Download the ESMO 2012 Abstract Book - Oxford Journals
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Annals of Oncology<br />
Methods: The presence and relative quantity of two ALK exon spanning transcript<br />
targets located before (ALK-5’) and after (ALK-3’) <strong>the</strong> translocation breakpoints of<br />
this gene were assessed with qRT-PCR in 198 NSCLC RNA samples from paraffin<br />
tissues upon stringent intra- and inter-run assay performance validation. ALK<br />
mRNA expression was compared with ALK gene status assessed with FISH. Patients<br />
had been treated in <strong>the</strong> adjuvant and/or 1 st line setting. None of <strong>the</strong>m received<br />
crizotinib.<br />
Results: Four patterns of ALK mRNA expression emerged: tumors negative for both<br />
transcripts (85/198, 42.9%) or positive for both (56/198, 28.3%), which were<br />
considered as close to normal (ALK-N); and, ALK-5’ positive only (34/198, 17.2%)<br />
or ALK-3’ positive only (23/198, 11.6%), which were termed as aberrant (ALK-A).<br />
ALK translocation was observed in 9/124 cases (7.3%). ALK copies >2.2 were noticed<br />
in 40 cases (32.3%) with >6 copies in 26 cases (21%) and overall complex gene gain<br />
patterns. ALK mRNA was unrelated to ALK translocation, but ALK-3’ was associated<br />
with increased ALK gene copies (p = 0.017). ALK-A was more common in stage<br />
IIIB-IV tumors, while ALK mRNA and gene copy gains were not associated with<br />
gender, smoking and histology. ALK gene status was not associated with patient<br />
outcome. In comparison to patients with tumors expressing ALK-N, those with<br />
ALK-A had a significantly shorter overall survival (OS, median 29.3 vs. 13.1 months,<br />
CI95% 19.1-39.6 vs. 5.4-20.9, p = 0.0007). The same unfavorable impact of ALK-N<br />
vs. ALK-A was observed on stage IIIB-IV patient OS (median 17.5 vs. 11 months,<br />
CI95% 9.1-26.0 vs. 6.6-15.3, p = 0.0050).<br />
Conclusions: ALK gene status and mRNA expression seem to suffer a complex<br />
pathology in NSCLC. When expressed, ALK mRNA may be fragmented, possibly<br />
due to currently unknown genomic alterations. Aberrant ALK mRNA expression<br />
appears to have an unfavorable prognostic impact on NSCLC patient outcome; its<br />
role on NSCLC biology merits fur<strong>the</strong>r evaluation.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
1313 PROGNOSTIC SIGNIFICANCE OF EGFR, HER-2, CEA ON<br />
CIRCULATINGTUMOUR CELLS (CTCS) IN PATIENTS WITH<br />
METASTATIC NON-SMALL-CELL LUNG CANCER (MNSCLC)<br />
C. Loretelli 1 , E. Galizia 2 , M. Scartozzi 1 , R. Giampieri 1 , D. Gagliardini 1 ,<br />
C. Brugiati 1 , S. Cascinu 1 , R. Cellerino 1<br />
1 Clinica di Oncologia Medica, AOU Ospedali Riuniti Ancona Università<br />
Politecnica delle Marche, Ancona, ITALY, 2 Oncologia Medica, Ospedale “E.<br />
Profili”, Fabriano, ITALY<br />
Purpose: We aimed to assess <strong>the</strong> role of CTCs in providing prognostic information<br />
of mNSCLC patients receiving chemo<strong>the</strong>rapy.<br />
Patients and methods: In this single-center prospective study, blood samples for<br />
CTCs analysis were obtained from patients with previously untreated mNSCLC.<br />
CTCs were measured using an epi<strong>the</strong>lial cell adhesion molecule-based<br />
immunomagnetic technique. Immunomagnetic bead enrichment for cells expressing<br />
epi<strong>the</strong>lial cell adhesion molecule (EpCAM) was performed, followed by multi-marker<br />
quantitative real-time PCR of a panel of marker genes: EGFR, HER-2, CEA.<br />
Results: We analysed 45 patients with mNSCLC: 24 adenocarcinoma, 8 squamous<br />
cell carcinoma and 13 poorly differentiated. EGFR, HER-2 and CEA expression<br />
were found in CTCs of respectively 12, 5 and 11 patients. Globally, 31 patients<br />
(68.9%) progressed during treatment, whereas disease control (i.e. patients with<br />
partial/complete response or stable disease) was achieved in 14 patients (31.1%).<br />
EGFR expression was detected in 11/31 patients with disease progression (35.5%)<br />
and in only 1 out of 14 patients with disease controlled (7.1%) (p 0.07). HER-2<br />
expression was detected in 3/31 patients with disease progression (9.7%) and in 2/<br />
14 patients with disease controlled (14.3%) (p 0.64). CEA expression was detected<br />
in 10/31 patients with disease progression (32.3%) and in 1/14 patients with<br />
disease controlled (7.1%) (p 0.13). Only EGFR expression in CTCs showed a<br />
correlation with clinical outcome, expressed by progression free survival (PFS).<br />
Patients with and without EGFR expression in CTCs were homogeneous for<br />
clinical characteristics. PFS was 2.8 v 2.3 months (p 0.03) respectively for patients<br />
without and with EGFR expression.<br />
Conclusion: CTCs are detectable in patients with mNSCLC and could show novel<br />
prognostic factor for this disease. Fur<strong>the</strong>r validation is warranted before routine<br />
clinical application.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
1314 ASSESSMENT OF THE PREDICTIVE/ PROGNOSTIC VALUE OF<br />
THE MYELOID-DERIVED SUPPRESSOR CELLS (MDSC) AND<br />
REGULATORY T CELLS (TREGS) IN NON-SMALL CELL LUNG<br />
CANCER (NSCLC). PRELIMINARY RESULTS<br />
E.K. Vetsika 1 , E. Skalidaki 1 , A. Koutoulaki 1 , D. Mavroudis 2 , V. Georgoulias 2 ,<br />
A. Kotsakis 2<br />
1 Laboratory of Tumor Cell Biology, University of Crete, School of Medicine,<br />
Heraklion, GREECE, 2 Medical Oncology, University Hospital of Heraklion,<br />
Heraklion, GREECE<br />
Background: The circulating MDSCs and Tregs in cancer patients suppress immune<br />
system. This study is investigating <strong>the</strong> expression of <strong>the</strong> MDSCs and Tregs in <strong>the</strong><br />
peripheral blood of NSCLC patients and <strong>the</strong>ir correlation with <strong>the</strong> clinical outcome<br />
of <strong>the</strong> 1 st line chemo<strong>the</strong>rapy.<br />
Methods: 62 chemo<strong>the</strong>rapy naive patients (57 males) with stage IIIB/ IV NSCLC<br />
have been enrolled in this study, so far; median age 67. Peripheral blood was<br />
collected prior to treatment. 19 healthy, aged-matched donors (12 males) were used<br />
as controls. The distinct MDSC subpopulations [A (monocytic):<br />
CD11b + CD14 + CD15 − CD33 + CD13 + IL-4R + Lin low/- HLA-DR − ; B (monocytic):<br />
CD11b + CD14 + CD15 + CD33 + CD13 + IL-4R + Lin low/- HLA-DR − and C (granulocytic):<br />
CD11b + CD14 − CD15 + CD33 + CD13 + IL-4R + )], CD4 + Tregs (CD4 + CD25 +high<br />
CD127 low FoxP3 + CD39 + CD13 + ) and CD8 + Tregs (CD3 + CD8 + CD25 +<br />
CD45RO + CD13 + CCR7 + FoxP3 + CD39 + ) were determined by using flow cytometry. A<br />
comparison of <strong>the</strong> overall survival (OS) and <strong>the</strong> progression-free survival (PFS)<br />
according to <strong>the</strong> frequency of <strong>the</strong> MDSC and Tregs was performed (high expression<br />
defined as <strong>the</strong> percentage of cells above <strong>the</strong> 75% percentile of <strong>the</strong> controls).<br />
Results: The levels of Tregs prior to treatment did not differ from <strong>the</strong> controls’.<br />
Patients with progression (PD) during <strong>the</strong> 1 st line treatment had significantly<br />
elevated percentage of CD4 + (24.6 ± 8.5) and CD8 + (0.7± 0.2) Tregs at baseline<br />
compared to those with no PD (3.7± 1.8, p = 0.04; 0.1± 0.05, p= 0.03, respectively).<br />
In contrast, MDSCs were significantly increased (A: 3.8 ±0.7; Β: 2.5 ± 0.5 and C: 10.8<br />
± 2.3) in patients compared to controls (0.8 ± 0.4, p = 0.001; 0.5 ± 0.2, p= 0.01, and<br />
2.7 ± 1.3, p= 0.05, respectively) but that difference was not associated with response<br />
to treatment. Patients with normal CD8 + Tregs levels at baseline had higher OS and<br />
PFS compared to those with high levels (13.2 mo vs 7.9 mo, p= 0.02 and 13.1 mo vs<br />
3.7 mo, p= 0.003, respectively).<br />
Conclusion: The MDSCs are elevated in NSCLC. The increased expression of CD4 +<br />
και CD8 + Tregs negatively correlated with <strong>the</strong> treatment outcome, indicating that<br />
CD4 + and CD8 + Tregs could be a potential predictive/prognostic biomarker. The<br />
study is still opened to accrual and more mature data will be presented at <strong>the</strong><br />
meeting.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
1315 CYTOLOGY SAMPLES (S) FOR EGFR AND KRAS MUTATION<br />
(MUT) TESTING IN NON-SMALL-CELL LUNG CANCER<br />
(NSCLC).EXPERIENCE FROM A SINGLE INSTITUTION<br />
T. Moran Bueno1 , E. Castella Fernandez2 , M. Tierno Garcia1 ,C.<br />
Buges Sanchez1 , C. Queralt Herrero1 , M. Perez Cano1 , D. Naranjo Hans2 ,F.<br />
Andreo Garcia3 , L. Capdevila Riera1 , R. Rosell1 1<br />
Medical Oncology Department, Catalan Institute of Oncology Badalona,<br />
Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN, 2 Pathology<br />
Department, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN,<br />
3<br />
Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona,<br />
SPAIN<br />
Background: Targeted <strong>the</strong>rapy has yielded impressive clinical outcomes in advanced<br />
NSCLC. For molecular testing, cytology samples are not commonly used since <strong>the</strong><br />
tumor content is less likely to be adequate. At ICO-Badalona, Hospital Germans<br />
Trias i Pujol we have used cytology specimens when biopsies are not available. We<br />
describe <strong>the</strong> general results when using cytology specimens in NSCLC to detect<br />
EGFR and KRAS mut.<br />
Methods: From January 2007 to February <strong>2012</strong>, 227 cytology samples from patients<br />
with NSCLC were collected at <strong>the</strong> Department of Pathology as cell blocks or fresh<br />
specimens extended over an appropriate slide (MembraneSlide 1.0 PEN, Zeiss®).<br />
Tumor cells (8-150) were captured by laser microdissection. DNA sequencing for<br />
Volume 23 | Supplement 9 | September <strong>2012</strong> doi:10.1093/annonc/mds409 | ix431