the conventional genetic test that can identify hundreds of genetic information simultaneously. In this study, we share our clinical experience of using an appropriate size NGS test in Taiwan NSCLC patients.

      Method

      The formalin-fixed, paraffin-embedded (FFPE) were collected from 100 patients with advanced NSCLC. 94 patients had received at least one treatment and six patients were treatment-naïve. The FFPE samples were profiled using a medium size NGS panel on the Ion Torrent system. The single nucleotide variants (SNV) and small InDels were detected in 35 or 40 genes, as well as copy number variations (CNVs) in 14 or 22 genes. The gene fusion status was evaluated by an RNA fusion test in 4 genes.

      Result

      In total, the alternation of FDA-approved biomarkers was identified in 70.0% (70/100) patients. Other genetic alterations, including suggested biomarkers in NCCN guideline (ERBB2 mutations and CNVs, MET exon 14 alterations and RET fusions), and other potential actionable mutations (EGFR exon 20 insertions and CNVs, BRAF rare mutations, KRAS mutations and CNVs, ALK CNVs, MET CNVs, mTOR pathway, and cell cycle pathway alternation) were detected in 60.0% (60/100) patients. The co-occurred potential genomic alterations were discovered in 60.7% (37/61) of patients who had EGFR mutations at diagnosis. 78.3% (18/23) patients with post third generation EGFR TKI therapy had at least a co-occurring potential actionable alterations with EGFR mutation. In patients with wild type EGFR and ALK or unknown-status at diagnosis, the targeted alternation was detected in 51.4% (19/37), and 21.6% (8/37) were FDA-approved biomarkers. Furthermore, we report two cases who responding to the targeted drugs followed the NGS testing results. One case had a potentially actionable alteration co-occurred with EGFR mutation and the other had a rare BRAF mutation.

      Conclusion

      The data reported here suggest that using genetic test by an appropriate size and cost-effective NGS panel for NSCLC patients at disease diagnosis or disease progression could identify more mutations other than FDA-approved biomarkers for targeted drug selection.

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