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V. Lorandi
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-029 - A Case of a Patient Harboring an EGFR Insertion of Exon 20 and Long Lasting Clinical Response to Afatinib (ID 9136)
09:30 - 09:30 | Author(s): V. Lorandi
- Abstract
Background:
Lung cancer remains a leading cause of mortality worldwide. Evolution in molecular biology has expanded and the identification of somatic mutations in the epidermal growth factor receptor (EGFR) as a clinically relevant oncogene also selected a subgroup of patients. Most commonly described as activating mutations, both deletion of exon 19 and L858R point mutation in exon 21 account for nearly 90% of all EGFR mutated patients. These patients usually benefit from tyrosine kinase inhibitors (TKIs). On the other hand, some patients harboring specific EGFR mutations – such as exon 20 insertions – do not benefit from the same strategy.
Method:
We describe a case report of a patient with advanced lung cancer. A female, 39-year-old patient was first diagnosed in late 2015 when she presented with dyspnea and lower back pain. Biopsy of the primary lung mass as well as a bone lytic lesion both revealed an adenocarcinoma. PET-CT showed extensive lymphangitic carcinomatosis, bone and cervical lymph node involvement. She underwent 5 cycles of cisplatin-pemetrexed with a good radiologic partial response and very good clinical response. During chemotherapy, the first molecular test (Cobas Z 480 Roche) became available showing an insertion of exon 20 in the EGFR gene.
Result:
Patient then requested an alternative treatment given that she was not inclined to accept maintenance with chemotherapy. We then proposed a short trial with afatinib, even though the chances of response were very low. She was started on afatinib PO 40mg/day on March 14[th,] 2016. Three weeks later the patient developed a grade 3 diarrhea and the drug was withheld until her symptoms resolved. She resumed afatinib PO at 30mg/day on April 20[th,] 2016. Her first radiologic evaluation two months later showed stable disease and she was kept on treatment and reported to feel healthier. Her second evaluation on November 2016 then showed a partial response, mainly in the bone and she was continued on oral TKI. New imaging studies on March 2017 revealed a progression of her disease only 12 months later.
Conclusion:
There is a lack of data addressing patients harboring rare and unique EGFR gene mutations. Most exon 20 insertions identified in patient samples have not been tested against reversible EGFR TKIs. Extrapolations from the few tested mutations might not apply for other exon 20 mutations. It is imperative that patient-derived cell lines of common EGFR exon 20 insertion mutations are developed to enhance our preclinical understanding on these tumors.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-018 - CT-Guided Percutaneous Barium Marking Prior to Video-Assisted Thoracoscopic Surgery (VATS) for the Localization of Small Pulmonary Nodules (ID 9497)
09:30 - 09:30 | Author(s): V. Lorandi
- Abstract
Background:
Widespread CT scan availability generates the challenge of managing small pulmonary lesions generally undetected on chest radiographs. Preoperative nodule localization is critical for adequate diagnosis and an accurate resection. Metallic hook wire localization under CT is a widely used method but can be associated with pneumothorax, hook related discomfort, and dislodgement. CT-guided percutaneous barium marking (CT-GPBM) can be simpler, low cost procedure, without risk of dislodgement, and radiopaque on fluoroscopy, increasing resection accuracy. Barium marking through bronchoscopy has been previously reported. This study describes our experience with CT-GPBM in the diagnosis and management of ground glass abnormalities and small pulmonary nodules.
Method:
Between January 2013 and May 2017, 36 patients underwent preoperative CT-GPBM and VATS resections at our institution, and were retrospectively reviewed. All cases were discussed in multidisciplinary rounds. After CT localization and local anesthesia, a 21-gauge Chiba needle was utilized, under CT guidance, to inject 0,2 mL of 140% barium sulfate suspension. A control CT confirms the marking and verifies possible complications. CT-GPBM and VATS resection are performed in the same day. VATS resection is performed under fluoroscopy guidance. Finally, the specimen is submitted to fluoroscopy to confirm a complete resection.
Result:
Thirty-six different cases were analyzed (41.7% male / 58.3% female). Median age was 65 (ranging from 32 to 91). 18/36 were never smokers. Most lesions were identified on routine follow-up CT (21/36 - 58.3%). Many had previous history of cancer (24/36 - 66.7%). 31/36 (86.1%) were single nodules - median size of 14mm (ranging from 5 to 47). Solid lesion was the most common radiologic finding (21/36 - 61,8%), while the others were semi-solid or ground glass abnormalities. Pathological findings confirmed primary lung cancer in 41,6% of cases (15/36). Adenocarcinoma was the most common histology. Nine patients had benign diseases. Metastatic lesions represented 33,3% (12/36), most derived from colorectal cancer. No patient had reported complications.
Conclusion:
This analysis shows that CT-GPBM is an effective, easy and safe pre-operative (VATS) localization procedure, allowing accurate diagnosis and resection of small or faint pulmonary nodules, avoiding thoracotomies in benign diseases and metastatic tumors. Data will be updated for presentation.
