Author of

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

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

  • 12881

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    P3.24-028 - Immuno-Histochemistry (IHC) typing of Molecular markers, its correlation with clinical parameters and response to chemotherapy in Non Small Cell Lung Cancer (NSCLC) - A Pilot study. (ID 1817)

    09:30 - 09:30  |  Author(s): P.C. Nagaraj
    • Abstract

    Background
    Incidence of Lung cancer is on the rise, especially among women in India. NSCLC constitutes the vast majority and there is tendency of rise in adenocarcinomas especially in smokers. Recent advances suggest that NSCLC is not a single entity but a cohort of different types based on molecular markers. IHC is a simple method to detect these changes. Recent trend is the use of IHC markers for molecular sub typing. A retrospective analysis of 35 patients who were diagnosed to have NSCLC and received at least 3 cycles of chemotherapy was included in this study. The objectives of the study: (1) To explore IHC pattern (Ki67, EGFR, Her2neu & ALK) (2) To correlate the IHC pattern to clinical presentation and response to chemotherapy.

    Methods
    Paraffin blocks of 35 cases of NSCLC were retrieved and analyzed. Histopathology sub-typing was done based on WHO classification. IHC markers (Biogenics) EGFR, Her2 neu, ALK & Ki67 were done & interpreted by using intensity of staining and percentage of positive cells. H-score was calculated for EGFR and allocated into low EGFR (< 200) & high (≥200-Positive). Her2neu analysis was graded from 0 to 3+, ALKs scoring was done using 0 to 3+scale and Ki67 was scored low (≤10% cells) and high (> 10% of nuclear positivity).

    Results
    Out of 35 cases studied, 7 cases were <50 years. Male 26, Female 9. 21 cases were smokers. 7 patients had significant weight loss. Morphological classification revealed adenocarcinoma 26 (76%) & squamous 8 (24%). EGFR was positive in 28 cases out of which 21 (80%) were adenocarcinoma and 7 (87%) squamous cell carcinoma. The positivity of Her2 and ALK was seen in one case each. High Ki67 was seen in 21 cases out of which 50% adenocarcinoma & 100% squamous cell carcinoma. EGFR Positivity was observed in 6 (85%) <50 years of age. There was no difference in sex distribution. Loss of weight did not correlate with high Ki67. Among EGFR positive cases high Ki67 was found in 17 cases (58%). The EGFR positivity did not differ between smokers and non smokers. Response (Partial Response & Stable Disease) to either Taxane / Gemcitabine based combination therapy was observed in 90% of low Ki67 group. In EGFR positive, 75% of chemotherapy group had good response (PR+SD) compared to upfront targeted therapy (Erlotinib). All the patients who received upfront targeted therapy were in low performance status.

    Conclusion
    This study has shown some interesting data. The EGFR status did not differ between smokers and non smokers. The observation of percentage positivity of ALK and Her2 was very low in this study. Low Ki67 patients responded well to chemotherapy. The response to treatment in EGFR positive NSCLC with Gemcitabine / Taxane with Platinum based combination chemotherapy was much better than those patients who received upfront EGFR targeted therapy, but needs more patients for statistical significance.