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Prachi Bhave
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P02 - Diagnostics and Interventional Pulmonology (ID 110)
- Event: WCLC 2020
- Type: Posters
- Track: Diagnostics and Interventional Pulmonology
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P02.07 - Impact of Diagnostic Test Sequencing on Effectiveness, Efficiency and Survival in Metastatic Non-Small Cell Lung Cancer. (ID 3456)
00:00 - 00:00 | Presenting Author(s): Prachi Bhave
- Abstract
Introduction
Diagnostic evaluation of metastatic non-small cell lung cancer (NSCLC) requires confirmation of malignancy, identification of histological subtype, provision of tumour staging and to identify targets for systemic treatments through molecular characterisation. The optimal diagnostic test sequence to achieve a timely diagnosis whilst minimising invasive procedures in metastatic NSCLC remains unclear. We sought to explore the impact of diagnostic test sequencing in metastatic NSCLC on efficiency, effectiveness, timeliness and survival.
Encore Abstract - parts of abstract presented as Poster Presentation at Australian Lung Cancer Conference in 2020.
Methods
A retrospective cohort study of adult patients newly diagnosed with metastatic NSCLC within Alfred Health in Melbourne, Australia between January 2016 and February 2019 was undertaken. Demographic data, diagnostic tests and sufficiency of tissue for histological diagnosis and molecular characterisation for EGFR, PDL1, ALK, ROS and BRAF, defined as complete diagnosis, were obtained. We assessed timeliness from referral to specialty review, diagnosis and treatment initiation.
Results
111 patients were included. The mean age was 68 years (IQR 60-75 years), 51% of patients were male and 89% were former or current smokers. Adenocarcinoma was the most common tissue histology (81%) with EGFR mutations identified in 7% of patients and PDL1 >50% in 17.1%. Less than half of the patient cohort (46%) received systemic therapy including immunotherapy (4.5%), a TKI (7%), chemotherapy (16.2%) or combined therapy. Two thirds of patients (86%) received radiotherapy. 28% of patients received no active treatment.
Efficiency and effectiveness: Complete diagnosis was achieved on first biopsy in 70% of cases with 33 patients requiring repeat biopsy for histopathological intent. A total of 151 procedures were performed, with biopsy of a metastatic lesion achieving complete diagnosis in 81% of cases; the highest efficacy compared to primary lung biopsy or EBUS.
Timeliness: Initial biopsy of a metastatic lesion demonstrated improved timeliness from referral to biopsy when compared to primary lung biopsy or EBUS. Initial primary lung biopsy had a longer median time from referral to complete diagnosis compared to initial metastatic biopsy. However, there was no significant difference in time from referral to diagnosis and referral to treatment between these groups.
Survival: Survival data stratified by initial biopsy site is demonstrated in Figure 1.
Conclusion
In our cohort, biopsy of a metastatic lesion demonstrated the highest effectiveness and timeliness in achieving complete diagnosis and staging of metastatic NSCLC. Multi-disciplinary discussion is recommended to ensure optimal biopsy site and to minimise delays to diagnosis and treatment.
