Author of

• 12824

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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
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12828

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    P3.21-004 - Therapeutic Delay due to Molecular Testing in Patients with Stage IV NSCLC Newly Diagnosed. (ID 1505)

    09:30 - 09:30  |  Author(s): M.D.V. Geist
    • Abstract

    Background
    The treatment of patients (pts) with advanced non–small-cell lung cancer (NSCLC) is based on clinical trials experience and molecular characteristics. Although molecular testing has become more mainstream, knowledge gaps need to be addressed to optimize treatment decision. Delay to treatment may compromise palliative efficacy. To evaluate therapeutic delays, procedures for 71 biopsies from pts with stage IV NSCLC newly diagnosed submitted to molecular testing were retrospectively analysed.

    Methods
    Demographic data, site of biopsy, type of first systemic treatment, EGFR mutations in exons 18, 19 and 21 using a dual technical approach (direct sequencing of polymerase chain reaction (PCR) products followed by bidirectional sequencing by Sanger method), EML-4-ALK rearrangements by fluorescence in-situ hybridization (both done in a single central laboratory sponsored by pharmaceutical companies), year of diagnosis, time from first consultation to molecular testing results (diagnostic delay, DD), and time from first consultation to treatment initiation (therapeutic delay, TD) were obtained from 71consecutive pts with stage IV NSCLC newly diagnosed seen from 8/2010 to 5/2013 in two general oncologic institutions located on Patagonia, Argentina.

    Results
    Median age was 59 years (range 22-82), 38 % were women. 86% were adenocarcinoma. 62% of specimens were derived from primary tumors, 38% from metastatic sites. EGFR analyses was done in all 71 specimens, 13 have insufficient material for testing (18%) (group ND) (27% of ND in biopsies obtained during 2010-2011 versus 10% of those seen during 2012-2013, p: 0.04). 8 evaluable pts (14%) presented any EGFR mutation, whereas 50 (86%) were negative. 11 pts were evaluated for ALK translocation in 2013. Only 1 pt was positive. As a consequence, 9 pts from the entire cohort were able to be treated with molecular directed treatments as first line (13%, group POS) Median DD for EGFR analyses was 18 days (range 8-32). It was 13 days during 2013 probably due to a better multidisciplinary approach. Median DD for ALK analyses was 18 days (range 14-32). Median TD was 24 days (13-77) for the entire cohort. It was 23 days (13-36) for Non-POS pts and 39 days (21-77) for POS pts (p:0.0001) Despite positivity only 4/9 POS pts were treated with TKI as first line treatment. Main reasons for no treatment were excessive delay for drug accessibility (5) and performance status deterioration (1). DD represent 75 % of TD in non-POS pts, and 48 % in POS pts

    Conclusion
    1- Molecular testing permit to indicate first line TKI treatments in 13% of pts 2- DD may compromise treatment in all pts, but specially in the numerous non-POS pts who otherwise would have been starting therapy after first consultation. 3- With a multidisciplinary approach, it is possible to have better testing results and to reduce DD. 4- Drug accessibility is an important cause of TD in POS pts 5- TD for any preventable reasons should be promptly reduced as survival or quality of life may be compromised.