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F. Manapov



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    Imaging and locally advanced NSCLC (ID 41)

    • Event: ELCC 2017
    • Type: Poster Discussion session
    • Track:
    • Presentations: 1
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      73PD - Prognostic value of pre- to post-treatment primary tumor metabolic volume reduction on 18F-FDG-PET/CT in a patient cohort with inoperable locally-advanced NSCLC treated with definitive chemoradiotherapy (ID 294)

      14:45 - 15:45  |  Author(s): F. Manapov

      • Abstract

      Background:
      Previous studies have shown that primary tumor metabolic volume (PT-MV) on 18F-FDG-PET/CT could serve as a prognostic factor in patients treated with definitive chemoradiotherapy (CRT). We analyzed a correlation between pre- to posttreatment PT-MV reduction during the course of CRT and overall survival.

      Methods:
      Sixty-five patients with histologically confirmed NSCLC IIIA-B, treated with definitive CRT in the sequential (21/65 pts, 32.3%) or concurrent (44/65 pts, 67.7%) mode, who underwent 18F-FDG-PET/CT before and about 4-6 weeks after the CRT, were analyzed. Histology yielded 22 (33.8%) adenocarcinomas, 34 (52.3%) squamous cell carcinomas, 8 (12.3%) large-cell carcinomas and 1(1.5%) NSCLC not otherwise specified (NOS). Thirty-five patients (35/65, 53%) were enrolled in randomized clinical trials (16 pts in GILT, 10 pts in InCoDor and 9 pts in BROCAT study CTRT 99/97). The most common concurrent chemotherapy regimen (18/65 pts, 27.7%) consisted of cisplatin given intravenously at a dose of 20mg/m[2] on days 1-4 and oral vinorelbine 50mg/m[2] on days 1, 8 and 15, every 4 weeks for two courses.

      Results:
      Median OS for the entire cohort was 16 months (95% [CI],11.5–20.5). Complete remission (CR) was reached in 20 (31%), whereas partial and non-response occurred in 31 (48%) and 14 (22%) patients, respectively. The mean change from pre- to posttreatment PT-MV was -51% (range: +125% to -100%). Various cutoffs of PT-MV reduction (100- 90-85-80-70-60 and 50%) after the CRT were analyzed. CR(n = 20) had a median OS of 26 (95 CI: 5-47) vs. 13 months (95 CI:9-16) observed in the rest of treated group (p = 0.01, log-rank test). The results also showed a significant difference in OS favoring patients with PT-MV reduction >90% (n = 18) vs. the rest with a median survival of 24 vs. 13 months, respectively (p = 0.04, log-rank test). However, the association between PT-MV reduction at 80% and 70% and survival showed borderline significance (p = 0.07 and 0.09, log-rank test). PT-MV reduction at 60 and 50% failed to show an effect on OS.

      Conclusions:
      In this inoperable locally-advanced NSCLC cohort, a PT-MV reduction of at least 90% after definitive CRT correlated with improved OS.

      Clinical trial identification:


      Legal entity responsible for the study:
      Deparment of Radiation Oncology, LMU Munich

      Funding:
      N/A

      Disclosure:
      All authors have declared no conflicts of interest.

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    Poster Display Session (ID 63)

    • Event: ELCC 2017
    • Type: Poster Display Session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 5/07/2017, 12:30 - 13:00, Hall 1
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      117P - Symptomatic pneumonitis in the irradiated lung after nivolumab: Three case studies (ID 295)

      12:30 - 13:00  |  Author(s): F. Manapov

      • Abstract

      Background:
      Nivolumab is a feasible therapy option in patients with advanced NSCLC who progress after first-line conventional treatment. There is limited information about an overlapping toxicity of nivolumab when applied after primary multimodality treatment. Here, we describe symptomatic pneumonitis in the irradiated lung in patients undergoing second- or third-line nivolumab therapy.

      Methods:
      Case 1: A 66-year-old female patient who presented with squamous NSCLC stage ypT2a pN2 cM0 underwent adjuvant thoracic irradiation. Nivolumab was started 6 months’ post-radiotherapy when recurrent disease was detected on restaging CT. Twelve days after the first nivolumab treatment, the patient developed grade 2 dyspnea and cough.rnCase 2: A 76-year-old male patient with non-squamous NSCLC stage cT1a cN2 cM1b (single metastatic brain tumor) recieved intracranial stereotactic radiosurgery followed by thoracic RT to a total dose of 66Gy. Second-line nivolumab was started 6 months later and after the fourth cycle (70 days after the first nivolumab treatment), the patient developed grade 2 dyspnea and cough.rnCase 3: A 56-year-old female patient with metastatic NSCLC was treated with Cisplatin/Pemetrexed followed by irradiation to the brain and thorax. Due to systemic progression, second-line chemotherapy with docetaxel/nintedanib. Six months later, the patient was started on nivolumab. After 6 cycles (77 days after the first cycle of nivolumab), the patient developed grade 2 coughing and dyspnea.

      Results:
      In all patients comprehensive radiological and functional diagnostic as well as bronchoscopy were performed after onset of respiratory symptoms. Imaging analysis was strongly consistent with parenchyma changes in the irradiated lung volume receiving 15 to 20Gy. Nivolumab treatment was interrupted and patients were treated with systemic corticoids for one to two months with rash alleviation of symptoms.

      Conclusions:
      Three cases of symptomatic pneumonitis in patients with advanced NSCLC treated with nivolumab were described. Interruption of immunotherapy and systemic corticosteroid therapy for several weeks was necessary. Future prospective investigation of the described phenomenon is urgently indicated.

      Clinical trial identification:


      Legal entity responsible for the study:
      Deparment of Radiation Oncology LMU Munich

      Funding:
      N/A

      Disclosure:
      All authors have declared no conflicts of interest.