Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
clinical staging, amputation or radiotherapy are most often therapeutic
options for pain palliation. We want to present an oligo-acrometastasis of
fourth proximal phalanx of left hand from EGFR-mutant non-small cell lung
cancer. Methods: A 58-year-old man was admitted with pain and swelling in
fourth finger of his left hand (Figure 1A). Magnetic resonance imaging (MRI) of
left upper extremity showed a destruction by a soft tissue measuring about
30x17 mm on the distal part of fourth proximal phalanx of left hand (Figure
1B-C). Three phase bone scan with technetium-99m methylene diphosphonate
(MDP) revealed increased radiotracer uptake in the fourth finger. Diffuse
increased uptake is seen at the left wrist secondary to the old fracture and
trauma in both blood pool and metabolic phases and hypertrophic
osteoartropathy in both tibia (Figure1E-F). Computed thorax tomography
(CTT) revealed a 25x21 mm lobulated contour lesion in the posterior segment
of right lower lobe (Figure 1H). CT-guided biopsy was performed and
pathological examination showed non-small cell lung carcinoma-not
otherwise specified (NSCLC-NOS). A 24x27x24 mm mass with SUV-max value
9.85 in the right lower lobe, right tracheobronchial and right hilar
lymphadenopathies 13 mm in diameter was detected (SUV-max: 7.51) on
PET-CT. Patient was staged as T1bN2M1b with oligoacrometastasis.
of females, 39% of smokers, 51% with wood smoke exposure and the
predominant histology was adenocarcinoma (86%) with intermediate
grade (acinar-papillary) in 65% of cases. In this study, recurrent somatic
mutations in GNAQ were found in 37/53 patients (70%) with a mutant allele
(QNAQmut) frequency over 1%. GNAQ mutations were more frequently
found in adenocarcinoma and stage IV (p=0.054 and p=0.098 respectively).
The GNAQmut allele was associated with metastasis to the Central Nervous
System (CNS) and bones (p < 0.001). This mutation was associated with a
decrease in overall survival (69 vs. 12 months, p = 0.047). Additionally, two of
these GNAQ-mutated patients having co-ocurring oncogenic mutations in
GNAS and GNA11 exhibited faster disease progression and a poorer overall
survival of only two months. There was no association between GNAQ and
frequently mutated genes like EGFR, KRAS or MET. Conclusion: This is the first
report of the presence of recurrent somatic mutations in GNAQ, GNA11 and
GNAS oncogenes in NSCLC based on targeted NGS. We found a correlation
between these genomic alterations and the patients response measured as
disease progression and overall survival.
Keywords: GNAQ-Mutation, NSCLC, metastasis, Prognosis
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
Clinical Outcome –
TUESDAY, DECEMBER 6, 2016
P2.02-007 TREATMENT OUTCOMES OF COMBINE
CHEMORADIATION IN LOCALLY ADVANCED NON-SMALL CELL LUNG
CANCER: A SINGLE INSTITUTION STUDY
Pitchayaponne Klunklin, Imjai Chitapanarux
Radiology, Chiangmai University, Chiangmai/Thailand
Results: His finger was amputated from metacarpophalangeal level and
surgery margin was negative for tumour. Pathological diagnosis was
metastatic NSCLC-NOS harbouring EGFR-21L858R mutation. After curative
treatment of acrometastasis, concurrent chemo-radiotherapy was planned
for primary lung cancer as a therapeutic approach. He is still under treatment.
Conclusion: Oligometastatic disease by acral involvement in NSCLC is
extremely rare. Curative treatment approach should be consider for both
primary tumour and metastasis side.
Keywords: Epidermal growth factor receptor mutations, Acrometastasis, nonsmall
cell lung cancer, Oligometastasis
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
BIOLOGY –
TUESDAY, DECEMBER 6, 2016
P2.02-006 TARGETED NEXT GENERATION SEQUENCING REVEALS
PROGNOSTIC RECURRENT SOMATIC MUTATIONS IN THE GNAQ
ONCOGENE IN NSCLC
Norma Hernández-Pedro 1 , Giovanny Soca-Chafre 1 , Carmen Alaez-Verson 2 ,
Karol Carrillo-Sánchez 2 , Alejandro Avilés-Salas 3 , Mario Orozco-Morales 1 , Pedro
Barrios-Bernal 1 , Eleazar Macedo-Perez 1 , Oscar Arrieta 4
1 Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto
Nacional de Cancerología, Mexico City/Mexico, 2 Laboratorio de Medicina
Traduccional, Instituto Nacional de Medicina Genómica, Mexico City/Mexico,
3 Department of Pathology, Instituto Nacional de Cancerología, Mexico City/
Mexico, 4 Thoracic Oncology Unit and Laboratory of Personalized Medicine,
Instituto Nacional de Cancerologia, Mexico City/Mexico
Background: GNAQ is a stimulatory αq subunit of heterotrimeric G-proteins
that is highly mutated in human melanoma and currently has no targeted
treatment. GNAQ protein is similar to the RAS protein, in which activating
mutations occurring within the catalytic (GTPase) domain confer constitutive
signaling activity of the RAS pathway. However, GNAQ mutations have
not been documented in Non-Small Cell Lung Cancer (NSCLC). Therefore,
the aim of this study was to examine genomic alterations in GNAQ and
correlate its mutation status with clinical characteristics of NSCLC patients.
Methods: A cohort of 53 patients treated at the Thoracic Oncology Unit of
the Instituto Nacional de Cancerologia (INCan) of Mexico were screened
in a mutation analysis of the GNAQ oncogene by targeted next generation
sequencing (NGS). All information from the patients was recorded in a
database containing clinicopathological characteristics. Results: Patients
characteristics included a median age of 66 years (36-82 years), with 77%
Background: Since 1990s, the standard treatment for locally advanced nonsmall
cell lung cancer (NSCLC) has been changed because the treatment by
adding chemotherapy to thoracic radiation (TRT) was proved to gain a survival
benefit over TRT alone. We conducted this study to report the outcome of
combination treatment along with determine the factors that effecting
survival. Methods: Medical records of 1,325 NSCLC patients who treated with
radiotherapy in our division during 2008 to 2013 were reviewed. The patient
characteristics, the management characteristics and outcome data were
recorded. Univariate and multivariate analysis were performed to identify
the prognostic factor for overall survival. Results: A total of 103 patients
were included in the analysis. With a median follow up time 13.27 months,
these patients had a median overall survival (OS) time of 21.4 months (95%-CI
17.6-25.2 months) and median progression-free survival (PFS) time of 11.67
months (95%-CI 9.69-13.65 months). The 2-year OS and PFS rate were 34.0 and
21.4%, respectively. For the patients treated by concurrent and sequential
chemoradiation, the 2-year OS rate were 31.0% and 37.8% (p=0.349) and the
2-year PFS rate were 24% and 20.6% (p=0.690), respectively. The multivariate
analysis revealed that age (hazard ratio (HR) 1.68; 95% CI: 1.06 – 1.69) and
stage (HR 2.13; 95% CI: 1.43 – 3.39) were significant prognostic factors for
overall survival. Conclusion: The treatment of locally advanced NSCLC in our
hospital is feasible and the outcomes are comparable to others. The results of
concurrent chemoradiation may improve further by careful patient selection.
Keywords: chemoradiation, Locally advance, non-small cell lung cancer
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
P2.02-008 HOW DO WE REALLY TREAT PATIENTS WITH STAGE III
NON-SMALL CELL LUNG CANCER (NSCLC)?
Allan Price, Sorcha Campbell, Sara Erridge, Janet Ironside, Felicity Little,
Tamasin Evans, Melanie Mackean, Ailsa Patrizio
Edinburgh Cancer Centre, Western General Hospital, Edinburgh/United Kingdom
Background: About a quarter of patients with NSCLC have stage III disease.
Standard treatment is cisplatin-based concomitant chemoradiotherapy,
established in trials with participants younger and fitter than many patients
seen in clinics. We have reviewed the treatment delivered to all patients
registered on the South East Scotland Cancer Network (SCAN) database in
2011 to determine how many patients received standard of care therapy, and
what might have influenced the decision not to administer this treatment.
Methods: Individuals with stage III NSCLC presenting between January and
December 2011 were identified from the SCAN database. Data were extracted
on patient age, stage, histology, performance status, co-morbidities and
treatment delivered. Results: 154 patients were identified who presented
S444 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017