Author of

• 16549

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  P1.02 - Poster Session with Presenters Present (ID 454)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Biology/Pathology
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16571

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    P1.02-022 - Establishing Reflex NGS Testing in NSCLC in a Regional Network of County Hospitals in Central Sweden (ID 4759)

    14:30 - 14:30  |  Author(s): S. Mindus
    • Abstract

    Background:
    Extended genetic testing of NSCLC tumor samples provides a foundation for personalized cancer treatment and use of new targeted medication. Testing with Next Generation Sequencing (NGS), mostly performed at university hospitals, has not been available for all patients due to geographic and economic reasons. Many lung cancer patients carry a heavy burden of disease and extensive travelling can negatively impact quality of life. The ability to perform a modern state-of the art work-up at local hospitals, without compromising on diagnostic quality, will enable equal access to personalized treatment for lung cancer patients.
    
    Methods:
    In Gävle County hospital routine diagnostic immunohistochemistry (IHC) on biopsies is performed at the local pathology lab. In the case of NSCLC the formalin-fixed, paraffin embedded (FFPE) tissue samples are sent to Uppsala University hospital for further molecular pathology and NGS testing. A targeted NGS test (18 gene panel) was established for mutation screening of small biopsies and cytology specimens (Moens et al., J Mol Diagn, 2015). Fusion genes - ALK, ROS1 and RET - are analysed by IHC, FISH and nanoString. Structured biobanking of surplus biopsies and blood samples during treatment, for explorative biomarker testing and research, was set up as a regional extension of the UCAN infrastructure, including detailed registration of clinical baseline and real-time follow-up data in a dedicated database.
    
    Results:
    Inclusion of patients in the biobanking cohort started gradually during 2015 in Uppsala, and in February 2016 in Gävle. The cumulative inclusion in the UCAN biobank is updated at www.u-can.uu.se (see Statistics). To date (July 2016) 70 patients have been included at Gävle County hospital covering 95% of the newly diagnosed NSCLC patients. So, far 242 patients from the region were tested by NGS yielding 23 EGFR+ (9.5%), 75 KRAS+ (31%), 5 BRAF+ (2.1%, codon 600), 2 MET (0.8%, exon 14 skipping), 1 ERBB2 (0.4%, exon 20 insertion), and 6 PIK3CA (2.5%, exon 9/20) cases. Fusion gene analysis resulted in 5 ALK+ (2.1%), 1 ROS1 and 1 RET patients.
    
    Conclusion:
    Decentralised local patient care, tissue/blood sampling and biobanking in combination with centralised molecular testing allows advanced lung cancer diagnostics and clinical research in networks of county hospitals. Survival benefits from modern targeted drugs, for national lung cancer cohorts, can only be achieved and evaluated in population-based settings without bias related to selective referral to major cancer centers.