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Shengxiang Ren
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JCSE01 - Joint IASLC-CSCO-CAALC Session (ID 63)
- Event: WCLC 2019
- Type: Joint IASLC-CSCO-CAALC Session
- Track:
- Presentations: 1
- Moderators:Chunxue Bai, Tony Mok, Yi-Long Wu, Qing Zhou, Nan Wu
- Coordinates: 9/07/2019, 07:00 - 11:15, Toronto (1985)
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JCSE01.26 - PD-1 Inhibitor Plus Chemotherapy as 2nd/Subsequent Line Setting Demonstrate Superior Efficacy over PD-1 Inhibitor Alone in Pts of Advanced NSCLC (ID 3863)
07:00 - 11:15 | Presenting Author(s): Shengxiang Ren
- Abstract
Abstract
Background
PD-1/PD-L1 inhibitors have become standard of care as the 2nd-line setting and also approved as 1st line setting when combined with doublet chemotherapy in patients with advanced NSCLC. This study aims to compare the efficacy of PD-1 inhibitor plus chemotherapy with PD-1 inhibitor alone as 2nd/subsequent lines setting in patients with advanced NSCLC
Methods
Patients who received PD-1 inhibitor monotherapy or PD-1 inhibitor plus chemotherapy as 2nd/subsequent lines setting in Shanghai Pulmonary Hospital, Tongji University were retrospectively collected. Detailed clinicopathologic characteristics and therapeutic outcomes were analysis.
Results
From January 2016 to February 2019, 148 patients who meet the criteria were included. Among them, 116 were in PD-1 inhibitor monotherapy group and 32 were in PD-1 inhibitor plus chemotherapy group. Chemotherapy regimens were pemetrexed(n=9), docetaxel(n=2), nab-paclitaxel(n=18) and gemcitabine(n=3). The baseline characteristics such as age, gender, smoking status, histology, PD-1 mono-antibodies, line of therapy were similar in the 2 groups. Combination group showed a favorable ORR (28.1% vs. 13.8%, p=0.055) and a significantly longer PFS(median 4.9 vs 2.5 months, p=0.005) compared with ICI monotherapy. Overall survial (OS) data was immature in the cutoff date of follow up. In the subgroup of 96 patients (monotherapy group n=69/ Combination group n=27) who were included as 2nd line setting, PD-1 inhibitor plus chemotherapy had significantly higher ORR(ORR:33.3% vs 18.8%, p=0.129) and longer PFS(median PFS: 4.9 vs 2.9 months, p=0.041).
Conclusion
PD-1 inhibitor plus chemotherapy as 2nd/subsequent lines setting demonstrated superior efficacy over PD-1 inhibitor alone in patients with advanced NSCLC.
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P1.01 - Advanced NSCLC (ID 158)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-62 - Association of Baseline Pulmonary Fibrosis with the Outcome of PD-1 Inhibitor in Patients with Advanced Non-Small Cell Lung Cancer (ID 2942)
09:45 - 18:00 | Author(s): Shengxiang Ren
- Abstract
Background
PD-1/PD-L1 inhibitors have become standard care for previously treated advanced non-small cell lung cancer (NSCLC). However, not all patients are suitable for the immunotherapy. This study aimed to investigate the efficacy and safety of PD-1/PD-L1 inhibitors in patients with advanced NSCLC and pre-existing pulmonary fibrosis (PF).
Method
Patients who had a NSCLC diagnosis, received anti-PD-1/PD-L1 monotherapy and had baseline chest HRCT screen at Shanghai Pulmonary Hospital, Tongji University were retrospectively collected from January 2016 to February 2019. The pre-existence of PF was identified by reviewing baseline chest imaging. Baseline clinicopathologic characteristics, treatment outcomes and immune-related pneumonitis were collected.
Result
116 patients were included with 61 age < 65. Among them, 97 (83.6%) were male, 76 (65.5%) were smoker, 51 (44%) were squamous, 61 (52.6%) received anti-PD-1 monotherapy (Pembolizumab n=62, Nivolumab n=28) as 2nd line setting, 28 (24.1%) had PF prior to PD-1 inhibitors. Baseline characteristics such as age, gender, ECOG PS, smoking history, pathology are similar between patients with or without PF. Patients with PF had a comparable response (ORR: 25% vs 15.9%, p=0.277, figure A), disease control (DCR: 60.7% vs 48.9%, p=0.274, figure B) and PFS (median 2.5 vs 2.8 months, p=0.950). The incidence of immune-related pneumonitis in the entire cohort was 9.2%, which was numerally higher in PF group (17.9% vs 6.8%, p=0.172, figure C). No death from immune-related pneumonitis occurred.
Conclusion
NSCLC patients with pre-existing PF showed comparable response to PD-1 inhibitors but a higher incidence to immune-related pneumonitis.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-30 - Hepatitis B Infection or Aminotransferase Increase Associate with Poor Outcome of Anti-PD-1 Monotherapy in Patients with Advanced NSCLC (ID 2508)
10:15 - 18:15 | Author(s): Shengxiang Ren
- Abstract
Background
Previous study demonstrated that the existence of liver metastases at the commencement of immunotherapy was associated with poor response. Since hepatitis B infection and liver dysfunction were higher prevalent in China, this study aimed to investigate the efficacy and safety of PD-1/PD-L1 inhibitor in Chinese NSCLC patients with hepatitis B infection or liver dysfunction.
Method
We retrospectively collected the patients who were diagnosed with non-small cell lung cancer and received anti-PD-1 monotherapy at Shanghai Pulmonary Hospital, Tongji University School of Medicine, China, from January 2016 to February 2019. Detailed clinicopathologic characteristics, therapeutic outcomes, hepatitis biomarker test and liver function test were collected.
Result
135 patients were enrolled with 73(54.1%) aged <65 years old. Among them, 113(83.7%) were male, 84(62.2%) were smoker, 57(42.2%) were squamous, 69(44.4%) received anti-PD-1 monotherapy (Pembolizumab n=28, Nivolumab n=21) as 2nd line setting, 5(3.7%) patients had hepatitis B infection and 17(12.6%) had increased ALT or AST. The baseline characteristics such as age, gender, smoking status, histology, PD-1 mono-antibodies, line of therapy was similar between hepatitis infection or liver dysfunction group vs. normal group. Hepatitis infection or liver dysfunction group had a lower ORR (9.5% vs. 17.5%, p=0.553, Figure A), significantly shorter PFS (1.6 months vs. 3.0 months, p<0.050, Figure B) when compared with these patients without. Out of the 22 patients with hepatitis or increase transaminase, 35.7% deteriorated the grading of alanine or aspartate aminotransferase increased.
Conclusion
NSCLC patients with hepatitis B infection or increased transaminase showed a high incidence of hepatic disfunction and poor outcome to anti-PD-1 monotherapy.
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P2.04 - Immuno-oncology (ID 167)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.04-57 - Predictive and Prognostic Value of CTC Monitoring in Advanced NSCLC Patients Treated with Immune Checkpoint Inhibitors (ID 1165)
10:15 - 18:15 | Author(s): Shengxiang Ren
- Abstract
Background
Immune checkpoint inhibitors (ICI) have recently emerged as a treatment option for selected patients with advanced non-small-cell lung cancer (NSCLC). However, there is a lack of effective biomarker to predict the treatment response and monitor disease progression. In this prospective observational study, we aimed to investigate the predictive and prognostic value of folate receptor-positive circulating tumor cell (FR+CTC), a well-established lung cancer biomarker, in advanced NSCLC patients treated with ICIs.
Method
Advanced NSCLC patients with at least one measurable lesion and expected to undergo ICIs treatment were recruited. Peripheral blood samples were collected from each participant at baseline, after each cycle of ICI treatment, and on disease progression. FR+CTCs were enumerated by using negative enrichment and ligand-targeted polymerase chain reaction methods. Treatment efficacy was analyzed according to the iRECIST criteria. The correlation of FR+CTC level and its dynamic changes with radiological responses was evaluated.
Result
Of the 35 patients, 17 received first-line treatment, 10 received second-line treatment, and 8 received third-line treatment or above. CTCs were detected (≥8.7FU/3ml) in 80.0% of patients at baseline. The baseline CTC of first-line/second-line therapy patients was significantly higher than that of third-line and above therapy patients (median values 16.68 vs 8.36, P=0.017). Meanwhile, there was no significant difference in baseline CTC values between different pathological subtypes and whether PD-L1 was expressed or not. For the radiological responses, after at least two cycles of ICI treatment, PR, SD, and PD were found in 10, 8, and 4 patients, respectively. The CTC count in the PD group at baseline was significant higher than that of the disease control (PR+SD) group (P=0.033). Similarly, the CTC value after two cycles of ICI treatment in PD group (17.84 ± 7.03) was higher than SD/PR group (12.50 ± 4.94), but not statistically significant (P=0.081). However, the changes of CTCs after one or two cycles of immunotherapy were poorly related to the treatment response (P>0.05), perhaps because of the polarization trend of CTC changes in the PR group after treatment.
Conclusion
In sum, these data confirm the predictive significance of CTCs in advanced NSCLC patients treated with immune checkpoint inhibitors. The baseline CTCs value correlated significantly with radiological response. Further studies are needed to confirm whether CTCs can be used as a prognostic factor for advanced non-small cell lung cancer.
