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J.W. Longshore
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MTE 04 - Molecular Testing in Community Settings (Ticketed Session) (ID 56)
- Event: WCLC 2015
- Type: Meet the Expert (Ticketed Session)
- Track: Community Practice
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 07:00 - 08:00, 109
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MTE04.01 - Molecular Testing in Community Settings (ID 1983)
07:00 - 08:00 | Author(s): J.W. Longshore
- Abstract
- Presentation
Abstract:
Recent advances in personalized medicine and associated companion diagnostic therapeutics have led to an increased utilization of genetic markers in oncology therapy selection. The rapid acceleration of biomarker driven therapy has been widely accepted into clinical guidelines based upon proven clinical utility and unprecedented patient outcomes. Despite these advances, utilization of molecular testing in community oncology practice has been more limited than in academic settings. The Levine Cancer Institute and Carolinas HealthCare System serve a wide variety of oncology patients in both academic and community settings using a multidisciplinary approach. During this session, a discussion of processes used for tissue acquisition and processing, pre-analytics, biomarker testing, and result reporting will be presented. Strategies that have been used in our system to eliminate common roadblocks in the testing process such as tissue stewardship will be discussed. A special emphasis will be given to the discussing the power and pitfalls of common biomarker testing techniques such as real-time PCR companion diagnostic testing, immunohistochemistry, FISH, and next-generation sequencing panels. During the presentation, a significant amount of time will be dedicated to a question and answer session so audience members can address community testing challenges from their local settings. Working to solve these challenges in the community setting will improve the oncology patient journey by increasing access to high quality biomarker testing.
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P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.04-043 - A Successful Case in Which Electromagnetic Navigation Bronchoscopy Identified an EGFR Mutation in Small Peripheral Lung Lesions (ID 2447)
09:30 - 09:30 | Author(s): J.W. Longshore
- Abstract
Background:
Our institution participated in a Phase I National Trial that treats patients with advanced NSCLC. Clinical enrollment not only required repeat biopsy of tissue for histopathological analysis and molecular testing, but the target lesions were technically challenging due to size, number of lesions, risk, and and time constraints. Utilization of electromagnetic navigation bronchoscopy (ENB) was used to enroll a patient in a clinical trial in which multiple target lesions were identified, but the only viable target lesion was a mere 6mm in diameter in the periphery of the lung.
Methods:
A 54 year old Asian male showed disease progression in a follow-up chest CT after 9 months of treatment with Erlotinib, suggesting that an acquired resistance to Erlotinib had developed after an initial successful response. Additional tissue specimens were needed to determine if the patient was eligible to participate in a Phase I National Clinical Trial that is attempting to prevent EGFR mutations from acquiring resistance mechanisms. An electromagnetic navigational bronchoscopy (ENB™) guided forceps biopsy tool was utilized to obtain tissue samples from 3 separately identified lesions. Figure 1
Results:
All 3 lesions were successfully navigated and tissue samples were all adequate for molecular testing. NSCLC favoring adenocarcinoma was diagnosed for all 3 sites. However, the admixture of cell types (bronchial epithelial, inflammatory cells, etc) meant that only the smallest 6mm peripheral right middle lobe lesion tissue sample biopsy could be used for this specific trial. Based on these pathology results this patient was enrolled.
Conclusion:
Newer minimally invasive biopsy technologies such as ENB™ guidance can facilitate biopsies of multiple pulmonary sites in one procedure; such procedures are safe and feasible in a community based setting. Moreover, these procedures are increasingly important to meet the expanding needs for advanced histological and molecular testing in oncology. This procedure enabled us to enroll this patient in a Phase I National Trial that may potentially address his acquired resistance to Erlotinib treatment.
