152P - The clinical utility of next-generation sequencing in lung cancer

Date 15 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Poster lunch
Topics Personalised/Precision medicine
Non-small-cell lung cancer
Basic Principles in the Management and Treatment (of cancer)
Presenter Anna Belilovski Rozenblum
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors A. Belilovski Rozenblum1, M. Ilouze1, E. Dudnik1, D. Flex1, A. Dvir2, L. Soussan-Gutman2, N. Peled1
  • 1Thoracic Cancer Unit, Rabin Medical Center Davidoff Cancer Centre, Beilinson Campus, 49100 - Petach Tikva/IL
  • 2Oncotest, Teva Pharmaceutical Industries Ltd., Shoam/IL

Abstract

Background

Targeted therapy significantly prolongs survival in adenocarcinoma of the lung. The current diagnostic practice includes EGFR and ALK testing, while other driver mutations may exist and their blockade may be beneficial as well. Next-Generation Sequencing (NGS) can accurately reveal more actionable genomic alterations than standard diagnostic methods, when performed either upfront, in reflex to initial diagnostic negative results or at treatment failure. However, limited data exists regarding the true influence of these tests on clinical decisions in lung cancer.

Methods

This retrospective study includes 101 sequential stage IV lung cancer patients (predominantly adenocarcinoma), that were electively profiled with tumor somatic capture-based NGS between November, 2011 and October, 2015 at the Davidoff Cancer Center, Rabin Medical Center, Israel. Demographic data, clinico-pathologic characteristics and treatment outcomes were collected.

Results

101 sequential advanced lung cancer patients who performed capture-based NGS (median age – 63 years, 53% females, 45% never smokers, 85% adenocarcinoma) were included. NGS was performed upfront or following previous negative/non-conclusive EGFR/ALK testing in 15% and 85% of patients, respectively. 50% of patients performed NGS before 1st line therapy and 50% after treatment failure. One or more actionable genomic alterations were found by NGS in 83% of the patients, with most common genes affected being KRAS (15.1%), EGFR (13.7%), STK11 (6.2%), ALK (5.5%), RET (5.5%), ERBB2 (4.8%) and MET (4.8%). Seventeen patients were diagnosed with an EGFR/ALK aberration after previous negative/false approved standard molecular testing. NGS testing resulted in a change in treatment strategy in 42 patients (42%). With targeted treatment based on the NGS results, overall response rate was 64.3% (complete response rate – 23.8%, partial response rate – 40.5%, stable disease – 9.5%). Survival analysis is not matured yet.

Conclusions

This study indicates that NGS is crucial in lung adenocarcinoma with a decision change in almost half of the patients in spite of previous molecular testing. It also reassures the >60% response rate for targeted therapies in lung cancer, which will probably translate into a survival benefit in the future.

Clinical trial identification

This study was approved by the ethical committee of Rabin Medical Center (approval no. 0391–14 RMC).

Legal entity responsible for the study

Rabin Medical Center (Clalit)

Funding

Rabin Medical Center (Clalit)

Disclosure

E. Dudnik: Consultant for BI, Merck/MSD, Roche Pharmaceuticals, Astra Zeneca and received payments upon expenses. A. Dvir, L. Soussan-Gutman: Employee of Teva Pharmaceutical Industries Ltd. N. Peled: Consultant for Pfizer, BI, Roche, AZ, MSD, BMS, Lilly, Novartis and NovellusDx. All other authors have declared no conflicts of interest.