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M. Pesek



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    P2.11 - Poster Session 2 - NSCLC Novel Therapies (ID 209)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.11-018 - EGFR mutations in NSCLC patients in Central Europe: the INSIGHT observational study (ID 1635)

      09:30 - 09:30  |  Author(s): M. Pesek

      • Abstract

      Background
      Central European countries are among those with the highest incidence rates of lung cancer and most of these cancers are smoking-related. The INSIGHT observational study aimed at assessing prevalence and treatment of patients with EGFR mutations in clinical practice in Central Europe. Here we report on the overall findings of this study.

      Methods
      Patients with NSCLC and tested for EGFR mutations between 15 November 2011 and 31 March 2013 in 14 centers from 6 Central European countries (Austria, Czech Republic, Hungary, Poland, Slovakia, Slovenia) were enrolled. EGFR mutations were determined by sequencing, PCR or other techniques.

      Results
      Here we report data on 1009 NSCLC patients who had been enrolled into the INSIGHT study. The patients had the following characteristics: median age 64 (range 29-93), 62% male, 38% female, 99.9% Caucasians, ECOG performance status 0-1, 2 and 3-4 in 79%, 17% and 4%; 19% never-smokers, 46% former smokers, 35% current smokers; 79% adenocarcinomas, 2% adenosquamous carcinomas, 7% squamous cell carcinomas, 9% NSCLC NOS and 3% others; tumor stages I-II, III and IV in 15.5%, 24% and 60.5% of the patients. EGFR mutations were found in 163 (16%) patients. Patients with mutations had the following characteristics: age median 66 (range 34-89) years, 46% male, 54% female, 47% never-smokers, 38% former smokers, 15% current smokers; performance status was recorded in 153 patients and was 0, 1, 2 and 3 in 30%, 50%, 14% and 6% of the patients. The mutation-positive tumors had the following characteristics: 85% adenocarcinomas, 4% adenosquamous carcinomas, 4% squamous cell carcinomas, 2% NSCLC NOS, and 5% others. Among patients with mutations, exon 18 mutations were seen in 7% of the patients, exon 19 mutations in 50% of the patients including deletions in 39%, exon 20 mutations in 12%, exon 21 mutations in 39% including L858R in 28% of the patients. Detailed data on systemic treatment were available for 122 patients with advanced EGFR mutation-positive NSCLC and most of these patients received EGFR-directed tyrosine kinase inhibitors during the course of their disease.

      Conclusion
      The INSIGHT observational study demonstrated that EGFR mutation testing has been established in the participating centres in Central Europe. The mutation rate of 16% is on the upper limit of the range seen in Western European countries but a potential selection bias for testing of patients with higher likelihood of harboring EGFR mutations cannot be excluded. Systemic treatment in patients with EGFR mutations is similar to treatment patterns observed in other countries. This study was supported by Boehringer Ingelheim Regional Center Vienna.

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    P3.18 - Poster Session 3 - Pathology (ID 177)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P3.18-005 - EGFR mutation testing methods in clinical practice in Central Europe: findings from the INSIGHT observational study (ID 1639)

      09:30 - 09:30  |  Author(s): M. Pesek

      • Abstract

      Background
      The INSIGHT observational study aimed at assessing the management of NSCLC patients with EGFR mutations in clinical practice in Central Europe. As part of this project, pathological findings including molecular testing methods were assessed.

      Methods
      Fourteen Pathology Departments from 6 Central European countries participated. Between 15 November 2011 and 31 March 2013, EGFR mutations were determined by one of the established standard methods in patients with NSCLC.

      Results
      Here we report data on 1009 patients who had been enrolled into the INSIGHT study. These patients consisted of 626 (62%) males and 383 (38%) females, 347 (35%) smokers, 452 (46%) former smokers and 182 (19%) never-smokers. Pathological diagnosis was based on histology (41%), cytology (19%) or both (40%) and revealed the following results: 54% non-mucinous adenocarcinomas, 4% mucinous adenocarcinomas, 21% unspecified adenocarcinomas, 9% NSCLC NOS, 7% squamous cell carcinomas, 2% adenosquamous carcinomas, and 2% others. Tumor material was obtained by bronchoscopy (44%), transthoracic needle biopsy (11%), surgery (19%), or other techniques. Specimens were either from primary tumor (88%), lymph node metastases (2.5%) or distant metastases (9.5%). EGFR mutation testing was done by PCR-RFLP (43%), Roche Cobas EGFR mutation test (26%), Sanger sequencing (18%), high resolution melting followed by sequencing (13%) or another method (11%). EGFR mutations were found in 163 (16%) of the patients. Among patients with mutations, the following mutations were found: 12 (7% of mutation-positive patients) exon 18 mutations, 82 (50%) exon 19 mutations including 63 (39%) deletions, 20 (12%) exon 20 mutations including 3 (2%) T790M, 63 (39%) exon 21 mutations including 45 (28%) L858R. Multiple mutations, both common and uncommon, were found in 12 (7%) of the patients. Mutations were found in 8% of smokers, 14% of former smokers and 43% of never-smokers. Mutations rates varied between centers which most likely reflected different patient selection criteria for EGFR mutation testing.

      Conclusion
      The INSIGHT project demonstrated that EGFR mutation testing by one of the standard tests in patients with NSCLC has been established in participating centers in Central Europe. EGFR mutation distribution is similar to other European and American NSCLC patient populations. This study was supported by Boehringer Ingelheim Regional Center Vienna.

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    P3.21 - Poster Session 3 - Diagnosis and Staging (ID 171)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P3.21-009 - Differential diagnosis of intrathoracic lymphadenopathy and/or infiltrates in patients with malignant tumours (ID 2171)

      09:30 - 09:30  |  Author(s): M. Pesek

      • Abstract

      Background
      Patients which are treated due to various malignant tumours, should be investigated by pneumologists because of having intrathoracic lympadenopathy and/or pulmonary infiltrates. We should consider either progression of first malignant tumour, secondary and tertiary malignancies, adverse reactions on therapy, infectious diseases, or, last but not least, systemic diseases, e.g. sarcoidosis. However in sarcoidosis patients, increased risk of hematologic and lung malignancies were reported. The occurrence of intrathoracic lymphadenopathy with or without pulmonary infiltrates is subject to frequent diagnostic difficulties in patients with cancer history. Accumulation of pulmonary infiltrates and lymphadenopathy may be mistakenly interpreted as metastases. We present 41 patients with malignancies, who contracted sarcoidosis simultaneously, subsequently or before the diagnosis of malignancy. The coincidence of both diseases hasn't been published in the Czech Republic yet. In these patients, according to a number of studies, increased prevalence of malignant diseases was found. Sarcoidosis is a non-tumor, chronic, systemic granulomatous disease of unknown etiology and characterized by T-cell dysfunction. It affects mainly the lungs and lymphatic system, but also other parenchymal organs, the skin, the eyes, the heart. The generally accepted hypothesis is some environmental factors may promote the development of sarcoidosis in genetically susceptible individuals. Characteristic lesions are noncaseating granulomas, which consist of epithelioid cells and T-lymphocytes.

      Methods
      During the course of 28 years we have examined around 500 patients with sarcoidosis. We selected patients with sarcoidosis and also malignant diseases from these.Using the method of retrospective study, we evaluated the frequency of the coincidence of the period since 1996.

      Results
      Of all the investigated we follow a group of 41 patients with malignancy and sarcoidosis. In 33 patients there was the primary tumor, in 7 patients primary sarcoidosis, 1 patient had two diagnoses simultaneously. These are 18 men and 22 women with the mean age of 62,3 years. The spectrum of malignancies covers hematological malignancy (6), lung (3), breast (13), head and neck (4), intestine (3), melanoma (4), seminoma (3) and other (5). All patients had sarcoidosis diagnosed by biopsy (23) by CT or PET / CT and the bronchioalveolar lavages (18). Mediastinal lymphadenopathy was presented by 37 patients, pulmonary infiltrates and nodules were detected in 31 patients, infiltrates only 3 patients, extrapulmonary disease in 9 patients. The interval between sarcoidosis and the primary cancer was 0-552 months with a median of 36.Treatment with corticosteroids (or in combination with immunosuppressive agents) had to be initiated in 28 patients, 12 patients were left without treatment. 31 patients showed regression or disappearance of lesions, 8 patients were stable and disease didn't progress, the development of 2 patient is still unknown.

      Conclusion
      Differential diagnosis of pulmonary lesions is a common problem in patients with primary malignant disease in history. Not every pulmonary lesion must be just a manifestation of the disease, but as we argue in this presentation, it may be a manifestation of sarcoidosis. Therefore, we stress the need of histological verification of each newly formed pathological finding. The exclusion of generalized malignancy should have a significant influence on the treatment and survival.