Evidence-based recommendations for the year 2017 specifically included the recommendation to test all non-squamous Stage IV lung cancer tumors for EGFR, ALK, and (starting in August 2017) ROS-1 mutations, as well as for expression of PD-L1 (starting in May 2017). For patients with Stage IV squamous cell lung cancer, testing for tumor expression of PDL1 (starting May 2017) and ROS-1 (August 2017) was recommended; if patients with squamous cell lung cancers had no smoking history, or mixed adeno-squamous histology, then EGFR and ALK testing were additionally recommended. NCCN guidelines otherwise recommend a CT of chest and upper abdomen, CBC, and chemistry profile for all patients with Non-Small cell lung cancer at the time of diagnosis. Additional PET/CT of whole body and MRI of brain is recommended specifically for Stage IV patients. Methods All Non-Small Cell Lung cancers diagnosed in 2017 at Augusta Health with Stage IV disease were identified by chart review. Cases were divided and charts reviewed separately as either Non-squamous or Squamous cell lung cancers. The elements of the pretreatment initial evaluation, including the molecular markers and PD-L1 expression assessed , and initial treatment were individually reviewed, and summarized. Results NON-SQUAMOUS CELL LUNG CANCER (#25) Table 1. Initial Pretreatment Evaluation Non-Squamous Discussion Based upon this study, it appears that there is a high level of compliance at Augusta Health with appropriate testing and treatment of Stage IV non-small cell lung cancer patients who are eligible for treatment, especially in regard to targetable mutations and PD-L1 expression. Most patients underwent elements of the initial evaluation and pretreatment evaluation (Tables 1 and 3). Those that did not undergo advanced testing with PET/CT and/or MRI of Brain were either treated elsewhere, or were not candidates for active treatments. 8 AUGUSTA HEALTH • CANCER PROGRAM ANNUAL REPORT continued on page 9 Table 2. Molecular / Immunologic Testing Non-Squamous SQUAMOUS CELL LUNG CANCER (#10) Table 3. Initial Pretreatment Evaluation Squamous Table 4. Molecular / Immunologic Testing Squamous
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