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John R Handy
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P1.07 - Immunology and Immunotherapy (ID 693)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.07-019 - Immune Cell Infiltrates in Non-Small Cell Lung Cancer and Interleukin-22 Expression (ID 9238)
09:30 - 09:30 | Author(s): John R Handy
- Abstract
Background:
In non-small cell lung cancer (NSCLC) the TNM staging remains standard for prognostic assessment and therapy decisions. Nevertheless, stage-specific outcomes vary significantly, indicating a need for additional prognosticators.Lymphocytic infiltrates are found in 6-11% of NSCLC patients and associated with a significant increase in disease-free and overall survival (OS). We now want to assess T cells and PD-L1[+] cells in tissue microarrays (TMAs) cored at the invasive margin (IM) and tumor center (CT) via multispectral imaging. We asked the question of their link to interleukin-22 (IL-22). Furthermore, we want to elucidate the role of IL-22 in prognosis, therapy response and recurrence.
Method:
TMAs were generated from formalin-fixed paraffin embedded tissue of 89 curatively resected patients with stage IA-IIIA NSCLC. TMAs included each 3 cores from CT and IM, selected from areas with the most dense lymphocytic infiltrates. Immunolabelling followed mIHC technique for PD-L1, CD8, CD3, FoxP3, CD163 and Cytokeratin. IL-22 expression was analyzed by immunohistochemistry (double-staining: IL-22, CD3).
Result:
We could show that the ratio of CD8[+] cells in CT compared to IM is significantly higher in stage I than stage II/III NSCLC. A similar pattern was seen for CD3[+], but not for ratios of PD-L1[+], FoxP3[+] or CD163[+]. Based on the CT/IM ratios of CD8[+] and PD-L1[+] we established an 'Invasive Score' ranging from 0–2. A Score of 0 (low CD8, low PD-L1) had a median OS of 45 months. A score of 1 (high CD8 or PD-L1) had a median OS of 53 months. A score of 2 (high CD8 and PD-L1) had a 62% survival rate at 72-months: Combining the rate of CD8 T cell infiltrates with PD-L1 positivity in the tumor is a stronger predictor for survival than one based only on CD8 CT/IM ratio. We will now combine these results with the IL-22 expression and present the respective progression free and OS data.
Conclusion:
Multispectral assessment of CD8 and PD-L1 performed on “hot-spots” NSCLC does show a clear correlation with clinical outcome: A tumor-controlling immune response appears to be associated with the permeability of the tumor to CD8 cells. This is consistent with other reports that immune infiltrates are associated with improved outcome. Current studies are seeking to verify these findings in a larger cohort of patients with NSCLC. *Authors Stump and Reu contributed equally to this study. Supported by the Harder Family, Lynn and Jack Loacker, Robert W. Franz, Wes and Nancy Lematta, the Murdock Trust and Providence Medical Foundation.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-009 - Results of Low-Dose CT Lung Cancer Screening at a Non-University Tertiary Hospital System in Oregon, USA (ID 9398)
09:30 - 09:30 | Presenting Author(s): John R Handy
- Abstract
Background:
Since the National Lung Screening Trial (NLST), doubt has been expressed as to whether the results could be replicated in a community setting. We aim to document our experience over 3.5 years and over 3000 CT scans.
Method:
The Providence Cancer Center in Portland Oregon initiated a lung cancer screening program in 2013 that included 7 hospitals (2 non-university tertiary medical centers and 5 community hospitals). Lung cancer screening candidates were referred by primary care providers from Noverember 2013 through May 2017. Candidates were screened using NLST criteria. Initially, shared decision making was provided by the team, but in 2015 transitioned to the PCP. Dedicated radiologists at the tertiary centers read all CTs and assigned Lung-RADS assessment categories. All Lung-RADS category 4 scans were reviewed by a multidisciplinary team of thoracic surgery, pulmonary, radiology and oncology to generate management recommendations. The navigator recorded all imaging, procedures, pathology, staging and complications. This individual ensured follow-up scans were completed.
Result:
2983 patients were referred. 353 were not eligible and 529 declined participation. 1950 underwent initial CT screening. 178 were presented at the multidisciplinary conference. Additional imaging included 1160 follow CT scans and 75 PET scans. Invasive diagnostic procedures included bronchoscopy (27) and CT-guided biopsy (19). Thoracic surgical procedures included pneumonectomy (1); lobectomy (21); segmentectomy or wedge resection (10). 55 cancers were diagnosed. 40 non-small cell lung cancers were found including 26 stage I; 5 stage II; 4 stage III and 5 stage IV. 6 small cell lung cancers were diagnosed including limited stage (3) and extensive stage (3). Lung cancer rate was 2.4%. 9 extra-thoracic malignancies were diagnosed including thyroid, renal cell (4), breast, colon, liver and prostate. The intervention rate was 5.6% with 46 major procedures (surgery) and 64 minor procedures (bronchoscopy, CT-guided biopsy, EUS, EGD). Adverse event rate was low and included pneumothorax (8) with 4 requiring chest tube, intra-operative bleeding requiring thoracotomy (1) and post-operative bleeding requiring repeat thoracoscopy (1). There was one death in a post-operative lobectomy patient.
Conclusion:
Low-dose CT screening for lung cancer can be done with low intervention and complication rates in a non-university setting using a systematic, multidisciplinary approach. This large group of screened patients demonstrates a stage shift toward early stage lung cancers with complication rates approximating those of the NLST. Our data contradict the argument that lung cancer screening cannot be done successfully and safely in the community.
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P2.13-021 - Community Network Lung Cancer Screening Experience Underrepresents Medically Underserved and Geographically Remote Individuals (ID 10402)
09:30 - 09:30 | Author(s): John R Handy
- Abstract
Background:
The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality. However, it’s study centers may not have represented remote populations with low socioeconomic status and/or health care access. Previous reports on other cancers have demonstrated higher rates of screening in urban populations, with lower adoption in underserved and geographically remote communities. We aimed to quantify the proportion of screened individuals from medically underserved and geographically remote areas represented in our multi-state hospital network lung cancer screening programs (LCSPs).
Method:
We performed a multi-institution review using data from individuals enrolled in Pacific Northwest LCSPs, which form part of a multi-state hospital network. Individuals from programs spanning Washington State, Oregon, Montana, and Alaska from 2012-2016 were included. Definitions include: medically underserved area [MUA; healthcare resources deficient region], medically underserved population [MUP; area with economic/cultural/linguistic barriers to primary care services], health professional shortage area [HPSA; primary care physician shortage].
Result:
We identified a total of 2,379 screening participants. Of these, 22% (529) resided in a medically underserved area and 5% (108) were from a medically underserved population. Only 9% (216) resided in a HPSA, compared to the combined state data reporting a rate of 20% HPSA residents. Individuals lived a median of 6 miles from the screening site. Data stratified by state is shown in the figure, and demonstrates a high capture rate of individuals residing in MUAs in Montana. Figure 1
Conclusion:
All sites showed poor penetration into communities identified as MUPs and HPSAs. All sites also had poor penetration into MUAs; except for Montana, likely due to its overwhelming rural nature. However, the vast majority of screening participants lived in close proximity to screening centers. Therefore, novel approaches such as telemedicine and mobile screening clinics may be needed to reach underserved populations for LCS.
