Author of

• 18972

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  P2.02 - Biology/Pathology (ID 616)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Biology/Pathology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 23242

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    P2.02-044 - Pulmonary Findings in 7 Autopsy Cases of Patients Treated with Immune Checkpoint Inhibitors (ID 10263)

    09:30 - 16:00  |  Author(s): E.D. Thompson
    • Abstract

    Background:
    Side effects of immune checkpoint therapy are milder than with standard chemotherapy. Pulmonary toxicity has been described in 5% of patients, most of which are low grade pneumonitis with varied radiologic and pathologic appearances. Here we report lung pathology findings in 7 autopsy cases of patients who died while on immune checkpoint therapy.
    
    Method:
    Patient characteristics are shown in table 1. We evaluated tumor burden, the presence of tumor infiltrating lymphocytes (TIL), and type of lung injury. TIL were quantitated using a 4 tier system (0 -3+ = none, mild, moderate, extensive)

    Table1. Summary of demographic and clinical information
    Case	Age	Sex	Immune Tx	Pneumonitis	Chest Imaging
    1	38	WM	3 mo	Yes	GGO, multifocal
    2	65	WM	9 mo	No	Bilateral pleural effusion
    3	54	WF	single dose	Yes	Bilateral reticular opacities
    4	30	BM	4 mo	No	GGO, patchy
    5	59	WM	7 mo	No	Pulmonaryemboli and tumor
    6	72	WM	25 mo	Yes	GGO, bilateral, diffuse
    7	68	WM	5 mo	Yes	GGO, bilateral, diffuse

    
    
    Result:
    Residual viable tumor with little or no therapy effects was present in all 7 cases. The 4 cases where pneumonitis was diagnosed clinically had at least focal DAD. The majority of tumors had at least scattered TIL present, while one tumor had a large number TIL.

    Table 2. Summary of autopsy findings
    Case	Tumor	TIL	LVI	DAD	Pneumonia	Tumor necrosis
    1	ACA in 5 lobes	1+	Yes*	Focal	No	<5%
    2	MM in LLL, LUL	3+	No	Focal RLL	No	None
    3	ACA in 4 lobes	1+	Yes	LUL, RUL, LLL	LLL, RLL, LUL	None
    4	MM in 4 lobes	1+	Yes	No	No	None
    5	MM in RUL	1+	No	No	No	None
    6	SCC in RLL, LL, LUL	2+	Yes	RUL, RML, RLL	No	10% and fibrosis
    7	SCC in 5 lobes	1+	Yes	LUL, LLL	No	20-30%

    ACA: adenocarcinoma; MM: Malignant melanoma; SCC: squamous cell carcinoma; *extensive LVI
    
    Conclusion:
    The majority of patients with clinical diagnosis of pneumonitis had DAD at autopsy and variable amount of viable tumor in the lungs and at least a few tumor infiltrating lymphocytes. Additional studies are pending to further characterize the phenotype of the TIL and to determine PD1 and PDL1/PDL2 expression on the tumor cells.