147O - Correlation of molecular status and anatomic sites of metastases (mets) at diagnosis (Dx) of non-small cell lung cancer (NSCLC)

Date 07 May 2017
Event ELCC 2017
Session ESMO-IASLC Best Abstracts
Presenter Chantal Kuijpers
Citation Annals of Oncology (2017) 28 (suppl_2): ii52-ii55. 10.1093/annonc/mdx094
Authors C. Kuijpers1, L. Hendriks2, J. Derks2, A. Dingemans2, A. Van Lindert3, M. Van den Heuvel4, R. Damhuis5, S. Willems6
  • 1Dept. Of Pathology, University Medical Center Utrecht, 3584 CX - Utrecht/NL
  • 2Dept. Of Pulmonary Diseases, Grow School For Oncology And Developmental Biology, Maastricht University Medical Center (MUMC), Maastricht/NL
  • 3Dept. Of Respiratory Medicine, University Medical Center Utrecht, Utrecht/NL
  • 4Dept. Of Thoracic Oncology, Het Nederlands Kanker Instituut Antoni van Leeuwenhoek (NKI-AVL), Amsterdam/NL
  • 5Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht/NL
  • 6Dept. Of Pathology, University Medical Center Utrecht, Utrecht/NL



Non-squamous (ns)-NSCLC is often driven by (targetable) molecular alterations, such as EGFR mutations (EGFR+), KRAS mutations (KRAS+), or ALK translocation (ALK+). Patterns of mets may differ between alterations, which may have implications for mets screening or treatment decisions. We assessed in a nationwide stage IV ns-NSCLC cohort whether molecular status is associated with anatomic sites of mets sites at Dx.


All patients (pts) with stage IV ns-NSCLC from 2013, without a recent history of cancer, were identified from the Netherlands Cancer Registry, in which anatomic sites of mets before treatment initiation are recorded. Tumors were matched to the Dutch Pathology Registry (PALGA), and data on molecular testing (EGFR, KRAS, ALK) were extracted. Correlation between molecular status and anatomic sites of mets was assessed. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios (OR) with 95% confidence intervals (CI).


In total, 2884 pts with stage IV ns-NSCLC were identified. Included for analysis were: EGFR + (n = 220; 7.6%), KRAS + (n = 775; 26.9%), ALK + (n = 42; 1.5%) and triple-negative (n = 1117; 38.7%). Most frequent mets sites were bone (33.7%), lung (23.6%), pleura (23.4%), and brain (22.5%). EGFR+ tumors significantly more often had bone mets (49.1%) than KRAS + (OR 2.01, 95% CI 1.48-2.72), ALK + (OR 2.22, 95% CI 1.09-4.50), and triple-negative tumors (OR 2.09, 95% CI 1.56-2.81). Compared to triple-negative tumors, EGFR+ tumors more often had metastasized to the pleura (OR 1.50, 95% CI 1.08-2.08) and liver (OR 1.52, 95% CI 1.00-2.25), and less often to the brain (OR 0.67, 95% CI 0.45-0.99) and adrenal gland (OR 0.49, 95% CI 0.31-0.79). KRAS+ and ALK+ tumors significantly more often had metastasized to the lung (OR 1.35, 95% CI 1.09-1.68) and liver (OR 2.09, 95% CI 1.00-4.35) than triple-negative tumors.


Molecular status of NSCLC is associated with biological behavior. At diagnosis, 49.1% of EGFR+ pts had bone mets. In particular, because EGFR+ pts have a notably better prognosis, screening for and prevention of skeletal-related events in NSCLC pts with an EGFR mutation is reasonable.

Clinical trial identification

Legal entity responsible for the study

University Medical Centre Utrecht


The research is sponsored by Roche and Pfizer.


C. Kuijpers, S. Willems: The research is sponsored by Roche and Pfizer. A-M. Dingemans: Attended advisory boards from Roche, Lilly, Clovis, AstraZeneca, MSD, Boehringer Ingelheim, fees were paid to institute. All other authors have declared no conflicts of interest.