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K. Kanai



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    MA 19 - Mesothelioma: Bench to Bedside (ID 680)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Mesothelioma
    • Presentations: 1
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      MA 19.01 - A Phase II Study of Nivolumab: A Multicenter, Open-Label, Single Arm Study in Malignant Pleural Mesothelioma (MERIT) (ID 9111)

      11:00 - 12:30  |  Author(s): K. Kanai

      • Abstract
      • Presentation
      • Slides

      Background:
      Malignant pleural mesothelioma (MPM) is a rare and highly aggressive malignancy with poor prognosis and limited treatment options beyond progression after platinum-based combination with pemetrexed chemotherapy. Nivolumab (anti-PD-1, ONO-4538, BMS-936558), a humanized monoclonal antibody, PD-1 immune-checkpoint inhibitor, has demonstrated antitumor activity and a manageable safety profile in several advanced malignancies. Here, we report the preliminary results of a phase II study to evaluate the efficacy and safety of Nivolumab in previously treated Japanese MPM patients (pts): ONO-4538-41/JapicCTI-No.163247.

      Method:
      This open-label study enrolled advanced or metastatic MPM pts previously treated with up to two regimens of chemotherapy including platinum-based combination therapy with pemetrexed. Enrollment criteria also included histologically-confirmed, unresectable MPM without prior surgery, measurable disease and ECOG performance status 0-1. There was no restriction of PD-L1 status. Pts received Nivolumab 240 mg flat dose Q2W until progression or unacceptable toxicity. The primary endpoint was the objective response rate (ORR) (modified RECIST by independent review committee, expected response rate was 19.2%); secondary endpoints included disease control rate (DCR), duration of response, progression-free survival (PFS), and overall survival (OS).

      Result:
      From July to October 2016, 34 pts were enrolled in 15 centers. Males: 85.2%, median age: 68.0 years (range 43-78), PS 1: 61.8%, epithelial/sarcomatoid/biphasic: 79.4%/8.8%/11.8%, 1 prior regimen: 70.6%. Median follow-up was 6.7 months. Independent review committee-assessed 6-month ORR was 29.4% (n=10, 95%CI: 16.8-46.2) and objective responses were observed across tissue types, epithelioid 7/27 (25.9%), sarcomatoid 2/3 (66.7%), biphasic 1/4 (25.0%). 13 pts (38.2%) had stable disease, resulting in a 6-month DCR of 67.6%. Median PFS was 6.1 months (95%IC: 2.9-NR). Median OS has not been reached. 6-month PFS and OS rates are 50.9% (95%CI: 32.7-66.5) and 85.3% (95%IC: 68.2-93.6). 23 (67.6%) pts experienced drug-related adverse event (DRAE), and 7 (20.6%) experienced grade 3/4 DRAEs. 2 pts required dose discontinuation because of pneumonitis (Grade2 and 3).

      Conclusion:
      Single-agent Nivolumab has significant activity in 2[nd]/3[rd] line MPM pts and met the primary endpoint, suggesting that Nivolumab has a potential to be a new therapeutic option for MPM.

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    P2.07 - Immunology and Immunotherapy (ID 708)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Immunology and Immunotherapy
    • Presentations: 1
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      P2.07-035 - Correlation Between Immune-Related Adverse Events and Efficacy in Non-Small Cell Lung Cancer Treated with Nivolumab (ID 9403)

      09:30 - 16:00  |  Author(s): K. Kanai

      • Abstract
      • Slides

      Background:
      Nivolumab has been established as a novel standard of care in patients with pre-treated non-small-cell lung cancer (NSCLC). Patients treated with nivolumab sometimes experience its unique adverse events, called immune-related Adverse Events (irAEs). Given the mechanisms of action of immune-checkpoint inhibitors (ICIs), occurrence of irAEs may potentially reflect antitumor response. Here, we report the clinical correlation between irAE and efficacy in NSCLC patients treated with nivolumab.

      Method:
      Between Dec 2015 and Feb 2017, 38 advanced NSCLC patients were treated with nivolumab at our institution. All patients were enrolled in our single-institutional observational cohort study (UMIN000024414). We divided the patients into two groups: irAEs group and no-irAEs group and evaluated the objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Efficacy was assessed by RECIST version 1.1, and toxicity was graded based on CTCAE version 4.0.

      Result:
      Of thirty-eight, median age was 68.5 (range, 49 to 86), 74% was male, 68% was non-squamous cell carcinoma, and 82% was performance status of 0-1. Among overall population, ORR was 23.7%, and median PFS was 91 days. Eleven patients (29%) experienced irAEs and median time to onset irAEs was 53 days (range, 14 to 213 days). There was no significant correlation observed between PD-L1 expression on tumor and occurrence of irAEs. Most common irAE was pneumonitis (n = 5) and others were hypothyroidism (n = 4), hyperthyroidism, hypopituitarism, hepatitis, rash and elevated thyroid stimulating hormone (one, each). Patients with irAEs had significantly higher efficacy compared with those without (ORR: 63.6% versus 7.4%, p < 0.01 (Fisher’s exact test), mPFS: not reached (NR) versus 49 days, p < 0.01 (log-rank test). Landmark analysis in patients who achieved progression free ≥ 12 weeks showed a similar trend (p = 0.07). Next, we performed additional analyses on correlation with specific irAEs. Patients with pneumonitis and those without demonstrated similar outcome (p = 0.95 (log-rank test)). With regard to endocrine irAEs, the similar result was also observed (p = 0.95 (log-rank test)).

      Conclusion:
      In our study, there was a correlation between irAEs and efficacy in NSCLC patients treated with nivolumab. Occurrence of specific irAE was not necessarily associated the efficacy.

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    P3.01 - Advanced NSCLC (ID 621)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.01-088b - Is Efficacy Result in Phase 2 Trial Replicated in Phase 3 Trial in Advanced NSCLC: A Meta-Analysis (ID 9125)

      09:30 - 16:00  |  Author(s): K. Kanai

      • Abstract
      • Slides

      Background:
      Phase 3 trial has been mandatory to establish new treatment. However, molecular targeted agents were often approved based on phase 2 trials. There have not been fully investigated whether efficacy data in phase 2 would be replicated in phase 3.

      Method:
      We extracted phase 2 and 3 trials for advanced non-small cell lung cancer (NSCLC) using platinum doublet (Plt) or EGFR-tyrosine kinase inhibitor (TKI) monotherapy, published between 2005 and 2015. Overall response rate (ORR) and median progression-free survival (PFS) in each study were collected. We compared these data between phase 2 and 3.

      Result:
      155 phase 2 trials and 13 phase 3 trials were adopted as Plt trials, while 21 phase 2 trials and 6 phase 3 trials were adopted as TKI trials. Plt trials had larger sample size (median number of patients: 47 in phase 2, and 203 in phase 3) than TKI trials (median number of patients: 29 in phase 2, and 101.5 in phase 3). In Plt trials, median ORR and median of median PFS were 31% and 5.2 months in phase 2, while 27% and 4.7 months in phase 3. There was statistically significant difference between phase 2 and phase 3 in ORR and mPFS (p = 0.03 and 0.03, respectively). In TKI trials, median ORR and median of median PFS were 64.0% and 9.7 months in phase 2, while 64.5% and 10.9 months in phase 3. There were not significant difference between phase 2 and phase 3 either in ORR and mPFS (p = 0.88 and 0.31, respectively). Among TKI trials, equivalence of efficacy data between phase 2 and phase 3 was also investigated in ORR and mPFS, but not proved (p = 0.30 and 0.45, respectively).

      Conclusion:
      Efficacy of TKI in phase 2 trial was well replicated in phase 3 trial.

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