Journal Thoracic Oncology

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Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 subsequent brain metastases (P = 0.003) Conclusion: The NLR is a predictive factor for the baseline presence of brain metastases and subsequent brain metastases in stage IV NSCLC. The NLR can be used to identify a subgroup of adenocarcinoma who is at a high risk for brain metastasis, and who may benefit from prophylactic treatment. Keywords: Predictive biomarker, neutrophil–lymphocyte ratio, Non-small-cell lung cancer, Brain metastasis POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY BIOMARKERS – TUESDAY, DECEMBER 6, 2016 P2.03B-062 ASSOCIATION OF THE FAACT TOTAL SCORE AND SUBSCALES WITH CLINICAL CHARACTERISTICS AND SURVIVAL IN ADVANCED LUNG CANCER Oscar Arrieta 1 , Julissa Luvian-Morales 2 , Luis Oñate-Ocaña 2 , Jenny Turcott 2 , Martha De La Torre-Vallejo 2 1 Thoracic Oncology Unit and Laboratory of Personalized Medicine, National Cancer Institute, Mexico City/Mexico, 2 Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, Mexico City/Mexico Background: Survival of lung cancer (LC) patients has increased and it is important to assess disease and treatment related symptoms that could negatively impact on prognosis and health-related quality of life (HRQL). The FAACT questionnaires have been proposed as a useful tool to measure HRQL, it includes 5 subscales: physical (PWB), emotional (EWB), functional (FWB) and social well-being (SWB), and AC/S-12 which is used to diagnose anorexia cachexia syndrome (CACS). The aim of this study was to associate the FAACT total score and subscales with clinical outcomes and survival. Methods: A cohort of patients with LC completed the FAACT instrument; regardless of age, gender, line of treatment, number of cycle, performance status, or histopathology subtype. Clinical and biochemical variables were collected. Survival was estimated from the day of questionnaire application until death or last follow-up. Results: The study included 200 patients. FAACT subscales had association with several clinical and biochemical data that are show in Table 1. PWB, FWB, AC/S-12 and FAACT total score were strongly associated to overall survival Conclusion: The FAACT questionnaire is reliable and valid for the assessment of HRQL and CACS in patients with LC and can be used liberally in clinical trials. Keywords: health related quality of life, anorexia cachexia syndrome POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY BIOMARKERS – TUESDAY, DECEMBER 6, 2016 P2.03B-063 MOLECULAR PROFILING IN ADVANCED NON- SMALL-CELL LUNG CANCER: PRELIMINARY DATA OF AN ITALIAN OBSERVATIONAL PROSPECTIVE STUDY Elisa Gobbini 1 , Vanesa Gregorc 2 , Domenico Galetta 3 , Ferdinando Riccardi 4 , Paola Bordi 5 , Vieri Scotti 6 , Anna Ceribelli 7 , Lucio Buffoni 8 , Evaristo Maiello 9 , Angelo Delmonte 10 , Tindara Franchina 11 , Maria Rita Migliorino 12 , Diego Cortinovis 13 , Salvatore Pisconti 14 , Massimo Di Maio 1 , Paolo Graziano 9 , Emilio Bria 15 , Giulio Rossi 16 , Antonio Rossi 17 , Giulia Pasello 18 , Concetta Sergi 19 , Olga Martelli 20 , Saverio Cinieri 21 , Alice Lunghi 22 , Silvia Novello 1 1 Department of Oncology, University of Turin, Aou San Luigi, Orbassano/Italy, 2 Department of Medical Oncology, Istituto Di Ricovero E Cura A Carattere Scientifico, San Raffaele Hospital, Milano/Italy, 3 Medical Oncology Unit, Clinical Cancer Centre “Giovanni Paolo Ii”, Bari/Italy, 4 Oncology Unit, Antonio Cardarelli Hospital, Napoli/Italy, 5 Medical Oncology Unit, University Hospital, Parma/ Italy, 6 Aou Careggi Sodc Radioterapia, Firenze/Italy, 7 Regina Elena National Cancer Institute, Roma/Italy, 8 Medical Oncology Unit I Aou Città Della Salute E Della Scienza, Torino/Italy, 9 Oncology Unit, Scientific Institute for Research and Health Care (IRCCS) “ Casa Sollievo Della Sofferenza”, San Giovanni Rotondo/Italy, 10 Thoracic Oncology Group, Istituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori - IRCCS, Meldola/Italy, 11 Department of Human Pathology, University of Messina and Medical Oncology Unit, A.O. Papardo, Messina/Italy, 12 Uosd Pneumologia Oncologica, San Camillo - Forlanini Hospital, Roma/Italy, 13 Oncology Unit, Asst H S Gerardo, Monza/Italy, 14 Oncologia Medica, S.G. Moscati Hospital, Taranto/Italy, 15 Oncologia, Università Di Verona, Dipartimento Di Medicina, Verona/ Italy, 16 Anatomia Patologica, Aou Policlinico, Modena/Italy, 17 Division of Medical Oncology, S.G. Moscati Hospital, Avellino/Italy, 18 Medical Oncology Unit 2, Veneto Institute of Oncology Iov-IRCCS, Padova/Italy, 19 Oncology Unit, A.O.R.N.A.S Garibaldi Nesima, Catania/Italy, 20 Medical Oncology Unit, San Giovanni Addolorata Hospital, Rome/Italy, 21 Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi/Italy, 22 Department of Oncology, Aou Careggi, Firenze/Italy Background: Molecular profiling of advanced non-small-cell lung cancer (NSCLC) is recommended according to patients’ histological and clinical features. Despite the existence of national guidelines, routine care is still heterogeneous. Aim of this observational study was to obtain prospectively a clinical practice picture of molecular testing and therapeutic choices in advanced NSCLC patients. Methods: Newly diagnosed metastatic or recurrent NSCLC patients enrolled in 38 Italian centres, from November 2014 S510 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 to November 2015, have been included in the study. Baseline information were collected about molecular profiling performed and therapies. Results: A total of 1787 patients were enrolled (64% males, 36% females; median age 67 years-old; 22% never smokers, 31% current smokers, 47% former smokers; 75% adenocarcinoma, and 73% with PS ECOG 0 or 1). The 73.9% of diagnosis was histological, while 26.1% was cytological. 1382 (77%) patients were tested for one or more molecular analysis during the history of disease, for a total of 3532 molecular tests. Only 405 patients did not receive any molecular test. 32.3% of patients presented a genetic alteration: EGFR mutation was reported in 17.8% of cases (319/1787), ALK translocation in 8.8% (82/926), KRAS mutation in 31.9% (154/482), MET amplifications in 15.8% (10/63), BRAF mutations in 3.7% (9/241), ROS1 translocation in 4% (11/269), HER2 mutation in 3.3% (3/89) of cases and FGFR alteration was found in 3 cases (only 15 tested). Considering patients younger than 45 years, never smokers and females, an EGFR mutation was detected in 25.4%, 43.5% and 30.6%, respectively. While 15.6%, 9.5% and 6.3% were ALK rearranged, respectively. For patients receiving an EGFR tyrosine-kinase inhibitor as firstline treatment, among those whose data are evaluable (79.2%), the median interval from diagnosis to first-line was 35 days. EGFR mutated patients received first-line erlotinib, gefitinib and afatinib in 9.4%, 39.1% and 33.8% of cases, respectively. At time of analysis, ALK-rearranged patients received an ALK inhibitor (crizotinib, alectinib or ceritinib) as first and/or second-line in 71.9% of cases. 29.3% of all patients received a maintenance therapy, mainly with pemetrexed (91.2% of cases). Conclusion: Routine molecular assessing is properly performed according to the national guidelines. A selection bias in including only those patients performing molecular tests, may explain the high proportion of patients with a molecular alteration. The low number of patients tested for ALK could be partially related to the impossibility to prescribe Crizotinib in first- line. In more than 70% of cases EGFR mutated patients received gefitinib or afatinib as first-line treatment. Keywords: molecular test, Italian cohort, lung POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/IMMUNOTHERAPY BIOMARKERS – TUESDAY, DECEMBER 6, 2016 P2.03b-064 Genomic Profiling in Non Small Cell Lung Cancer: New Hope for Personalized Medicine Satheesh Thungappa 1 , Shekar Patil 1 , H Shashidhara 1 , Mithua Ghosh 2 , Sheela L 2 , Siddesh Southekal 2 , Upasana Mukherjee 2 , Vidya Veldore 2 1 Medical Oncology, Hcg Bangalore Institute of Oncology Speciality Centre, Bangalore/India, 2 Molecular Genetics, Hcg Bangalore Institute of Oncology Speciality Centre, Bangalore/India Background: Lung cancer is rich in molecular complexities and spurred by different molecular pathways. Personalized medicine has begun to bring new hope to people with lung cancer, especially non-small cell lung cancer (NSCLC). Personalized medicine involves looking at the cells obtained from a biopsy to see if there are any genetic mutations able to exploit these unique pathways to develop targeted therapies. Very few publications are there from India related to lung cancer and genomics by Next generation Sequencing (NGS). Methods: The patients with NSCLC with initially negative for EGFR by PCR and ALK by IHC or FISH method treated at HCG Hospital from Jan-2013 to April -2016 are subjected for Gene profiling. The patients were consented to be profiled by targeted deep sequencing for hotspot mutations in 48 cancer-related genes using Illumina’s TSCAP panel and MiSeq technology. The average coverage across 220 hot spots was greater than 1000X. Data was processed using Strand Avadis NGS. Mutations identified in the tumor were assessed for ‘actionability’ i.e. response to therapy and impact on prognosis. Results: . A total of 65 patients were analyzed. Male: Female ratio- 2.6:1. In 11 patients NGS were rejected due to poor quality DNA tumor availability in paraffin blocks. In 19 patients didn’t find any actionable mutation. The pathogenic mutations were identified in remaining 35 patients. The following mutations were found. (table) Types of mutations Number of cases TP 53 18 EGFR 7 EGFR, T790M 3 PIK3CA 4 K-RAS 4 N-RAS 1 KDR 2 RET 2 PTEN 3 MPL 1 HER2 1 MET 1 CTNNB1 1 ATM 1 Out of 35positive patients, 13 had two mutations and 43.75% could offer targeted therapy. 38% of them responded to therapies who were treated with targeted drugs. Conclusion: There is a potential role for PIK3CA, EGFR +/- T790M, KDR, RET and PTEN as therapeutic targets as personalized therapy in NSCLC. Present study helps us in understanding the diversity of molecular drivers in lung cancer and its clinical management for these patients, along with understanding of prognosis. Keywords: NSCLC, NGS, mutations POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY BIOMARKERS – TUESDAY, DECEMBER 6, 2016 P2.03B-065 SERUM AND BRONCHOALVEOLAR LAVAGE LEVELS OF ADIPONECTIN IN ADVANCED NON-SMALL CELL LUNG CANCER: RESULTS OF A PROSPECTIVE STUDY Paraskevi Boura, Dimitra Grapsa, Stylianos Loukides, Apostolos Achimastos, Kostas Syrigos Medical School, University of Athens, Athens/Greece Background: Adiponectin (APN) is a major adipokine systhesized by the adipose tissue. A significant body of preclinical evidence has documented the involvement of APN in molecular pathways with a key role in carcinogenesis, while some, but not all, previous clinical studies have suggested the potential value of this molecule as a biomarker of diagnosis and/or prognosis in various malignancies, mainly including obesity-related solid tumors. The main objective of this study was to further explore the prognostic implications of APN levels in the serum and bronchoalveolar lavage of patients with advanced non-small cell lung cancer (NSCLC). Methods: Twenty-nine (29) consecutive newly diagnosed NSCLC patients with stage IV disease were prospectively enrolled. Serum and BAL levels of APN were obtained at baseline (before initiation of any therapeutic intervention) and assayed by enzyme-linked immunoassay (ELISA). Serum and BAL levels of APN were correlated with standard clinicopathologic parameters, including gender, age, body mass index (BMI), weight loss, size, histology and grade of the primary tumor, pathologic nodal status and performance status (PS). The association of each study variable with overall survival (OS) was assessed by univariate and multivariate Cox regression analyses. Results: Mean age of patients was 65.6 years (SD=10.1 years), while the majority were male (24/29 cases, 82.8%). The predominant histological type was adenocarcinoma (18/29 cases, 62.1% ). PS was 0 and ≥1 in 17/29 (58.6%) and 12/29 (41.4%) patients, respectively. Weight loss more than 10% was noted in 10/29 patients (34.5%). Median serum and BAL APN levels were 911.5 ng/ml and 17710 ng/ml, respectively. No statistically significant correlations were observed between the serum or BAL levels of APN and the clinicopathologic parameters evaluated. Univariate Cox regression analysis showed that APN levels were not significantly associated with survival. The only prognostic factor identified, both by univariate and multivariate survival analysis, was PS. Conclusion: The results of our prospective cohort failed to reveal any significant associations between serum or BAL levels of APN and several prognostic parameters (including OS) in stage IV NSCLC, thus confirming most previous observations. Keywords: serum, bronchoalveolar lavage, non-small cell lung cancer, adiponectin POSTER SESSION 2 – P2.03B: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/ IMMUNOTHERAPY BIOMARKERS – TUESDAY, DECEMBER 6, 2016 P2.03B-066 DIAGNOSTIC VALUE OF PLEURAL CYTOLOGY TOGETHER WITH PLEURAL CEA AND VEGF IN PATIENTS WITH NSCLC AND LUNG METASTASES FROM BREAST CANCER Franco Lumachi 1 , Paolo Ubiali 2 , Renato Tozzoli 3 , Sandro Sulfaro 4 , Stefano Basso 2 1 Department of Surgery, Oncology & Gastroenterology, University of Padua, School of Medicine, Padova/Italy, 2 Department of Surgery, General Surgery, S. Maria Degli Angeli Hospital, Pordenone/Italy, 3 Department of Laboratory Medicine, Clinical Pathology Laboratory, S. Maria Degli Angeli Hospital, Pordenone/Italy, 4 Department of Laboratory Medicine, Pathology and Histopathology, S. Maria Degli Angeli Hospital, Pordenone/Italy Copyright © 2016 by the International Association for the Study of Lung Cancer S511
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