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S.P. Gangadharan



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    ORAL 36 - Translational Science/Radiation (ID 151)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      ORAL36.05 - Results of a National Database Review of Video-Assisted Thoracoscopic versus Open Lobectomy after Induction Therapy (ID 1533)

      17:28 - 17:39  |  Author(s): S.P. Gangadharan

      • Abstract
      • Presentation
      • Slides

      Background:
      Minimally invasive lobectomy has become the standard of care approach for early stage non-small cell lung cancer (NSCLC); however video assisted thoracoscopic (VATS) lobectomy after induction therapy remains controversial. We sought to evaluate perioperative outcomes of VATS and open lobectomy after induction therapy using a national database.

      Methods:
      A cohort study of patients that underwent VATS and open lobectomy after induction chemotherapy and/or radiotherapy was conducted using the National Surgical Quality Improvement Program (NSQIP) database from 2005 through 2012. Perioperative complications and mortality were compared between groups. Comparisons were made using two-sided student’s t-test or chi square test as appropriate.

      Results:
      A total of 6730 patients underwent lobectomy during the study period and 166 patients had prior induction therapy (open = 132, VATS = 34). There were no statistically significant differences in age, comorbidities or ASA class between groups. There were no significant differences in the surgeon specialty between groups (cardiac, thoracic, general, and vascular). Operative time was similar (VATS: 228 minutes, Open: 190 minutes; p = 0.07). Perioperative complications, return to OR, respiratory complication, mortality, and hospital length of stay were similar between groups. Table 1. Patient Demographics

      N (%) All (N = 166) Open (N = 132) VATS (N = 34) P-value
      Age, yrs; Mean (SD) 62.9 (10.2) 62.4 (10.7) 65.2 (7.6) 0.077
      Female 88 (53) 72 (55) 16 (49) 0.563
      Diabetes 16 (10) 11 (8) 5 (15) 0.325
      COPD 35 (21) 26 (20) 9 (27) 0.479
      Creatinine > 1.2 17 (10) 13 (10) 4 (12) 0.757
      ASA Class ≥4 18 (11) 14 (11) 4 (12)
      VATS = video assisted thoracoscopic, COPD = chronic obstructive pulmonary disease, ASA= American Society of Anesthesia class Table 2. Post-Operative Outcomes
      N (%) All (N = 166) Open (N = 132) VATS (N = 34) P-value
      LOS, days; mean (SD) 7.3 (6.1) 7.4 (6.1) 6.6 (6.3) 0.471
      Wound complication 5 (3) 5 (4) 0 0.584
      Pneumonia 16 (10) 15 (11) 1 (3) 0.197
      Reintubation 18 (11) 15 (11) 3 (9) 1.000
      Respiratory complication 25 (15) 22 (17) 3 (9) 0.419
      Return to OR 15 (9) 14 (11) 1 (3) 0.311
      In hospital mortality 9 (5) 8 (6) 1 (3) 0.687
      30 day mortality 13 (8) 12 (9) 1 (3) 0.471
      VATS= video assisted thoracoscopic, LOS = length of stay, OR= operating room

      Conclusion:
      This is the first review of a prospective national database comparing outcomes for VATS and open lobectomy after induction therapy for NSCLC. VATS lobectomy appears to be safe with no increased morbidity or mortality compared to open in patients that had prior induction therapy. A larger series of matched VATS and open approaches after induction therapy is needed.

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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
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      P3.04-027 - Targeted next Generation Sequencing in Lung Cancer: Genomic Oncology in Daily Practice (ID 103)

      09:30 - 09:30  |  Author(s): S.P. Gangadharan

      • Abstract
      • Slides

      Background:
      Tumor genotyping using single gene assays (SGAs) is a standard approach in the management of advanced NSCLC. We evaluated how therapeutic decision-making was altered by the introduction of next generation sequencing (NGS) into routine clinical practice.

      Methods:
      Clinicopathologic data, tumor genotype, and clinical decisions were retrospectively compiled over 6 months following introduction of NGS assay use at our institution.

      Results:
      82 tumors were genotyped: 75 by SGAs, 7 by NGS alone, and 22 by SGAs and NGS. SGAs identified 10 EGFR-mutated, 3 ALK-rearranged, and 21 KRAS-mutated tumors. Sequential testing with SGAs followed by NGS was more common for patients with EGFR/ALK/KRAS-negative tumors (22/29 or 75.9%) and adenocarcinomas (ACs) (21/22 or 95.5%). Most EGFR/ALK/KRAS-negative tumors were sent for NGS (21/35 or 60%). Of 17 ACs, 10 harbored abnormalities in a known driver oncogene (1-EGFR, 2-ERBB2, 1-ROS1, 1-RET, 2-MET, 2-KRAS and 1-MAP2K1). Primary NGS was used mainly in squamous cell cancers (SCCAs) (6/7 or 85.7%). In 7 SCCAs, 1 sample had a driver aberration (FGFR1); 6 had other genomic events (all with TP53 mutations). NGS was successful in 24/29 (82.7%) tumors overall. There was a trend toward increased assay failure in those samples undergoing sequential SGAs followed by NGS as compared to primary NGS alone. All patients with EGFR-mutated or ALK-rearranged tumors received approved tyrosine kinase inhibitors (TKIs) or were consented for clinical trials. Clinical decisions were impacted by NGS results in 8/17 (47.0%) ACs (trial consideration in 6, off-label TKI use in 2). Therapeutic decisions were influenced by NGS results in 0/7 SCCAs (p=0.0538 when compared to ACs). Actionable therapeutic targets were significantly more frequent in patients with a ≤15 pack-year tobacco history vs. those with >15 pack-years of tobacco use (17/27 or 62.9% vs. 3/42 or 7.1%, respectively; p<0.0001). Only 1/9 (11%) of oncologists demonstrated a detailed understanding of the genomic technologies being used. Figure 1



      Conclusion:
      Targeted NGS can identify a significant number of driver events in lung ACs—particularly in never/light smokers—for which targeted therapies are available or in development. However, for SCCAs, NGS results are less likely to alter standard practice, barring participation in biomarker-driven studies. Future research into the cost effectiveness and optimal use of NGS in NSCLC is warranted, as well as continued efforts to improve provider awareness and application of genomic technologies.

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