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A. Schwartz



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    O24 - Cancer Control and Epidemiology III (ID 134)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      O24.04 - Risk of second primary lung cancer (SPLC) in patients (pts) with previously treated lung cancer: Analysis of the Surveillance, Epidemiology and End Results (SEER) data (ID 2204)

      16:45 - 16:55  |  Author(s): A. Schwartz

      • Abstract
      • Presentation
      • Slides

      Background
      BACKGROUND: Second primary lung cancer (SPLC) in patients who have been treated for a prior lung cancer is a recognized phenomenon. There has been an improvement in the staging and treatment of lung cancer in the last several decades resulting in longer survival for pts and affording an opportunity for the development of SPLCs. The objective of this study was to establish the frequency of SPLCs and to characterize the demographics, histology and stage at presentation, time interval between diagnoses, and cumulative risks of developing a SPLC in this pt population.

      Methods
      METHODS: The pts were identified from population-based SEER-9 Registries Data Base. All pts with a primary lung cancer between 1973 and 2004 were included with follow-up to 2009. The histology and stage of the SPLCs were evaluated in comparison to the initial primary lung cancer (IPLC). The incidence of SPLCs was compared to the expected incidence by calculating multiple primary-standardized incidence ratios (MP-SIRs) using the SEER Stat program. Selected cohorts were stratified by sex, race, age at diagnosis, and date of diagnosis. Sex-specific cumulative risks of developing SPLCs were calculated using the Kaplan-Meier method.

      Results
      RESULTS: 208,486 pts had an IPLC diagnosed from 1973-2004. No smoking history was available. Patient Characteristics at time of IPLC: 60.4% male; 84.3% white; 8.5% (20-49 yr), 55.9% (50-69 yr), 35.6% (≥ 70 yr); 84% non-small cell lung cancer (NSCLC); 33.8% distant disease, 23.5% regional, 29.9% local. 5,302 pts developed SPLC. The majority were male (56.6%), white (84.9%), and in the 50-69 yr age group (68%). Females had the highest SIR values across all ethnicities and age groups particularly in the youngest cohort (20-49 yr) where the SIR was 8.58. The SIR values were ≥ 2 for all cohorts expect for males ≥ 70 yr (SIR=1.65). The predominant histologic types for IPLCs were adenocarcinoma (ADC) and squamous cell cancer and the associated SPLCs were usually of the same histology. IPLC ADC and BAC pts were most likely to develop a SPLC. Most SPLCs (50%) presented with regional or distant disease, while only 37% were localized at diagnosis. The median time to development of SPLCs was 68 mo for males and 74 mo for females. The risk of developing a SPLC continually increased as a function of time for both sexes.

      Conclusion
      CONCLUSION: Patients with a history of IPLC are at high risk for developing SPLC and this risk increases over time. This is especially true of females who are diagnosed at an early age with their initial lung cancer. The majority of SPLCs present late and at a more advanced stage. These findings could have major implications with regard to the length and type of surveillance in pts who survive their initial lung cancer diagnosis.

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    P1.18 - Poster Session 1 - Pathology (ID 175)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P1.18-007 - Multiplex testing of driver mutations in Non-Small Cell Lung Cancer (NSCLCs) of African-American (AA) patients (ID 1312)

      09:30 - 09:30  |  Author(s): A. Schwartz

      • Abstract

      Background
      Recently driver genetic alterations have been identified in NSCLC that can be targeted for therapeutic interventions. Previous reports have suggested that rates of certain mutations may vary according to ethnic background. We conducted multiplex testing of NSCLCs of AA and white patients to assess variability in the mutation rates by race.

      Methods
      We identified tumor tissues of 139 AA and 340 white NSCLC patients collected as part of three different institutional review board approved studies. Using the Sequenom MassArray system and a multiplexed panel, we analyzed tumor DNA for 214 oncogenic mutations in 26 genes previously identified in NSCLC. Estimated risk (Odds Ratios (OR)) of any mutation and specific gene mutations among AA patients compared to white patients were calculated after adjusting for age, sex, smoking status and histology (adenocarcinoma versus non-adenocarcinoma). Information on smoking status was unavailable on 45 patients and was not included in calculations of ORs for some genes (OR[b]).

      Results
      The median age at diagnosis was 60 vs 66 years in AA vs white patients; 42% of AA patients and 65% of white patients were males; 67% of AA patients and 49% of white patients had adenocarcinoma; 67% of AA patients and 85% of white patients had stage I/II NSCLC and 10% of AA patients and 6% of white patients were never smokers. 43% of the AA patients and 46% of white patients had at least one mutation detected (OR=0.8; 0.5-1.2). 19% of AA patients and 8% of white patients had more than 1 mutation detected (OR 2.1; 1.1-4.1) (Table 1). AA patients were more likely to harbor mutations in STK11 (LKB1) (OR=7.5; 3.1-18.2) and NOTCH1 (OR[b]=8.4; 2.2-31.7), and they were less likely to have MET mutations (OR[b]=0.2; 0.1-1.1) then white patients. While not statistically significant, AA had lower prevalence of Kras mutations (OR[b]=0.5, 0.2-1.0) and p53 mutations (OR= 0.7; 0.4-1.4). Table 1

      Outcome OR for African American Race 95% CI P
      Any driver mutation[a] 0.8 0.5-1.2 0.203
      >1 driver mutation[a] 2.1 1.1-4.1 0.036
      STK11 Mutation[a] 7.5 3.1-18.2 <.001
      P53 Mutation[a] 0.7 0.4-1.4 0.359
      Kras Mutation[b] 0.5 0.2-1.0 0.041
      NOTCH1 Mutation[b] 8.4 2.2-31.7 0.002
      MET mutation[b] 0.2 0.1-1.1 0.065
      [a]Adjusted for age, sex, ever/never smoking and adeno/non-adeno
      [b]Adjusted for age, sex, and adeno/non-adeno

      Conclusion
      Our analysis of NSCLCs shows that AAs were more likely to have multiple genetic mutations than whites and the mutation profile differs by race.