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P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
P1.01-08 - Hyperresponsive Disease: A New Pattern of Response in NSCLC Patients Treated by Anti-PD-1/PD-L1 (ID 13577)
16:45 - 18:00 | Author(s): Marie-Pier Gauthier
Immune-checkpoint inhibitors are standard of care for stage IV non-small cell lung cancer. Pembrolizumab, an anti-PD-1 monoclonal antibody, boosts the host anti-tumor response. Some patients have a better benefit, especially with strongly positive PD-L1 tumors. To our knowledge, hyperresponsive disease has never been reported.a9ded1e5ce5d75814730bb4caaf49419 Method
We present 3 of these cases.4c3880bb027f159e801041b1021e88e8 Result
A 52-year-old woman with lung adenocarcinoma with peritoneal carcinomatosis presented to her community hospital for vomiting and abdominal pain of 3-days duration. She had received first-line chemotherapy (carboplatine-pemetrexed) and after progression, was switched to pembrolizumab, started 10 days ago. PD-L1 expression was 100%. Narcotics and antiemetic medications relieved her severe symptoms, but she required hospitalization for 11 days. She did not receive any corticosteroid medication. Medical team was considering palliative care. Three weeks later, imaging showed an almost complete response. Pembrolizumab was restarted, without any gastrointestinal symptoms, with an ongoing response persisting after 13 cycles.
A 73-year-old man with lung adenocarcinoma with bone metastases was started on first-line pembrolizumab. PD-L1 expression was 100%. Two weeks later, he had severe pelvic pain where a bone metastasis had been previously diagnosed, not treated with radiation therapy. He required a 3-weeks hospitalization, with palliative care for pain control. Imaging showed three weeks later a major regression. He was rechallenged with pembrolizumab without recurrent symptoms, currently receiving his 9th cycle.
A 74-year-old man with squamous cell lung cancer with bone and liver metastases was started on first-line pembrolizumab. PD-L1 expression was 95%. Three weeks later, he had severe nausea and vomiting lasting two weeks, not relieved by outpatient antiemetic medications. He was hospitalized for IV medications during 8 days. While hospitalized, imaging showed a major regression of the lung and liver lesions. He even needed corticosteroid medication to decrease his symptoms for 2 weeks. He was rechallenged without recurrent symptoms.
No other etiologies were identified for the symptoms of these 3 patients, including immune-related adverse event (especially endocrine and liver tests), radiation therapy, infection, disease progression or medications. We diagnosed hyperresponsive disease on the basis of the severe symptoms, impressive response on the CT scan and rechallenge with the same medication without recurrent symptoms.8eea62084ca7e541d918e823422bd82e Conclusion
A major response to immune checkpoint inhibitors may mimic a progressive disease. Severe symptoms related to the tumor locations should not systematically be attributed to local progression. Clinicians should suspect the possibility of a hyperresponsive pattern and prescribe imaging to confirm or refute this hypothesis.6f8b794f3246b0c1e1780bb4d4d5dc53
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