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G.G. Finley
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-011 - 'Peripheral Limited' Small Cell Lung Cancer (SCLC). Does Surgical Resection Have a Role in Primary Management? (ID 3138)
09:30 - 09:30 | Author(s): G.G. Finley
- Abstract
Background:
Limited stage SCLC, even peripheral completely resectable disease, is considered by many thoracic oncologic specialists to be a systemic process with a limited role of surgery beyond diagnosis. We hypothesized that surgical resection may improve local control, and potentially enhance survival for the small subset of SCLC patients (pts) with peripheral, resectable disease.
Methods:
Retrospective review of outcomes of all pts (n=127) with “limited stage” SCLC treated at our Institution from 2004-2014. Local disease progression and distant recurrence among pts undergoing primary systemic therapy +/- radiation therapy (n=106, 83%) were compared to pts with peripheral SCLC (n=21, 17%) undergoing surgical resection as first line therapy + adjuvant therapy. Patient demographics, surgical mortality, disease-free and overall survival outcomes were compared between the non-surgical and surgical groups. Systemic therapy was Platinum agent based. Survival was estimated using Kaplan-Meier survival analysis. Groups were compared using a log-rank test.
Results:
Pts demographics were similar between non- surgical and surgically treated SCLC pts. Systemic therapy / radiation was utilized for 88 (83%) non-surgical pts. Systemic therapy alone was utilized for 18 (16.9%) pts, and 2 (1.8%) patients received radiotherapy alone. Local disease progression represented first site of treatment failure in 19 (17.9%), while distant metastases was first noted in 65 pts (61.3%). Of the 65 distant metastasis first site of progression, 27 (41.5%) were cerebral. First site of progression was unable to be verified 16 (26.2%) medically treated pts. Among the 21 pts having “surgical resection” of peripheral, limited SCLC, there was no perioperative (30 day) mortality. Local recurrence was noted first in 7 (33.3%) of surgical pts. Distant metastases was discovered first in 3 (14.3%), and cerebral metastasis was found in 2 of these 3 pts. Nine (42.9%) surgical pts were recurrence free (mean 43 months), while only 7 (5.7%) medically treated pts were free of recurrence (mean 31 months). The 5 year survival among medially treated pts was 8% compared to 21% among patients undergoing surgical resection of peripheral SCLC (p= 0.008). (See figure 1. below) Figure 1
Conclusion:
Survival for all SCLC patients is affected by the common presence of systemic disease, despite an apparently limited, peripheral disease presentation. Surgical resection as “First line” therapy combined with adjuvant systemic + radiation therapy for peripheral, limited small cell lung cancer may be beneficial. Cerebral metastases are important sites of first distant recurrence for all limited stage SCLC.
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-007 - Pneumonectomy for Non Small Cell Lung Carcinoma: Pre-Operative Comorbidities and Post-Operative Morbidity Affect Long Term Survival (ID 3160)
09:30 - 09:30 | Author(s): G.G. Finley
- Abstract
Background:
Pneumonectomy for NSCLC is commonly associated with significant morbidity and mortality. Patients with pre-existing medical comorbidities experience an increased frequency of post-operative complications. This is of increased importance in this patient population, compared to patients undergoing lesser anatomic resections, as it is associated with a decrease in overall survival.
Methods:
A retrospective review of all patients undergoing pneumonectomy for non small cell lung cancer from 2004 to 2014 was undertaken. IRB approval was obtained. Demographics and pre-existing medical comorbidities, including the utilization of neoadjuvant therapy, were evaluated. Major morbidities occurring in the post-operative period were evaluated. Stage specific survival was evaluated and compared to published survival data following anatomic lobectomy.
Results:
From 2004 to 2014, 84 pneumonectomies were performed for resectable non small cell lung carcinoma. Complete STS data and staging information was available for 81 patients. Demographics and pre-existing medical comorbidities are reported in Table 1. Post-operative major morbidities are reported in Table 2. Mean stage specific survival was 32, 28 and 26 months for Stage I, II and III respectively. Figure 1 Figure 2
Conclusion:
Overall survival is decreased in patients undergoing pneumonectomy for NSCLC compared with patients undergoing lesser anatomic resections. Pre-existing medical conditions may contribute to the increased frequency of post-operative morbidity, resulting in decreased overall survival in these patients. Further evaluation of the severity of pre-existent medical comorbidities and the impact on post-operative morbidity on long term survival following pneumonectomy for non small cell lung carcinoma is warranted.
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-043 - Driver Mutations in Non-Small Cell Lung Cancer in Western Pennsylvania: Prevalence and Barriers to Testing (ID 1426)
09:30 - 09:30 | Author(s): G.G. Finley
- Abstract
Background:
EGFR gene mutations and EML4-ALK rearrangements are key therapeutic targets in nonsquamous non-small cell lung carcinoma (nsNSCLC). Therapy targeted towards these mutations has been shown to improve tumor response, progression-free survival, and quality of life. Current guidelines recommend testing all advanced (Stage IIIB and IV) nsNSCLC patients for these genetic aberrations. Despite this recommendation, not all patients eligible for mutation analysis are tested. In our institution, preliminary observations suggest the percentage of patients being tested and the frequency of driver mutations are significantly lower compared to published data. The purpose of the study was to review tumor registry data in order to determine the rate of testing and the frequency of driver mutations in Western Pennsylvania. Our secondary aim was to evaluate whether biopsy size impacts the frequency of EGFR and ALK testing.
Methods:
From the tumor registry, 167 cases of advanced nsNSCLC were identified (2011-2013). The testing rates for driver mutations, frequency of driver mutations, and the tissue procurement technique were determined by individual chart review. Surgical specimens, core biopsies, and large volume thoracentesis specimens were categorized as large tissue biopsies and samples obtained by fine needle aspiration, bronchial washing, and bronchial brushing were considered small tissue biopsies. Using a Chi-square analysis, mutation testing rates were compared between the large and small biopsy groups. Frequency of driver mutations was determined, excluding unknown or inadequate samples.
Results:
Of the 167 cases, there were 120 (71.9%) large and 47 (28.1%) small biopsy specimens. 61 (50.8%) large sample biopsies and 17 (36.2%) small sample biopsies were submitted for EGFR analysis. 39 (32.5%) large sample biopsies and 10 (21.3%) small sample biopsies were tested for ALK rearrangements. It was found that large tissue biopsies were more likely to be analyzed for EGFR mutations and ALK rearrangements although the results did not reach statistical significance (p=0.088 and p=0.150, respectively). Across all samples, a total of 7 EGFR mutations and 0 ALK rearrangements were identified representing a frequency of 10.0% and 0.0% respectively.
Conclusion:
Despite current guidelines for testing driver mutations in advanced nsNSCLC, we are testing less than 50% of our patients. There are several barriers that continue to thwart this recommendation, including failure to integrate driver mutation testing into routine pathology practice (i.e., reflex testing), lack of care coordination with relevant clinical specialties beyond medical oncology and pathology, and insufficient tissue obtained from biopsy. More importantly, these trends are not isolated to our institution and reflect a significant challenge within the oncology community. In the coming months, we will be initiating a Lean Six Sigma approach to modify our current clinical practice and improve our testing rate. In addition, we have begun using a blood based assay (liquid biopsy) to interrogate advanced nsNSCLC for driver mutations. We have also demonstrated that the frequency of driver mutations in Western Pennsylvania is lower than published data. Accession of additional patients to this data set continues and a final analysis will be presented.
