Between January 1981 and December 1991, 4137 adult patients underwent various cardiac procedures via a median sternotomy under cardiopulmonary bypass. The overall infection rate was 1.33%, including superficial wound infections (SWI) (1.18%) and deep sternal infection (DSI) (0.145%). Pericardial and retrosternal suction drains with a vent allowed a better drainage of blood and serosities and probably contributed to our low DSI rate. Eleven factors predisposing to infection were evaluated by Fisher's exact test. Only the operative urgency (P = 0.006), reexploration for bleeding (P = 0.00001) and preoperative renal failure (P = 0.0005) were statistically significant. Twenty of our infected patients had no risk factors for infection. When the risk factors described in the literature were applied to our infected patients, only one had no risk factor.

Objective Immune checkpoint inhibitors are now a standard of care for the management of many metastatic cancers, including non-small-cell lung cancer. Pembrolizumab, a selective anti–PD-1 monoclonal antibody, augments the host antitumoural response. This hyperactivation of the immune system has side effects, the so-called immunerelated adverse effects. The objective of this case report was to review and point out a new pattern of immune checkpoint inhibitor–associated pneumonitis.Case Description A 69-year-old woman with stage iv non-small-cell lung cancer receiving pembrolizumab presented for increased dyspnea. Pembrolizumab-related obstructive bronchiolitis was diagnosed based on a new severe obstructive disorder, without bronchodilator reversibility, and mosaic attenuation on angiography, without other identifiable causes.Summary To our knowledge, this is the first description of a case of pembrolizumab-induced obstructive bronchiolitis. Various patterns of immune checkpoint inhibitor–associated lung disease have been described, and bronchiolitis should be included in the differential diagnosis.

e20671 Background: For metastatic non-small cell lung cancer (NSCLC), guidelines include molecular testing for actionable biomarkers and recommend broad profile testing. Yet previous studies indicate that not all patients with NSCLC receive testing, even for actionable mutations in EGFR, ALK, and ROS. We hypothesized low testing rates for patients calling a community HelpLine and that we could increase rates with one-on-one caller education and free precision medicine services. Methods: Caller statistics were collected on the toll-free Lung Cancer Alliance (LCA) HelpLine from Sept 1, 2016 – Jan 31, 2017. Recruitment to the LungMATCH molecular testing program began Nov 10, 2017. Patients are recruited through conversations on the LCA HelpLine, then consented into Perthera Cancer Analysis (PCA) through an IRB-approved registry protocol. PCA includes tissue acquisition, multi-omic molecular profiling, and medical review of testing results and clinical and treatment history. PCA reports are returned to both treating physicians and patients. Data is being collected longitudinally on treatment decisions, patient outcomes including progression-free and overall survival, and patient experience. Results: Data from the LCA Helpline identified a gap in molecular testing. 50% (57/115) of patients asked if they received any kind of molecular testing replied "No". Of 32 patients who were tested and knew the results, patients indicated potentially actionable changes in EGFR(15), ALK(8), PD-L1(3), RET, MET, BRAF, and HER2, along with KRAS (4). Since LungMATCH launch, 23 interested patients were referred for PCA. Six patients consented and are undergoing PCA with seven more in the consent process. Reasons for non-consent include: doctor refusal, initiation of testing at the treating institution, concern about financial implications, and one death. Updated results will be presented. Conclusions: Our data indicate that patients with lung cancer are not receiving molecular testing in accordance to guidelines. To address this, we created a program through nonprofit-corporate partnership that navigates patients and their physicians through comprehensive precision therapy. This type of program is feasible and there is patient interest.

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Background: For metastatic non-small cell lung cancer (NSCLC), guidelines include molecular testing for actionable biomarkers and recommend broad profile testing. Despite these recommendations, previous studies indicate that not all patients with NSCLC are receiving testing, even for actionable mutations in EGFR, ALK, and ROS. There are widespread gaps in the community setting, and Lung Cancer Alliance (LCA) data show that fewer than 50% of callers to the patient HelpLine have had molecular testing on their lung cancer. Methods: To help address this problem, we developed an innovative program that combines direct patient services with increasing enrollment to clinical studies. Patients are recruited to the LungMATCH molecular testing program through conversations on the LCA HelpLine. They are then entered into the Perthera Program to receive a Perthera Report (PR) through consent into an IRB-approved registry protocol. The Program includes tissue acquisition, multi-omic molecular profiling, and collection of patient treatment history followed by integration into a computational pipeline with extensive drug and clinical trial databases to provide ranked therapeutic options matched to the patient. An every-patient, real-time medical review board then reviews and approves the PR. PRs are returned to both treating physicians and patients. Data are being collected longitudinally on treatment decisions, patient outcomes including progression-free and overall survival, and patient experience. Results: In the first nine months, 72 patients were referred into the Program. The majority of the patients (76%) came from community centers across a wide geographic region in the United States. There were a number of barriers to signing informed consent and completing biopsy identified. Most common reasons included patients in poor health, cost concerns, unsupportive doctors, and patient loyalty to the physician (discomfort with advocating for the testing). Of the first 11 patients who received a PR, 9 had actionable alterations that indicated either a standard-of-care agent or a clinical trial. Actionable alterations were identified by next-generation sequencing, in situ hybridization, and immunohistochemistry. Two patients also had high tumor mutation burden. Conclusions: We introduced a nonprofit-corporate partnership that navigates patients and their physicians through a comprehensive precision-therapy program. We have demonstrated that this type of program is feasible and there is broad patient interest, particularly from patients seen in nonacademic settings. A number of barriers were identified and are being addressed. Importantly, the majority of patients who received a completed PR (82%) had actionable molecular alterations, underscoring the potential impact of the program. Citation Format: Jennifer C. King, Andrew Ciupek, Tara Perloff, Ashley Blanchard, Kimberly Mason, Edik Blais, David Halverson, Joseph Bender, Subha Madhavan, Emanuel Petricoin. Addressing gaps in molecular testing for patients with lung cancer [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr B26.

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