In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. 10592-10592
Abstract:
10592 Background: Genomic profiling for personalized targeted therapy is emerging for NSCLC. DFCI introduced systematic testing for mutations in BRAF, HER2, PIK3CA and ALK translocations in addition to EGFR and KRAS in July 2009 as part of a prospective study. We report the utility, efficacy and safety of CT guided TTNB in this cohort. Methods: Patients with stage IV or relapsed NSCLC seen at the DFCI were referred to BWH for CT guided TTNB of their tumors to identify driver mutations prior to starting therapy. Pathology specimens were dissected and analyzed by PCR-Sanger sequencing for mutations in selected exons of EGFR, KRAS, BRAF, PIK3CA and HER2. ALK rearrangements were detected with fluorescence in-situ hybridization (FISH). Testing was performed after the pathologist deemed that the tissue was adequate. Complications such as pneumothorax and hemorrhage were recorded. Admission rates were also recorded. Results: Between 7/1/2009 and 1/09/2011, 81 patients underwent TTNB. The median age was 63 years. 54 (67%) were female, 66 (88%) were former/current smokers and 58(72%) had stage IIIB/IV disease. 64(79%) patients had sufficient tissue on core biopsies for genomic profiling, 4 (6%) of the 64 patients failed analysis for ALK rearrangements due to less than 50 tumor cells on the hybridized slide. The number of samples obtained ranged from 1-5 (2 cm 18-20 (G)). Lesions biopsied ranged in size from 1.2–8.9 cm. Mutations were identified in 38/81 (46.9%) patients (EGFR: 18; KRAS: 17; ALK: 2; PIK3CA: 1). 23(28.3%) had pneumothoraces 15( 〈 10%), 5 (10-30%) and 3( 〉 30%). 6 (7%) patients needed chest tubes. 9 (11%) were admitted post procedure for observation (8 for (24hrs) and 1 (72hrs). 19(23%) (18 grade1; 1 grade 2) had intra-parenchymal hemorrhage. A higher rate of pneumothorax was observed with the 18 gauge needles (p =.05). 15 of 20 (75%) patients with EGFR, HER2, BRAF or ALK alterations were treated with molecularly targeted therapy based on their genetic alteration. Conclusions: CT guided TTNB is a feasible, safe and efficacious technique for genomic profiling for targeted therapy and enables the acquisition of sufficient tissue for gene mutation analyses.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2012.30.15_suppl.10592
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2012
detail.hit.zdb_id:
2005181-5
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