Author of

• 25846

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  MA08 - Clinical Trials in Brain Metastases (ID 906)

  • Event: WCLC 2018
  • Type: Mini Oral Abstract Session
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 15:15 - 16:45, Room 203 BD

  • 25852

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    MA08.09 - Impact of Brain Metastases in Immune Checkpoint Inhibitors (ICI) Treated Advanced Non-Small Cell Lung Cancer (NSCLC) Patients (ID 12575)

    16:10 - 16:15  |  Author(s): Samy Ammari
    • Abstract
    • Presentation
    • Slides

    Background
    

    Brain metastases (BM) are frequent in NSCLC. Unfortunately, patients with (untreated) BM are often excluded from ICI trials so that their outcome on ICI is largely unknown..

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Retrospective data collection of all consecutive advanced ICI treated NSCLC patients in 6 centers (5 French, 1 Dutch) (nov 2012 – march 2018). Active BM was defined as non-irradiated new and/or growing lesions on brain imaging < 6 weeks before ICI start. Progression free survival (PFS), overall survival (OS) and site of progression on ICI was collected.

    4c3880bb027f159e801041b1021e88e8 Result
    

    945 patients included: 63% male, 83% WHO PS 0-1, median age 64 years, 73% non-squamous, 4% targetable driver mutations, 33% known PD-L1 (65% ≥1% expression). ICI treatment was median 2nd line (range 1-12), 94% had monotherapy PD-(L)1 inhibition. 241 patients (26%) had BM, 68% had previous cranial irradiation, 40% had active BM. BM patients were significantly younger than others (61 vs 66 years), had more adenocarcinoma (78 vs 62%), more organs involved (median 3 vs 2), a poorer PS (0-1: 76 vs 85%) and more steroids at baseline (26 vs 9%). Median follow-up: 15 months. Median (95% CI) PFS and OS without and with BM were 2 (2-3) vs 2 (1-2) months and 13 (9-16) vs 9 (7-13) months, respectively. In multivariate analysis, > 2 metastatic sites, PS ≥2 and steroids use were associated with worse PFS and OS, BM were not (table 1). In univariate analysis of BM patients, active BM were not associated with worse outcome compared to stable BM (HR PFS 0.98 (p=0.66), HR OS 0.93 (p=0.92)). Progressing BM patients had more often brain PD and a dissociated response (not specifically brain dissociated) on ICI (40 vs 12% and 13 vs 7%, respectively).

    Factor	PFS HR (95% CI)	p-value	OS HR (95% CI)	p-value
    Age > 65 vs ≤ 65	1.02 (0.87-1.20)	0.79	1.11 (0.92-1.34)	0.29
    Smoking yes vs no	0.53 (0.41-0.69)	<0.001	0.81 (0.59-1.12)	0.20
    Histology squamous vs adeno	1.07 (0.89-1.28)	0.78	1.24 (0.99-1.55)	0.12
    Nr of organs with metastases > 2 vs ≤ 2	1.28 (1.09-1.50)	0.003	1.48 (1.22-1.80)	<0.001
    Immuno line > 2 vs ≤ 2	1.11 (0.94-1.30)	0.22	1.10 (0.91-1.33)	0.34
    WHO PS 0-1 vs ≥2	2.14 (1.75-2.62)	<0.001	3.48 (2.78-4.36)	<0.001
    Use of corticosteroids yes vs no	1.36 (1.10-1.69)	0.005	1.31 (1.03-1.68)	0.03
    BM yes vs no	1.05 (0.88-1.26)	0.58	0.96 (0.77-1.19)	0.70

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    BM, treated or active, do not negatively impact outcome on ICI although BM failure is more common in these patients.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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