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S.L. Andarini
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-016 - Pulmonary Tuberculosis among Newly Diagnosed-Therapy Naive Advanced NSCLCÂ in Persahabatan Hospital Jakarta Indonesia (ID 5886)
14:30 - 14:30 | Author(s): S.L. Andarini
- Abstract
Background:
The prevalence of lung cancer increased in the recent years in Indonesia, meanwhile pulmonary tuberculosis (TB) is still a major public health problems in this community. Malignancy such as lung cancer increase the risk of tuberculosis infection and reactivation, therefore evaluation of tuberculosis among lung cancer patients is needed
Methods:
Newly diagnosed, therapy-naive advanced NSCLC subjects were enrolled from a referral respiratory hospital Persahabatan Hospital Jakarta Indonesia between 2014-2015. Active pulmonary tuberculosis were diagnosed by Xpert MTB/ RIF from induced sputum and LPA M. TB culture. Latent Tuberculosis Infection (LTBI) was determined by Quantiferon-TB Gold-In-Tube (QFT-GIT). Demographic and clinical characteristics were evaluated.
Results:
Of 50 lung cancer subjects enrolled, 30 (60%) men with mean of age 55 years old (31- 74 years old). Eighty five percents were adenocarcinoma (42 subjects) and 15% squamous cell lung cancer. Most of them were at end stage (87% stage IV and 13%stage IIIB) with WHO performance status (PS) 1 to 3 (20 % PS 1, 70% PS 2 and 10% PS 3). Comorbidities among this group were COPD (3 ssubjects), diabetes mellitus (2 subjects), hypertension (4 subjects), congestive heart failure (1 subjects). Active tuberculosis were diagnosed in 2 % (1 subject). Based on Quantiferon results, 14 % were positive (7 subjects) and classified as latent tuberculosis infection (LTBI); 60% (30 subjets) classified as non-LTBI (negative Quantiferon result) but 12 (24%) indeterminate cases. The characteristics of LTBI patients were 67% men, two third were adenocarcinomas, 80% stage IV of lung cancer, 80% having WHO PS 2 and 3, 50% were underweight (body mass index (BMI) < 17.5.
Conclusion:
Active pulmonary tuberculosis and latent tuberculosis infection is common among newly diagnosed therapy naive advanced NSCLC in this population. Most of them are men, adenocarcinoma, PS 2-3, and half of them were underweight.
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P3.02b - Poster Session with Presenters Present (ID 494)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 3
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.02b-004 - EGFR Mutation in Squamous Cell Advanced NSCLC in Persahabatan Hospital, Jakarta Indonesia (ID 5878)
14:30 - 14:30 | Author(s): S.L. Andarini
- Abstract
Background:
Tyrosine kinase domain gene mutations of the epidermal growth factor receptor gene (EGFR) have proven to be clinically significant in nonsmall-cell lung cancer (NSCLC), particularly in adenocarcinoma. However, EGFR mutations in other type of lung cancer such as squamous cell lung cancer is uncommon.
Methods:
This is a preliminary study of which EGFR mutations were investigated using mutation-specific High Resolution Melting (HRM) polymerase chain reaction (PCR) from cytologic samples of squamous cell lung cancer. Cytological samples were obtained from bronchoscopy or transthoracal needle biopsy. Trained lung pathologist determined the cytological type of the tumor as squamous cell lung cancer. Immunohistological evaluation were not done since the cytological sample were limited.
Results:
Twenty subjects with confirmed squamous cell lung cancer were enrolled between June 2014 -December 2014 in Pulmonary Refferal Hospital/ Persahabatan Hospital Jakarta Indonesia, of which 18/20 (percents) were male, age between 50-75 years old. Eighty percents subjects has stage IV/metastatis with Performance Status of 2-3 at the time of diagnosis. EGFR mutations were detected in 4 of 20 subjects (20%) . Two subjects harbour exon 19 deletion, and 2 subjects harbour L858R mutation.
Conclusion:
These results suggest that EGFR mutations are found in 20% cytologically confirmed squamous cell lung cancer in this group.
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P3.02b-033 - Filter Paper as Specimen Storage and Transport Medium of EGFR Mutation Testing Collected from Lung Cancer Patients in Remote Areas of Indonesia (ID 6235)
14:30 - 14:30 | Author(s): S.L. Andarini
- Abstract
Background:
Indonesian National Insurance and Formulary mandates EGFR molecular testing for all newly diagnosed lung cancer patients. Cytological smears prepared from pleural effusions are routine sources for molecular testing. However, pathological reviews and molecular diagnostics are not always accessible in many Indonesian remote hospitals. We evaluated filter paper as simple storage and transport medium of pleural effusion sediment to central laboratory.
Methods:
Pleural effusions obtained from 16 lung cancer patients were split and prepared in two paralled methods, ie smeared on cytological slides and sedimented into filter paper. Cytological slides were reviewed by a pathologist, who selected areas enriched with tumor cells for DNA extraction. Pleural effusion sedimented on filter papers were air dried and DNA were extracted. EGFR mutation was detected using combined PCR High Resolution Melting (HRM) and Restriction Fragment Length Polymorphism (RFLP) having analytical sensitivity of detecting 3% EGFR mutant alleles. EGFR genotypes obtained from cytological slides were compared with those from filter paper to determine specificity and sensitivity. Another set of 63 pleural effusion specimens collected on filter papers were also evaluated and tested for EGFR mutation.
Results:
EGFR mutations rates from same patients (N=16) using two different methods were 43.75% and 18.75% using cytology and filter paper, respectively. Mutations L858R (5 cases) and L861Q (1 case) were obtained using cytology, and L858R (3 cases) using filter paper. Agreement between two methods were 75% yielding Kappa value 0.458 (moderate). Diagnostic sensitivity and specificity were 42.86% and 100%, respectively. Another set filter papers with sedimented pleural effusions obtained 63 patients showed 15.9% mutation rate.
Conclusion:
Our data demonstrated that filter paper may serve as ancillary medium to store and transport lung specimens for lung patients residing in remote areas and/or where pathology review is not accessible in many parts of Indonesia. In this study, mutation rate (15.9%), sensitivity (42%) and specificity (100%) using filter paper were similar to mutation rate (22%), sensitivity (47%), specificity (96%) obtained from plasma of Asian lung cancer patients as described recently (Han, B et al 2015). High rate of specificity to detect EGFR mutation may inform therapy choice or diagnosis for patients highly suspected with malignancy. However, poor sensitivity of using filter paper as collection medium points out that patients with negative results should be invited and sent to tertiary hospital for further workup.
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P3.02b-054 - EGFR Mutation Profile in Newly Diagnosed Lung Adenocarcinoma in Persahabatan Hospital, Jakarta-Indonesia (ID 5889)
14:30 - 14:30 | Author(s): S.L. Andarini
- Abstract
Background:
In Indonesia, gefitinib or erlotinib were given for free under National Health System Insurance, for EGFR sensitizing mutaton positive patients. Our previous study showed proportion of common EGFR mutation in Indonesian patients, however, the proportion of uncommon mutation and resistant mutation were not yet known. Here we report the spectrum of EGFR mutation among newly diagnosed-therapy naive adenocarcinoma NSCLC in respiratory referral hospital, Persahabatan Hospital, Jakarta Indonesia.
Methods:
Newly diagnosed-therapy naive lung adenocarcinoma were evaluated for EGFR mutation between September 2015-April 2016. Four exons of EGFR were tested using a combination of PCR High Resolution Melting, fragment sizing, and direct DNA sequencing.
Results:
One hundred and thirty nine subjects were enrolled from September 2015 to March 2016 in Persahabatan hospital, with distribution 63% were male, and 56 years old (mean). Most specimens were obtained using bronchoscopy (31%) followed by TTNA (30%) and pleural effusion (17%). Overall EGFR mutation rate was 61.9%, and more frequent in female ( 72% of female subjects has EGFR mutation whereas only 55% of male subjects has positive results). Of the positive EGFR mutation subjects; 1 % has Exon 18 G17S; 5.8 % Exon 18 G719S; 17.5% Exon 19 In/Del; 43% Exon 21 L858R; and 21% Exon 21 L861Q. The incidence of primary resistant Exon 20 T790M mutation was 11.6% and more frequent in female.
Conclusion:
EGFR mutation is common in Indonesian population of newly diagnosed naive adecarcinoma NSCLC. Baseline rate of T790M was not rare when detected using standard direct DNA sequencing. Further study is needed to elaborate proportion of primary resistant and biological mechanism in Indonesian lung cancer patients.
