Author of

• 25776

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  MA04 - Novel Approaches with IO (ID 900)

  • Event: WCLC 2018
  • Type: Mini Oral Abstract Session
  • Track: Immunooncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 13:30 - 15:00, Room 107

  • 25779

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    MA04.03 - Immunotherapy for Non-Small Cell Lung Cancers (NSCLC) with Oncogenic Driver Mutations: New Results from the Global IMMUNOTARGET Registry (ID 13187)

    13:40 - 13:45  |  Author(s): Alesha A Thai
    • Abstract
    • Presentation
    • Slides

    Background
    

    Prospective data on immunotherapy for NSCLC with oncogenic driver mutations are limited. We recently reported first results from the global IMMUNOTARGET registry (Mazières, ASCO 2018). Here, we present new data for PD-L1 and mutation subgroups.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    In 2017, we started an international retrospective registry study ("IMMUNOTARGET") for patients with advanced NSCLC, known driver mutations (KRAS, EGFR, ALK, ROS1, BRAF, HER2, MET and RET) and PD-L1 immune checkpoint inhibitor therapy. The registry is approved by University of Toulouse and Swissethics, and funded by University of Toulouse and Cantonal Hospital of Lucerne. Anonymized real-world data submitted to the coordinating center include: patient and tumor characteristics, mutation test methods and results, systemic therapy lines, immune related adverse events, best response by RECIST, survival, and tumor PD-L1 expression (optional). Statistical calculations including best response, median PFS and OS are done at University of Toulouse.

    4c3880bb027f159e801041b1021e88e8 Result
    

    In April 2018, the registry included 551 pts from Europe, USA, Israel and Australia. Patients were 50% male/female, 28% current smokers, median age 60 years (range 28-83), 85% had PS0/1. Most (73%) tumors were stage IV at diagnosis, almost all (96%) were adenocarcinomas. Molecular classification by dominant driver mutation: KRAS=271 (49%), EGFR=125 (23%), BRAF=43 (8%), MET=36 (7%), HER2=29 (5%), ALK=23 (4%), RET=16 (3%), ROS1=7 (1%), 1 (0.2%) not classified (ALK+RET+MET). Most pts received nivolumab (466) or pembrolizumab (48) and were treated with immunotherapy in second or third line (67%). The median number of cycles was 5 (range 1-68). Fifty (11%) pts had grade 3-5 toxicity. Median OS from start of immunotherapy was 13.3 months, median PFS was 2.8 months. Best response was PR/CR in: KRAS=26%, BRAF=24%, ROS1=17%, MET=16%, EGFR=12%, HER2=7%, RET=6%, ALK=0%. Percentage of PD-L1 positive cells was available for 177 pts: 0%=71 (40%), 1-49%=46 (26%), 50-100%=60 (34%). Median % of positive cells was highest for ROS1 (90%), BRAF (50%), MET (30%) and RET (26%) mutant tumors. PD-L1 positivity was predictive for improved PFS in KRAS and EGFR mutant tumors. PD-L1 status was known in 18 tumors with ALK, ROS1 or RET rearrangements: 5 had 0%, 4 had 1-49% and 9 had 50%-100%. No tumor remissions were observed in this subgroup. The registry remains open, updated results will be presented at the conference.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Although response rates were lower than in KRAS mutant NSCLC, individual tumors with other driver mutations responded to immunotherapy. PD-L1 expression may not accurately predict clinical benefit from immunotherapy in some molecular subgroups, better markers are needed.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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• 25936

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  P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26768

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    P1.16-58 - Hospital Lung Surgery Volume and Patient Outcomes in Victoria (ID 12674)

    16:45 - 18:00  |  Presenting Author(s): Alesha A Thai
    • Abstract

    Background
    

    Surgical resection remains the primary curative option for early stage non-small cell lung cancer (NSCLC) with lobectomies considered the gold standard due to a reduction in local recurrence and improved overall survival. There has been growing evidence of an association between patient outcomes and the number of cancer surgeries performed at a hospital since the seminal paper by Luft et al in 1979.

    To our knowledge, there are no Australian data on hospital cancer surgery volumes and patient outcomes by procedure, and few data worldwide on specific lung surgery procedures and outcomes. We evaluated the relationship between hospital NSCLC surgery volume and patient outcomes in Victoria.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Victorians with a primary diagnosis of NSCLC between 2008 and 2014 were identified in the Victorian Cancer Registry (n=15,469), 3,420 (22%) of whom had surgery. Primary outcome was death within 90 days of surgery and secondary outcomes were overall survival, use of postoperative ventilation, ≥24hours spent in ICU and length of stay >17days. Hospital volume was measured as the average number of lung surgeries performed per year, with quartiles Q1: 1-17, Q2: 18-34, Q3: 35-58 and Q4: 59+.

    4c3880bb027f159e801041b1021e88e8 Result
    

    57% (1,941/3,420) lung cancer patients underwent lobectomy, 38% (1,299/3,420) sub-lobar resection and 5% (180/3,420) pneumonectomy. The overall 90-day mortality after lung surgery was 3.5%, and was 2.6% for patients undergoing lobectomy compared with 4.5% for those undergoing sub-lobar resection. There was no difference in 90-day mortality between low- and high-volume centres regardless of procedure. Patients operated in lower volume centres had more admissions to ICU ≥24hours (Q1. 55% vs. Q4. 11%, p-trend <0.001). Median overall survival was 6.2 years, 5.4 years and 5.8 years for lobectomy, sub-lobar resection and pneumonectomy, respectively. The distribution of ASA scores differed between patients attending public and private hospitals. A higher proportion of patients attending private hospitals (19%) had an ASA score of 4 compared with patients attending a public hospital (9%).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    We observed no evidence of survival differences between lung cancer patients attending low- and high-volume hospitals for surgery, regardless of surgical procedure. Median overall survival in Victorian is substantially better compared to interstate and international data. Of interest, a higher proportion of patients had an ICU admission ≥24hours in lower volume centres. We also observed a higher proportion of patients with an ASA score of 4 in private hospitals compared to public hospitals; the reasons for this are unclear and warrant further investigation.

    6f8b794f3246b0c1e1780bb4d4d5dc53