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J.E. Slansky
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P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.01-046 - Characteristics of Complete Remission Cases in Advanced Non-Small Cell Lung Cancer (ID 419)
09:30 - 17:00 | Author(s): J.E. Slansky
- Abstract
Background:
Various types of chemotherapies have been extensively investigated in advanced non-small cell lung cancer (NSCLC). Although median survival times have been getting long, the outcomes remain poor. This study aimed to analyze the characteristics of those with complete remission among advanced NSCLC patients.
Methods:
Based on our hospital database, 1,699 patients who were registered as lung cancer between August 2004 and April 2011 were examined, and Stage III or IV NSCLC patients, whose treatment began between September 2004 and April 2011, were retrospectively evaluated at September 2014. We defined complete remission as a continuous complete response observed in spite of the treatment initiation over three years ago, regardless of treatment continuation.
Results:
Seven patients were observed. Two patients were at stage IIIA, one at stage IIIB, and four at stage IV. The treatment modalities included cytotoxic chemotherapy only (one patient), chemotherapy and EGFR-TKI followed by surgery (one patient), radiosurgery for brain metastasis followed by surgery and chemotherapy (one patient), and chemoradiation (four patients). Three patients had adenocarcinoma, three squamous cell carcinoma, and one large-cell carcinoma. The numbers according to survival time since the date of treatment initiation were two (between three and four years), three (between four and five years), and two (over five years). All cases had complications of inflammatory diseases. In case 1, an acquired immunological response against lung cancer was suggested. The patient had rheumatoid arthritis and stage IV adenocarcinoma with massive pleural effusion, treatment was only 1 course of vinorelbine, and sepsis occurred after chemotherapy. After that, complete remission has been achieved. Acquired cancer immunity was also suggested in case 2, who had stage IV adenocarcinoma with cardiac tamponade. Pericardial drainage was done and three courses of cisplatin and gemcitabine were administered, followed by EGFR-TKI. Gefitinib have continuously been used for four years, however the tumor in the right upper lobe had gradually getting large. The tumor was resected, while EGFR mutation was negative and many inflammatory cell infiltrations were observed. In case 3, oligo-metastatic states have been controlled by surgery and radiation. The patient had stage IV large cell carcinoma with a brain metastasis, the primary pulmonary lesion was surgically removed after cyber-knife therapy. Chemotherapies were started. Oligo-metastatic new brain lesions were firstly cyber-knife therapies, and the relapsed or new lesions were removed by brain surgeries. After the brain surgery, encephalitis and meningitis developed. Many inflammatory cells were observed around and inside the brain tumor. Finally, the brain tumors and the pleural dissemination disappeared. In case 4, who had stage IIIA adenocarcinoma with bulky N2, PET-assisted three-dimensional conformal radiation therapy was used to control oligo-metastases. The tissue types of chemoradiation-induced complete remission were squamous cell carcinoma in three patients and adenocarcinoma in one patient.
Conclusion:
These results suggest that complete remission can be achieved for several types of advanced NSCLC by employing combinations of treatment modalities. Oligo-metastatic states could be controlled by surgery and radiation therapies with or without chemotherapies. The acquired immune response against lung cancer might be important to induce complete remission.
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P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.04-079 - Targeting Antigen Presentation by Tumor Infiltrating B Cells to CD4 T Cells in Non-Small Cell Lung Cancer Patient Tumors (ID 3241)
09:30 - 17:00 | Author(s): J.E. Slansky
- Abstract
Background:
B cells in tumors (TIL-Bs) are detected in non-small cell lung cancer (NSCLC) and their frequency correlates with improved survival, however, the functional mechanism of TIL-Bs in solid tumors is not well understood. We hypothesize that TIL-Bs help generate potent, long-term immune responses against cancer by presenting tumor antigens to CD4 tumor infiltrating lymphocytes (TILs) in primary human lung tumors.
Methods:
not applicable
Results:
Using un-manipulated, primary human B cells from fresh tumor, tumor-adjacent, and normal (cancer-free) lung tissue we observed that the total number of B cells at the site of the tumor versus the tumor-adjacent tissue was increased compared to other immune subsets. Further, in analyzing B cell markers of activation and exhaustion, we observed a spectrum of activation of TIL-Bs. Finally, we showed that TIL-Bs present autologous tumor antigens to CD4 TILs in a subset of NSCLC patients, and that depending on the activation or exhaustion profile of the TIL-Bs, differentiate CD4 TILs to T regulatory cells (Treg). These data suggest that some patients with TIL-Bs have differential function that is influenced by their activation or exhaustion phenotype.
Conclusion:
In conclusion, the anti-tumor functon of TIL-Bs can be stimulated in some NSCLC patients, and TIL-Bs that cannot be stimulated have increased immune exhaustion and promote Treg differentiation. Ultimately, results from this study will help predict which TIL-B functions to target in future TIL-B-specific immunotherapies or in combination with current immunotherapies for NSCLC patients like blockade of the inhibitory receptor, PD-1.
