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C. Parks



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    P1.04 - Poster Session with Presenters Present (ID 456)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Pulmonology
    • Presentations: 1
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      P1.04-003 - Incidence of Non-Caseating Granulomas Diagnosed in PET Avid Mediastinal/Hilar Nodes in Patients with Known Breast Cancer (ID 4189)

      14:30 - 14:30  |  Author(s): C. Parks

      • Abstract

      Background:
      Breast cancer is known to metastasize to the lung.. Most breast malignancies are clinically staged using radiographic modalities (e.g. PET scans). Importantly, many inflammatory disorders will present similar lymph node FDG-uptake on PET- as that of metastasized breast cancer. The latter confuses the treatment for individuals within whom both undiagnosed autoimmune disorders and breast cancer co-occur. We aim to examine the frequency of non-caseating granulomas diagnosed in PET avid mediastinal/hilar nodes in patients with known breast cancer.

      Methods:
      Between March 2013 and December 2015, 46 patients diagnosed with breast cancer were staged by PET-CT. Those with positive result in the mediastinum/hilum underwent linear endobronchial ultrasound (EBUS) for pathologic diagnosis and ensuing treatment

      Results:
      Of the 46 patients with avid mediastinal/hilar adenopathy, 31 (67%) had malignant cytology on EBUS; the remaining 15 had positive PET but negative cytology for malignancy. Twelve of the 15 patients with false positive PET had reactive lymph nodes, and 3 had non-caseating granulomas on cytology (table 1). . Table 1: Results from EBUS Procedure and Resulting Percentage Following Identification of Sarcoid-like Symptoms

      Total Number of patients in study: n=46 with positive PET Number of patients Percentage of total (all PET positive patients) Percentage among negative patients
      Positive EBUS 31 67.40%
      Negative EBUS 12 26.10% 80%
      Negative/Non-caseating granulomas EBUS 3 6.50% 20%
      Twenty percent of the patients with negative cytology and positive PET had non-caseating granuloma, and 6.5 % of all patients with positive PET had non-caseating granulomas.

      Conclusion:
      Conclusion: This study represents the largest cohort of breast cancer patients, where the incidence of non-caseating granulomas is investigated in PET-positive mediastinal/hilar nodes. We conclude that PET may not be sufficient for staging the mediastinum in patients with breast cancer and, in selected patients, pathologic staging should be done. In addition, the finding of non-caseating granulomas in these patients may either indicate an incidental diagnosis of early stage sarcoidosis, or an inflammatory reaction to the current treatment (sarcomatoid reaction). We also suggest that these patients should be followed for any manifestations of sarcoidosis.

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    P1.07 - Poster Session with Presenters Present (ID 459)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: SCLC/Neuroendocrine Tumors
    • Presentations: 1
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      P1.07-032 - Most Common Genomic Alterations in SCLC (ID 5112)

      14:30 - 14:30  |  Author(s): C. Parks

      • Abstract

      Background:
      Lung cancer is the leading cause of cancer death in US. The American Cancer Society’s estimates for lung cancer in the United States for 2016 are: approx 224,390 new cases of lung cancer and approx 158,080 deaths. Approximately 10-15% of lung cancers are classified as small cell (SCLC). These cancers portend a poor prognosis. Genomic sequencing of non-small cell lung cancer led to developing of new therapeutic modalities, i.e. targeted therapy with superior results to conventional cytotoxic chemotherapy. At this time, there is no approved targeted therapy for SCLC. In order to develop targeted therapies we need to identify and characterize molecular targets (alterations). This study aims to report our experience with genomic sequencing of SCLC

      Methods:
      We performed a retrospective analysis of a dataset of 54 cases of SCLC, who underwent genomic sequencing. Patients were treated at 5 tertiary referral centers, between October 2012 and June 2016. The recorded data included: age at diagnosis, date of the genomic sequencing, genomic alteration (affected genes and the type of molecular alteration identified). For genomic profiling we used a platform commercially available (FoundationOne).

      Results:
      We obtained 54 samples from 54 patients. Age range is 42 to 75 years, mean 60 and median 61 years old. All cases had a histologic diagnosis of SCLC. The genomic analysis found 88 affected genes with 230 alterations. The most common affected genes: Tp53 alteration, 45 cases (83%) and Rb1 33 cases (61%). There were an average of 4.3 mutations per patient; with a median of 4 mutations per patient, with a minimum of 0 and a maximum of 13. Figure 1



      Conclusion:
      Sustained investigations and sequencing of larger numbers of SCLC are aiming to identify potential actionable mutations in these tumors. The ultimate goal is to determine new therapies and optimal treatment strategy based on the genomic profile.

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    P1.08 - Poster Session with Presenters Present (ID 460)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P1.08-083 - Hyperthermic Pleural Lavage for Pleural Metastases (ID 5343)

      14:30 - 14:30  |  Author(s): C. Parks

      • Abstract

      Background:
      To evaluate the safety and efficacy of hyperthermic pleural lavage (HTPL) with cisplatin in patients who have undergone cytoreductive surgery pleurectomy/decortication (PD) for isolated chemoresistant pleural metastases (PM). This may be an alternative treatment for patients with isolated pleural metastases with controlled primary disease.

      Methods:
      After Health Care System and Cancer Committee approval, 10 patients with unilateral chemo resistant pleural metastasis were registered prospectively. The patients’’ primary sites of malignancy were under control for a median of 40 months (range, 28-76). Patients underwent a unilateral radical P/D and lymph node dissection, 60 minute pleural lavage (1,500 – 1,700 cc/min) with 225 mg/m2 of cisplatin at 42°C. Cisplatin levels were drawn at time zero, 1 hour, 4 hours, and 24 hours after completion of HTPL.

      Results:
      Median age was 53 years (range, 38-64); 7 patients (70%) were women. Primary tumor: breast 5, colon 2, and thymic, renal cell and anal cancer 1 each. Surgical approach was a thoracotomy in 9 patients (90%). Morbidity included atrial fibrillation in 3 (30%), and acute respiratory distress syndrome in 1 (10%). Median hospital stay 7 days (range, 4-14). Serum cisplatin levels peaked at 4 hours after lavage; none to toxic range. Median dose of cisplatin was 386 mg (range, 299-450); no patient developed renal insufficiency. Median follow up was 10 months (range, 1-15). 8 patients had no signs of malignant disease at last follow up; 1 patient (anal cancer – 6 months) developed local recurrence and 1 patient (renal cell cancer – 9 months) developed contralateral pleural disease. All patients experienced improved quality of life, respiratory function, and reduced pleuritic pain.

      Conclusion:
      Surgical cytoreduction of chemoresistant PM followed by HTPL with cisplatin was well tolerated with no cisplatin-related toxicities. Early results are promising. This novel treatment for patients with isolated secondary PM represents the first series reported. Longer follow-up is warranted to determine a survival and quality of life advantage as well as defined inclusion and exclusion criteria.