Features of Failed Genomic Testing in Advanced NSCLC Specimens

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S147-S148
Author(s):  
E M Gardner ◽  
W Li ◽  
M B Cohen ◽  
U Topaloglu ◽  
S Ramkissoon
Keyword(s):  
Lung Cancer ◽  
Medical Center ◽  
The United States ◽  
Tumor Location ◽  
Advanced Lung Cancer ◽  
Genomic Testing ◽  
Error Type ◽  
Common Features ◽  
Test Standards ◽  
Genomic Test

Abstract Introduction/Objective Lung cancer continues to be the leading cause of cancer death in the United States. For individuals with advanced lung cancer, genomic testing has the potential to direct patients and their care teams toward a targeted therapy or a specific clinical trial. In some instances, however, submitted specimens fail to meet test standards or do not survive the analytic process. The implications of a failed genomic test for patients can be grave. In this study, we aim to identify common features among non-small cell lung cancer (NSCLC) samples submitted from our medical center that failed FoundationOne testing (Foundation Medicine Inc. Cambridge, MA). Methods From all 366 NSCLC samples listed in the FoundationOne database, we identified 31 (8.5%) unique and accessible accession numbers submitted from our institution that failed processing between 2013-2018. These 31 samples were compared for common features, including NSCLC subtype, tumor location, sampling method, tumor size, submitting team, and reported error type. Results From all of our samples, 45% (14/31) were adenocarcinoma, 29% (9/31) were squamous cell carcinoma (SCC), 22% (7/31) were NSCLC otherwise unspecified, and 3% (1/31) was adenoid cystic carcinoma. The majority of samples (20/31) were sampled from primary sites including core biopsies (n=9), FNA (n=5), lobectomy specimens (n=4), and bronchial washings (n=2). The remaining metastatic samples came from sites including lymph node, bone, brain, and adrenal gland. Per FoundationOne: the majority of samples (27, 87%) failed following sequencing, while the remaining four (4, 13%) samples failed in the analytic phase. Conclusion At this time, it remains unclear why many of these samples failed sequencing. Our next steps include comparing the degree of necrosis from samples and comparing our failed sample pool to a successful sample pool of equal size to remove potential confounding factors.

scholarly journals Medical Oncologists’ Experiences in Using Genomic Testing for Lung and Colorectal Cancer Care

2017 ◽  
Vol 13 (3) ◽  
pp. e185-e196 ◽  
Author(s):  
Stacy W. Gray ◽  
Benjamin Kim ◽  
Lynette Sholl ◽  
Angel Cronin ◽  
Aparna R. Parikh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Care Delivery ◽  
Participation Rate ◽  
The United States ◽  
Genomic Testing ◽  
Genomic Test ◽  
Medical Oncologists ◽  
Health Care Delivery Systems ◽  
Test Use

Purpose: Genomic testing improves outcomes for many at-risk individuals and patients with cancer; however, little is known about how genomic testing for non–small-cell lung cancer (NSCLC) and colorectal cancer (CRC) is used in clinical practice. Patients and Methods: In 2012 to 2013, we surveyed medical oncologists who care for patients in diverse practice and health care settings across the United States about their use of guideline- and non–guideline-endorsed genetic tests. Multivariable regression models identified factors that are associated with greater test use. Results: Of oncologists, 337 completed the survey (participation rate, 53%). Oncologists reported higher use of guideline-endorsed tests (eg, KRAS for CRC; EGFR for NSCLC) than non–guideline-endorsed tests (eg, Onco typeDX Colon; ERCC1 for NSCLC). Many oncologists reported having no patients with CRC who had mismatch repair and/or microsatellite instability (24%) or germline Lynch syndrome (32%) testing, and no patients with NSCLC who had ALK testing (11%). Of oncologists, 32% reported that five or fewer patients had KRAS and EGFR testing for CRC and NSCLC, respectively. Oncologists, rather than pathologists or surgeons, ordered the vast majority of tests. In multivariable analyses, fewer patients in nonprofit integrated health care delivery systems underwent testing than did patients in hospital or office-based single-specialty group settings (all P < .05). High patient volume and patient requests (CRC only) were also associated with higher test use (all P < .05). Conclusion: Genomic test use for CRC and NSCLC varies by test and practice characteristics. Research in specific clinical contexts is needed to determine whether the observed variation reflects appropriate or inappropriate care. One potential way to reduce unwanted variation would be to offer widespread reflexive testing by pathology for guideline-endorsed predictive somatic tests.

Clinical outcome of chemoradiotherapy in elderly patients with non-small cell lung cancer at G.V Montgomery Veterans Affairs Medical Center

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19683-19683
Author(s):  
M. Choi ◽  
W. Chan ◽  
J. Jaiwatana ◽  
T. Khansur
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Median Survival ◽  
Concurrent Chemoradiotherapy ◽  
Medical Center ◽  
Survival Rates ◽  
The United States ◽  
Lung Cancer Patients

19683 Background: More than 2/3 of lung cancer patients are age = 65 and the proportion of elderly patients are expected to rise in the United States. However data on the use of optimal chemoradiotherapy in this group of patients are limited. Methods: All lung cancer patients = 65 years, who received both chemotherapy and radiation therapy at the G. V. Montgomery VAMC between Jan 2000 to Dec 2005, were analyzed from tumor registry and computerized medical records. Patients who only received palliative radiation therapy for bone and brain metastasis were excluded. Results: Among 652 lung cancer patients diagnose, 46 patients = 65 years received both chemotherapy and radiation therapy over the 6 year study period. The median age was 72 (range:65–84) and 70% of the patients were = 70 years. All patients were male with 65% white and 35% black population. The majority of patients were stage III (85%) while there was one stage I and six stage II patients. 41 patients (89%) were able to complete the planned radiation therapy and median dose delivered was 6140 cGy. The chemotherapy regimen was carboplatin and paclitaxel either weekly during radiation therapy and every three weeks in sequential treatment. There was only 1 treatment related mortality and only 15% of patients survived less than 6 months. The 1, 2, 3 year survival rates were 67%, 24%, and 15% respectively and median survival was 15.3 months. 15 patients were treated sequentially(S) with chemotherapy (median cycle-3) followed by radiation therapy and 31 patients concurrently (C) with chemoradiotherapy. (median- 5 weekly treatment) The survival among the two groups did not differ statistically. (median survival-19.1 month (S) vs. 14 month (C) p=0.78) Conclusions: Both sequential and concurrent chemoradiotherapy is feasible and beneficial in elderly patients with lung cancer. Sequential treatments might be as effective as concurrent chemoradiotherapy in elderly VA patient population. No significant financial relationships to disclose.

scholarly journals Burden of Hospitalization in Patients with Advanced Lung Cancer in the United States

2013 ◽  
Vol 16 (7) ◽  
pp. A424
Author(s):  
G. Taylor-Stokes ◽  
A. Rider ◽  
A. Roughley ◽  
S. Iyer
Keyword(s):  
United States ◽  
Lung Cancer ◽  
The United States ◽  
Advanced Lung Cancer

scholarly journals Whole-Genome Sequencing for Investigation of Possible Hospital Transmission of Tuberculosis

2020 ◽  
Vol 41 (S1) ◽  
pp. s435-s435
Author(s):  
Jenna Rasmusson ◽  
Priya Sampathkumar ◽  
Nancy Wengenack
Keyword(s):  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Information ◽  
The United States ◽  
Advanced Lung Cancer ◽  
Massive Hemoptysis ◽  
Whole Genome ◽  
Foreign Born

Background: Whole-genome sequencing (WGS) is increasingly used in epidemiological investigations of infectious diseases. We describe the use of WGS to identify drug-resistance variants of tuberculosis (TB) and to determine potential transmission between patients at an academic medical center. Methods: Chart review and interviews of patients and healthcare workers along with WGS of M. tuberculosis isolates from the patients. Clinical information: In June 2019, patient A, a 20-year-old college student born in the United States was admitted with massive hemoptysis. The patient was identified as having active, cavitary TB that was acid-fast smear positive, and the mycobacterial culture grew M. tuberculosis. Patient B, a 40-year-old foreign-born patient with advanced lung cancer was acid-fast smear negative, but mycobacterial cultures were positive for M. tuberculosis. The 2 patients had overlapping stays in the medical intensive care unit. There was concern that patient B had acquired TB during her stay in the hospital from patient A, who was highly infectious. WGS showed that the mycobacterial isolates from the 2 patients were unrelated. Patient A was a student at a college campus where the state health department had previously issued a health advisory concerning active pulmonary TB in a student; and 7 additional TB cases were subsequently identified through contact investigation. Patient A denied any contact with other persons who were part of the outbreak and had not been included in the contact investigations of any of the cases. Of the 8 outbreak cases, 6 had been seen at our institution and had isolates available for testing. WGS showed that these 6 isolates matched patient A, establishing that she was part of the college outbreak. Conclusions: WGS was useful in establishing the source of M. tuberculosis infection in a patient who did not have known exposure to TB and in demonstrating that transmission of TB did not occur in the hospital.Funding: NoneDisclosures: None

scholarly journals Appropriateness of Imaging for Lung Cancer Staging in a National Cohort

2014 ◽  
Vol 32 (30) ◽  
pp. 3428-3435 ◽  
Author(s):  
Leah M. Backhus ◽  
Farhood Farjah ◽  
Thomas K. Varghese ◽  
Aaron M. Cheng ◽  
Xiao-Hua Zhou ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Imaging ◽  
Pet Imaging ◽  
Regional Variation ◽  
Clinical Stage ◽  
Locally Advanced ◽  
The United States ◽  
Advanced Lung Cancer ◽  
Provider Education ◽  
National Cohort

Purpose Optimizing evidence-based care to improve quality is a critical priority in the United States. We sought to examine adherence to imaging guideline recommendations for staging in patients with locally advanced lung cancer in a national cohort. Methods We identified 3,808 patients with stage IIB, IIIA, or IIIB lung cancer by using the national Department of Veterans Affairs (VA) Central Cancer Registry (2004-2007) and linked these patients to VA and Medicare databases to examine receipt of guideline-recommended imaging based on National Comprehensive Cancer Network and American College of Radiology Appropriateness Criteria. Our primary outcomes were receipt of guideline-recommended brain imaging and positron emission tomography (PET) imaging. We also examined rates of overuse defined as combined use of bone scintigraphy (BS) and PET, which current guidelines recommend against. All imaging was assessed during the period 180 days before and 180 days after diagnosis. Results Nearly 75% of patients received recommended brain imaging, and 60% received recommended PET imaging. Overuse of BS and PET occurred in 25% of patients. More advanced clinical stage and later year of diagnosis were the only clinical or demographic factors associated with higher rates of guideline-recommended imaging after adjusting for covariates. We observed considerable regional variation in recommended PET imaging and overuse of combined BS and PET. Conclusion Receipt of guideline-recommended imaging is not universal. PET appears to be underused overall, whereas BS demonstrates continued overuse. Wide regional variation suggests that these findings could be the result of local practice patterns, which may be amenable to provider education efforts such as Choosing Wisely.

End-of-life care for elderly patients with advanced lung cancer in the United States and Ontario.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. 6021-6021
Author(s):  
K. Yabroff ◽  
J. Warren ◽  
L. C. Barbera ◽  
K. Bremner ◽  
J. Hoch ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Elderly Patients ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Advanced Lung Cancer ◽  
Life Care

A retrospective cohort study of inpatient chemotherapy utilization in hospitalized advanced lung cancer patients in the United States.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6611-6611
Author(s):  
Hyunseok Kang ◽  
Sungjin Kim ◽  
Zhengjia Chen ◽  
Bassel F. El-Rayes ◽  
Johann Christoph Brandes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Performance Status ◽  
The United States ◽  
Advanced Lung Cancer ◽  
Loss Of Function ◽  
Lung Cancer Patients ◽  
Risk Of Death ◽  
Chemotherapy Administration ◽  
Co Morbidity

6611 Background: The administration of chemotherapy to patients with limited performance status and within 6 weeks of death is considered an indicator of poor quality care. We assessed predictors of inpatient chemotherapy use and the risk of death in hospitalized lung cancer patients treated with chemotherapy in the US. Methods: Data were obtained from all US states that contributed to the Nationwide Inpatient Sample (NIS) by Agency for Health Care Research and Quality (AHRQ) in 2006 and 2010. Lung cancer diagnoses and inpatient chemotherapy were identified using Clinical Classification Software (CCS) code which is based on ICD9 and CPT codes. Univariate and multivariate analyses were performed to compare patients based on chemotherapy administration using ANOVA, chi-square test, and logistic regression. Initial analysis in the 2006 NIS data was validated in the 2010 NIS data. Results: 24,025 and 24,323 eligible hospitalized lung cancer patients including 1,005 (4.2 %) and 869 (3.6 %) patients treated with chemotherapy were identified in 2006 and 2010 respectively. Female gender, radiation use, urban location and longer length of stay (LOS) were significantly associated with receipt of chemotherapy. Chemotherapy administration was associated with prolonged hospital stay (14.1 ± 9.8 vs. 8.8 ± 8.1 days, p<.001) and increased odds of death in unadjusted analyses. Adjusted analysis showed significant increased odds of death in chemotherapy-treated patients with metastatic disease (vs. no metastasis); poor performance status indicated by severe loss of function (vs. minor/moderate loss of function) and increased LOS (Table). Conclusions: Inpatient administration of chemotherapy to hospitalized US lung cancer patients is associated with higher mortality and can be explained by treatment given to patients with high co-morbidity and disease burden. [Table: see text]

scholarly journals The Clinical Impact of Comprehensive Genomic Testing of Circulating Cell-Free DNA in Advanced Lung Cancer

2018 ◽  
Vol 13 (11) ◽  
pp. 1705-1716 ◽  
Author(s):  
Smadar Laufer-Geva ◽  
Anna Belilovski Rozenblum ◽  
Tal Twito ◽  
Roxana Grinberg ◽  
Addie Dvir ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Impact ◽  
Advanced Lung Cancer ◽  
Genomic Testing ◽  
Cell Free Dna ◽  
Free Dna ◽  
Circulating Cell Free Dna

A phamacoeconomic analysis of personalized dosing versus fixed dosing of pembrolizumab in first-line PD-L1 positive non-small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9013-9013 ◽  
Author(s):  
Daniel A. Goldstein ◽  
Noa Gordon ◽  
Michal Davidescu ◽  
Moshe Leshno ◽  
Conor Ernst Steuer ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
The United States ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Small Cell Lung ◽  
First Line ◽  
Line Setting

9013 Background: In October 2016 pembrolizumab became the new standard of care for first-line treatment of patients with metastatic non-small cell lung cancer (mNSCLC) whose tumors express programmed death ligand 1 in at least 50% of cells. The FDA recommended dose is 200mg every three weeks. Multiple studies have demonstrated equivalent efficacy with weight-based doses between 2mg/kg to 10 mg/kg. The objective of this study was to compare the economic impact of using personalized dosing (2mg/kg) versus fixed dosing (200mg) in the first line setting of mNSCLC. Methods: We performed a budget impact analysis from the US societal perspective to compare fixed dosing with personalized dosing. We calculated the target population and weight of patients that would be treated with pembrolizumab annually in the first-line setting. Using survival curves from the KEYNOTE 024 trial with Weibull extrapolation we estimated the mean number of cycles that patients would receive. Using the Medicare average sales price we calculated the difference in cost between personalized and fixed dosing. Results: Our base case model demonstrates that the total annual cost of pembrolizumab with fixed dosing is US$ 3,440,127,429, and with personalized dosing it is US$ 2,614,496,846. The use of personalized dosing would lead to a 24% annual saving of US$ 825,630,583 in the United States. Conclusions: Personalized dosing of pembrolizumab may have the potential to save approximately 0.825 billion dollars annually in the United States, likely without impacting outcomes. This option should be considered for the first-line management of PD-L1 positive advanced lung cancer.

Differences in rates of low-dose computed tomography screening for lung cancer amongst various outpatient care centers.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 245-245
Author(s):  
Lukas Delasos ◽  
Anna Kookoolis ◽  
Meghana Singh ◽  
Alla Turshudzhyan ◽  
Nerea Lopetegui-Lia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Community Health ◽  
Health Center ◽  
Low Dose ◽  
Medical Center ◽  
Community Health Center ◽  
Lung Cancer Screening ◽  
The United States ◽  
Low Dose Computed Tomography ◽  
University Of Connecticut

245 Background: Despite low-dose computed tomography (LDCT) screening for lung cancer recommended by the United States Preventive Services Task Force (USPSTF) demonstrating a relative reduction in mortality, there remains low rates of testing nationwide. Yet studies are limited regarding specific differences in screening rates amongst various outpatient care settings. Methods: We performed retrospective chart reviews of patients followed by resident providers within an academic internal medicine residency program who met USPSTF guidelines for lung cancer screening between 2015-2020. This was conducted at three separate outpatient clinic sites including a state-funded academic institution, inner city community health center, and veteran affairs medical center. Data collection included patient demographic and smoking histories as well as rates of ordered and completed LDCT screening. Results: A total of 832 patients were identified as current or former smokers between the ages of 55 and 80 years: 320 from Hartford Hospital Community Health Center (HHCHC), 262 from University of Connecticut Health Center (UCHC), and 250 from the Veteran Affairs (VA) Medical Center. 85 (27%) of these patients from HHCHC, 84 (32%) from UCHC, and 56 (22%) from the VA met USPSTF eligibility criteria for LDCT screening. Overall compliance rates of screening were found to be 44% at HHCHC, 59.5% at UCHC, and 51.8% at the VA. Results are outlined in Table. Conclusions: Screening rates for lung cancer with LDCT remain low but have been steadily improving throughout the United States following new recommendations and increased awareness provided by multiple medical organizations. We sought to compare differences in compliance rates amongst various outpatient clinics within the same internal medicine residency program at University of Connecticut. Our findings demonstrate significant differences in LDCT screening for lung cancer between the program’s community health center versus its state and federally funded outpatient clinics. Automatic reminders to providers can potentially improve rates of lung cancer screening. Patients should also be educated about the importance of screening to improve adherence with imaging. [Table: see text]

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