Author of

• 10874

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  P1.13 - Poster Session 1 - SCLC (ID 200)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10878

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    P1.13-004 - The heterogeneous phenotype of large-cell neuroendocrine pulmonary carcinoma (LCNEC): A clinico-pathological single institution series. (ID 1775)

    09:30 - 09:30  |  Author(s): M. Perelman
    • Abstract

    Background
    According to 2004 WHO classification there are four pulmonary neuroendocrine (NE) histopathologic entities, ranging from low- to high-grade (HG) neoplasms. LCNEC belongs to the latter group. There are different opinions regarding whether LCNEC and small-cell lung cancer (SCLC), both HG, are essentially indistinct and thus deserve the same therapy, or not. LCNEC consists only about 3% of all lung cancer patients. We aimed to examine biologic characteristics of LCNEC patients and their implications on therapy choice and outcome.

    Methods
    A retrospective observational study of 21 consecutive patients seen at the thoracic oncology unit, division of oncology, Sheba Medical Center during the years 2008-2012. Histopathology was studied in a dedicated thoracic pathology unit and was based on 2004 WHO classification. Ki67 index evaluation was performed. Staging followed the 2009 TNM classification. Patients were examined for tumor somatostain receptors (SSTR): by In-111 Octreoscan or by Ga68 DOTANOC/DOTATATE PET/CT scans. We studied circulating proGRP as NE tumor marker.

    Results
    21 Patient fulfilled the LCNEC diagnostic criteria, 14 M, 7 F. 8/21 were diagnosed at an operable stage, 7/8 had received post operative adjuvant chemotherapy and 5/7 of this subgroup are still alive. At a 17-month median follow-up time, of the entire series 7/21 are alive. The Ki67 score ranged 20-100%, median 72.5%. The score was less than 70% in 7 cases. Two cases were defined HG, without Ki67 score. Five Stage IV patients were SSTR-positive and received octreotide depot therapy, which in 2/5 was given 1[st]-line (their Ki67 index was 20-25%). One of the latter received also peptide-related radionuclide therapy ( PRRT). An additional patient had received octreotide as 2[nd]-line therapy, and achieved durable (> 3-years) stabilization. Of note is metastatic brain disease in six patients: synchronous with initial diagnosis in two cases and metachronous in the others. Also, six patients have had non cerebral, non synchronous 2nd primary tumors. Additional histological elements were found in 6 patients: SCLC in 3, basaloid- 2 and adenocarcinoma-1. Circulating proGRP in LCNEC was elevated less frequently, and showed lower titers, as compared with SCLC patients data.

    Conclusion
    LCNEC is an uncommon entity within the pulmonary NE neoplasms spectrum. Despite its similarity to SCLC it is distinct in several senses: biologically, an aggressivity profile is not always seen, as reflected by the broader Ki67 range. A related feature is the higher rate of LCNEC operable patients, compared with exceptional primary surgery in SCLC. A substantial fraction of patients are SSTR positive and can benefit from corresponding targeted therapy. Due to LCNEC heterogeneity it is important to characterize it adequately prior to 1[st] line therapy so that the therapeutic options are delineated on time, thus optimizing patients benefit and quality of life. Due to the limited patient number in a given institution, collaborative studies are warranted.