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Zia Poonja



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    P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.01-24 - Clinical Efficacy of Immunotherapy in Metastatic Non-Small Cell Lung Cancer Patients Treated with Prior Radiotherapy (ID 13530)

      16:45 - 18:00  |  Author(s): Zia Poonja

      • Abstract
      • Slides

      Background

      Pivotal clinical trials (KEYNOTE-001) have demonstrated improved survival in non-small cell lung cancer (NSCLC) patients treated with both radiotherapy (RT) and immunotherapy (IO). The purpose of this study was to document response rates and survival in patients receiving both RT and IO in routine clinical practice.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All metastatic NSCLC patients treated with Nivolumab or Pembrolizumab between 11/2015 and 10/2017 in one Canadian province were identified. Demographic, tumor, treatment, toxicity, and response data were collected. Fisher’s Exact Test and Chi Squared Test were used to assess the relationship between treatment characteristics and outcome. Log Rank Test and Cox Regression were used to assess overall survival (OS) and progression free survival (PFS).

      4c3880bb027f159e801041b1021e88e8 Result

      271 patients treated with IO were identified of which 202 were treated with previous RT (75%) including 153 treated with chest radiotherapy. Median follow up from initiation of IO was 30.3 (0.3-139.9) weeks. At time of last follow up, 56% of patients had died. There were no statistically significant differences in physician assessed response rates in patients treated with prior radiotherapy (52 vs 58%, p=0.41) or prior chest radiotherapy (52% vs 55%, p=0.71). Median PFS was 11 weeks in patients who received RT and 13.9 weeks in patients who did not (p=0.73). Median OS was 41.3 weeks in the radiotherapy cohort versus 42.9 weeks (p=0.50). On univariate analysis, ECOG (p<0.001) and CCI (p<0.001) were associated with OS while prior chest radiotherapy, prior curative radiotherapy, brain metastases, type of IO, squamous histology, smoking status and age did not.

      8eea62084ca7e541d918e823422bd82e Conclusion

      There were no statistically significant differences in response rates, PFS or OS in patients receiving IO for mNSCLC treated with or without prior RT.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.01-50 - Real World Experience of Nivolumab in Patients with Metastatic Nonsmall Cell Lung Cancer (mNSCLC) (ID 14187)

      16:45 - 18:00  |  Author(s): Zia Poonja

      • Abstract
      • Slides

      Background

      Immune related adverse events (irAE) from immunotherapy in metastatic melanoma have been correlated with efficacy; this association is less clear in mNSCLC. We aimed to evaluate the correlation between irAE and clinical efficacy of Nivolumab (N) in mNSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All mNSCLC patients (pts) treated with N between 11/2015 to 10/2017 at BC Cancer were identified. Demographic, tumor, treatment details, and frequency and grade (Gr, CTCAE v4.0) of irAE, were collected from chart review. Kaplan-Meier curves of overall survival (OS) from initiation of N based on the development of irAE and utilizing a 6-week landmark analysis were evaluated using the log-rank test.

      4c3880bb027f159e801041b1021e88e8 Result

      Characteristics of cohort (n=230): median age 64y (range 39-82), primary histology: non-squamous (74%), brain metastases rate: 13%, ECOG PS>1: 31% at start of N, and median Charlson Comorbidity Index (CCI) 6, and 72% of pts had received 1 prior line of systemic therapy. 100 pts (44%) experienced 143 separate irAE of Gr 1(64), Gr 2(54), Gr 3(12), Gr 4(9), and Gr 5(4). Three treatment related deaths were due to pneumonitis, hepatitis and colitis. 48 pts (21%) required treatment interruption due to irAE, of whom 28 discontinued N completely. With a median follow-up of 7.0 months (range: 0.07-30), 136 pts died and median OS from initiation of N was 9.2 months (95% CI 7.8-12.9). Median OS was 12.9 months and 8.6 months for patients requiring treatment interruption due to irAE or not, respectively. For landmark analysis, 15 pts were excluded as they died within 6 weeks from initiation of N. Using 6-week landmark analysis, there was no significant difference in OS amongst pts who developed any irAE (median 8.1 months, 95% CI: 6.1-not reached) compared to those who did not (median 10.8 months, 95% CI: 8.6-14.5; log rank test p=0.567). Development of colitis was associated with a lower median OS (4.4 months, 95% CI: 3.8-not reached) versus pts who did not (10.8 months, 95% CI: 8.6-14.5; p=0.0103). Thyroid changes (p=0.473), dermatitis (p=0.29), pneumonitis (p=0.318), hepatitis (p=0.135), and arthralgias (p=0.465) were not associated with different OS compared to those without irAE.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite 31% of pts having PS>1 and a high CCI, N was well tolerated. In the studied cohort, development of any irAE was not associated with improved survival. The finding of worse survival amongst pts with colitis requires further study.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.01-51 - Real world Experience of Pembrolizumab in Patients with Metastatic Nonsmall Cell Lung Cancer (mNSCLC) (ID 14223)

      16:45 - 18:00  |  Author(s): Zia Poonja

      • Abstract
      • Slides

      Background

      Immune related adverse events (irAE) from immunotherapy in metastatic melanoma correlate with efficacy; this association is less clear in mNSCLC. We aimed to evaluate the correlation between irAE and clinical efficacy of pembrolizumab (P) in mNSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All mNSCLC patients (pts) treated with P between 11/2015 to 10/2017 at BC Cancer were identified. Demographic, tumor, treatment details, and frequency and grade (Gr, CTCAE v4.0) of irAE, were collected from chart review. Kaplan-Meier curves of overall survival (OS) from initiation of P based on the development of irAE and utilizing a 6-week landmark analysis were evaluated with the log-rank test.

      4c3880bb027f159e801041b1021e88e8 Result

      Characteristics of cohort of 41 pts were: median age 68y (range 50-81), females 49%, non-squamous histology 81%, PD-L1 status <1%/1-49%/>50%/unknown 0/12%/83%/5%, brain metastases rate 15%, and liver metastases rate 12%. ECOG PS>1 at start of IO 32% and median Charlson Comorbidity Index (CCI) 4. P was delivered to 42% in first line setting. With a median of follow-up of 6.6 months (range: 0.7-32.3), 17 pts (41%) had died and 16 (39%) were still receiving drug. 16 pts (39%) experienced a total of 24 irAE; Gr of irAE 1/2/3/4/5: 10/12/1/1/0. The most common irAE were arthralgias (5pts), pneumonitis (4pts), and dermatitis (4pts). Treatment was temporarily held in 4pts (10%) due to irAE and permanently discontinued in 3 pts (7%). Median OS from initiation of P was 22.6 months (range: 10.6-not reached, NR). On univariate analysis, male gender (HR=3.36, 95% CI: 1.08-10.48) and ECOG>1 (HR=3.24, 95% CI: 1.13-9.35) correlated with worse OS. Median OS amongst pts requiring treatment interruption due to irAE was NR and for those treated continuously was 14.0 months. 1 pt was excluded from landmark analysis as they died within 6 week from initiation of P. Using 6 week landmark analysis, there was no significant difference in OS amongst pts who developed any irAE (median NR, 95% CI: 4.8 months-NR) compared to those who did not (14.0 months, 95% CI: 10.6-NR, log rank test p=0.84). Thyroid changes (p=0.411) and dermatitis (p=0.951) were not associated with differences in OS compared to those without irAE.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite 32% of pts having PS>1 and a high CCI, the incidence of serious irAE was low. The impact of gender on response to P requires more study. Development of irAEs was not correlated with improved survival.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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