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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
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
P1.01-002 - Response Evaluation and Predictors in NSCLC During Treatment with AntiPD-L1 (ID 1264)
09:30 - 17:00 | Author(s): U. Tirelli
Treatment of metastatic NSCLC patients with immune-checkpoint medicine is intriguing for the potential efficacy, even in difficult setting such as smokers or squamous-carcinoma; however it may be difficult to evaluate the clinical response due to the lack of reliable immuno-monitoring markers and the possibility of radiological pseudo-progression.
Herein we report five cases treated with antiPD-L1(MPDL3280A, Genentech): four patients were male and one female, all of them were ex-smokers, affected by metastatic NSCLC; 4 adeno- and 1 squamous cell carcinoma- in progression after one cycle of platin-based combined chemotherapy, median age 60 yrs (58-64), renal function after cisplatin was normal. They received anti-PD-L1 i.v. every 3 weeks in a clinical trial. Two patients had progression of disease, while 3 patients showed a clinical benefit. Patient #1 had stable disease at the pleural and right lung disease in the CT-scan after 6 weeks of treatment. He had low Magnesium values at basal and at every further control during PD-L1 therapy. Patient #2 showed progression of mediastinal lymph nodes and liver metastases in the CT scan after 6 weeks of treatment and progression was confirmed by CT-scans 4 and 8 weeks later; eventually a biopsy of the liver metastasis confirmed that there was a massive neoplastic invasion with tumor infiltrating lymphocytes (Tils) <5%. His basal Magnesium values were always normal. He stopped anti-PD-L1 therapy due to progression. Patient #3 had a volumetric increase of bilateral lung nodules in the CT-scan after 6 weeks while mediastinal lymph nodes were stable; lung nodules again and lymph nodes were both in progression 12 weeks later. His basal and further on Magnesium values were always normal. Patient #4 showed partial response in the CT-scan after 6 weeks of treatment, and benefit was confirmed later on by CT-scan after 12 weeks; he reported a clinical benefit for decrease of fatigue and chest pain; his basal Magnesium value was lower than normal and it has been always abnormal at every further blood check during PD-L1 treatment. Patient #5 showed partial response in the CT-scan after 6 weeks of treatment; she reported a clinical benefit for decrease of fatigue and increase of appetite; her basal Magnesium value was lower than normal and she continued to have low magnesemia at every further blood check during anti-PD-L1 treatment.
Conclusion: evaluation of response may be difficult with immune checkpoint inhibitors and in one case we performed a biopsy to study tumor infiltrating lymphocytes to decide whether pseudoprogression or real progression. Data about PDL1 expression were not available because patients in a clinical trial. In our experience lower basal Magnesium value may predict a clinical benefit with anti-PD-L1, although we do not know its possible explanation.
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