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A7353 - Molecular Testing of Lung Cancer
Author Block: A. Trabolsi1, E. Rodriguez2; 1internal medicine, mount sinai medical center, Miami Beach, FL, United States, 2Hematology/Oncology, mount sinai medical center, Miami Beach, FL, United States.
Rationale: a growing body of research has demonstrated a relationship between genomic alternations and response of advanced-stage lung cancer to targeted therapies. We examined the incidence of mutational testing of epidermal growth factor gene (EGFR), anaplastic lymphoma kinase (ALK) rearrangements among patients diagnosed with non-small-cell lung cancer at the Mount Sinai Medical Center. Our objective were to identify the prevalence of of clinically actionable EGFR/ALK mutations, and to determine whether testing and treatment were guideline concordant.Methods: A retrospective review was conducted of consecutive patients with non-small cell lung cancer adenocarcinoma diagnosed in 2015 at the Mount Sinai Comprehensive Cancer Center. We analyzed the prevalence of EGFR/ALK mutations and prescription of EGFR/ALK tyrosine kinase inhibitor treatment based on pharmacy records. Patients demographic and clinical characteristics were collected from the Cancer Registry Database. Results: Among 49 patients diagnosed at the Mount Sinai Medical Center with advanced adenocarcinoma of the lung in 2015, 10 patients (20%) had sensitizing EGFR mutations, 27 (55%) were EGFR wilde type, and 12 (24%) had unknown EGFR status. EGFR mutations were mostly found in women (60%), never and light smokers (75%). ALK testing was negative on 34 (69%) patients, 15 (30%) had unknown ALK status. There were no ALK positive cases identified in this cohort. There was a rare case with EGFR and ROS alternations identified in the molecular testing. EGFR/ALK testing was not done in 12 patients (24%). EGFR and ALK inhibitor administration was in agreement with test results in the majority of cases (97%).Conclusions: Routine molecular assessment was applied in Stage IV NSCLC adenocarcinoma patients according to national guidelines in 75% of cases. The rate of sensitizing EGFR mutations was higher (20%) than the reported average of 10-15%. As expected, there was a higher percentage of women and never to light smokers among EGFR+ patients. There were no ALK+ rearrangements identified in this cohort, compared to a national average of 2-3%. The majority of EGFR mutant patients (97%) received appropriate EGFR targeted therapy as first and/or second line in accordance to clinical guidelines. Considering these results, reflex testing in the pathology department for all new diagnoses of advanced adenocarcinoma should be implemented to reach a 100% compliance rate with national guidelines. In addition, biopsy techniques to assert sufficient tissue collection should be discussed with surgeons (core biopsy over FNA) and utilization of liquid plasma biopsy to allow further test for limited tissue samples.