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R.A. Gucalp
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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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P1.07-027 - PD-L1 Expression Analysis in African American (AA) and Hispanic Lung Cancer Patients at a Minority-Based Academic Cancer Center (ID 9734)
09:30 - 09:30 | Author(s): R.A. Gucalp
- Abstract
Background:
PD-L1 testing has been incorporated into the standard treatment paradigm given recent immunotherapy approvals for metastatic lung cancer (LC). Minority populations are notoriously under-represented in large immunotherapy clinical trials. Thus, we examined PD-L1 expression profiles in a minority-based academic cancer center. Among 989 patients with newly diagnosed LC at Montefiore Medical Center (MMC) from 2014-2015, 330 (33%) were AA and 195 (20%) were Hispanic.
Method:
Retrospective chart review was conducted to determine PD-L1 expression patterns between 1/1/14-6/19/17 at MMC. PD-L1 testing was performed using 22C3pharmDx IHC and positivity was defined as >/=1%. Chi-squared statistical analysis was performed with SPSS. All statistical tests were two-sided.
Result:
We identified 92 patients who had PD-L1 testing, with a median age of 66. Based on race, 43 (46.7%) were AA, 20 (21.7%) were White, 20 (21.8%) were Other and 9 (9.8%) were race unknown. Based on ethnicity, 27 (29.3%) were Hispanic, 54 (58.7%) were non-Hispanic and 11 (12%) were ethnicity unknown. Adenocarcinoma was the dominant histology (61%). Nine (9.8%) were EGFR mutant and 1 (1.1%) had an ALK rearrangement. Fresh tissue was used in 50% of cases. PD-L1 TPS >50% was found in 30 (33%), 1-49% in 22 (24%) and <1% in 39 (42%). At time of this analysis, 29 (32%) had received immunotherapy. In the racial analysis, 9 were excluded due to unknown race. Amongst the 43 AA patients, 28 (65%) were PD-L1 positive, and 15 (35%) were negative compared to the 40 non-AA patients which were PD-L1 positive in 20 (50%) and negative in 20 (50%). AAs trended toward increased PD-L1 positivity compared to non-AAs although it was not significant (p=0.163). In the ethnicity analysis, 11 were excluded due to unknown ethnicity. Amongst the 27 Hispanic patients, 11 (40.7%) were PD-L1 positive and 16 (59.3%) were negative compared to the 54 non-Hispanic patients who were PD-L1 positive in 37 (68.5%) and 17 (31.5%) were negative. Analysis suggests there is a negative association between Hispanic ethnicity and positive PD-L1 testing (p=0.016).
Conclusion:
This is the first known report on PD-L1 expression in AA and Hispanic patient populations. We found that Hispanics had significantly more PD-L1 negative cases compared to non-Hispanics. Correlation with response to immunotherapy is ongoing. Continued research and focus on minority populations will further help to narrow known health disparities based on race and ethnicity.
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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: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-008 - Lung Cancer Screening Improves Mortality: Examining Screening Patterns in an Urban Underserved Community (ID 9134)
09:30 - 09:30 | Author(s): R.A. Gucalp
- Abstract
Background:
The landmark Lung Cancer Screening (LCS) Trial demonstrated a significant reduction in mortality. However, European LCS trials have not confirmed such benefit. We examined the impact of LCS-led diagnosis on the mortality of newly diagnosed lung cancer patients at an urban medical center.
Method:
Medical records of patients diagnosed with primary lung cancer for the period 2013-2015 (n=638) were reviewed to identify those who had an established primary care provider (PCP), were LCS-eligible/ non LCS-diagnosed, and LCS-eligible/LCS-diagnosed as per the United States Preventative Services Task Force (USPSTF) guidelines. Baseline characteristics between LCS-eligible/non-diagnosed patients and LCS-eligible/diagnosed patients were analyzed using chi-squared and Wilcoxon-Mann-Whitney tests. Kaplan-Meier curves were generated, and predictors of overall survival were evaluated using Cox proportional hazards modeling.
Result:
134 primary lung cancer patients had an established PCP and were LCS-eligible; 19/134 (14%) were LCS-diagnosed. LCS-eligible/LCS-diagnosed patients were of younger age (p=0.03), English-speaking (p=0.03), of higher socioeconomic status (p=0.02), active smokers (p<0.01), and had earlier disease stages (p=0.02) than LCS-eligible/non-diagnosed patients. All-cause mortality was significantly lower in LCS-eligible/diagnosed patients compared to LCS-eligible/non-diagnosed patients (p=0.03). Disease stage was found to be the main factor associated with higher mortality by multivariate regression analysis (HR: 6.13, stage 4 vs. stage 1-2, p<0.01).
Conclusion:
To our knowledge, this is the first report of lung cancer mortality differences in LCS eligible patients as a function of them undergoing or not LCS in a single-center setting since the inception of the USPSTF guidelines. Patients with an LCS-led diagnosis had a reduced mortality, probably as a result of having an earlier disease stage, which echoes the findings of large prospective LCS trials. LCS-led diagnosis rates remain low among lung cancer patients. Fully implementing the USPSTF guidelines constitutes a great unrealized opportunity to decrease lung cancer mortality.
