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Andrés Barba Joaquín
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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: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.01-63 - Correlation Between Immune-Related Adverse Events and Efficacy of Immune-Checkpoint Inhibitors in Patients with Non-Small Cell Lung Cancer (ID 13038)
16:45 - 18:00 | Author(s): Andrés Barba Joaquín
- Abstract
Background
Immune-checkpoint inhibitors (ICIs) are a standard treatment in advanced non-small cell lung cancer (NSCLC). However, ICIs can induce immune-related adverse events (irAEs) that may compromise treatment continuation. Here we report our experience in patients with NSCLC, the incidence of irAEs and its correlation with efficacy.
a9ded1e5ce5d75814730bb4caaf49419 Method
We have retrospectively analyzed 101 patients with advanced NSCLC receiving ICIs in our institution from March 2014 to January 2018. IrAEs were graded following CTCAE v4.0. Kaplan Meier and log-rank tests were used to evaluate progression-free (PFS) and overall survival (OS). Analyses were performed using SPSS v24 package.
4c3880bb027f159e801041b1021e88e8 Result
Median age was 66.4 [37-85] years, 74.3% were male. 33 (32.7%) patients presented squamous and 68 (67.3%) non-squamous histology. Most frequent ICIs were nivolumab (50%), pembrolizumab (31%) and atezolizumab (16%), used as monotherapy (79.2%) or in combination with chemotherapy (20.8%). 37.6% patients were treated with ICIs in first line setting, while 62.4% in second or beyond. Median duration of treatment was 2.7 [0.6-26.2] months.
61 (60.4%) patients developed 106 irAEs, with a mean of 1.02 [0-4] irAEs per patient. Most frequent irAEs were rash (24.5%), pruritus (22.6%), diarrhea (21%), arthritis (8.5%), hypothyroidism (7.6%), hyperthyroidism (2.9%), hepatitis (2.9%) and pneumonitis (2%). 8 (7.5%) patients experienced grades (G) 3-4 irAEs: 1 G3 pneumonitis, 4 G3 diarrhea, 1 G3 mucositis, 1 G3 nephritis and 1 G3 hemolytic anemia. One treatment-related death due to pneumonitis was reported.
Patients receiving ICIs in second line or beyond experienced significantly less irAEs (54.1%) than those treated in first line (73.7%), p 0.04.
47 (46.5%) patients received systemic corticosteroids during immunotherapy, 29.8% for irAEs management. 11 patients (10.9%) discontinued treatment due to irAEs. At the time of data analysis, 86.8% of irAEs had improved.
With a median follow-up of 8.9 [0.6-48.2] months, median OS was superior in patients experiencing irAEs: not reached (NR) vs 7.8 [95%CI, 5.2-10.5] months (p 0.001). Similarly, PFS was significantly longer: 6.2 [95%CI, 2.3-10.1] vs 2.7 [95%CI, 1.8-3.5] months (p <0.0001). OS was higher in patients who did not receive steroids during ICIs therapy: NR vs 9.9 [95%CI, 6.8-13.0] months (p 0.024). No association was found between efficacy and the use of antibiotics in the 3 months before first ICIs injection or during treatment.
8eea62084ca7e541d918e823422bd82e Conclusion
In our series, the presence of irAEs in patients with advanced NSCLC treated with ICIs was associated with efficacy in terms of PFS and OS. A negative correlation between usage of systemic corticosteroids and outcomes was found.
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P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.17-17 - Multimodal Treatment in Pathologically Confirmed Single-Station Resectable IIIA-N2 Non-Small Cell Lung Cancer: A Single Center Experience (ID 13747)
16:45 - 18:00 | Author(s): Andrés Barba Joaquín
- Abstract
Background
The management of patients with resectable stage IIIA-N2 (7th Edition) non-small cell lung cancer (NSCLC) is controversial. Multimodal treatment with neoadjuvant chemotherapy (CT) and radiotherapy (RT) followed by surgery may be recommended for a selected group of patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
We have retrospectively analyzed 21 patients with single-station resectable stage IIIA-N2 NSCLC treated in our center from April 2011 to June 2017. N2 was confirmed by EBUS or mediastinoscopy. Patients received CT with cisplatin (70 mg/m2)/carboplatin (5AUC) + vinorelbine (25 mg/m2 C1, 15 mg/m2 C2-3) concurrent RT with the 2nd cycle of CT with a total dose of 60Gy. PET-CT and mediastinoscopy was performed after induction treatment, and only those patients with mediastinal downstaging disease were proposed for surgery (lobectomy + systematic lymph node dissection). Kaplan-meier analysis was used to evaluate local control (LC), Overall survival (OS), Cause-specific-survival (CSS) and Disease-free-survival (DFS).
4c3880bb027f159e801041b1021e88e8 Result
13 patients were males (62%) and 8 females (38%), median age was 63 (52-75). Histology was: 10(48%) adenocarcinoma, 6(28%) squamous and 5 (24%) NOS NSCLC. Surgery was not performed in 5 patients (24%): 1 presented progressive disease, 2 had persistent mediastinum disease and 2 were excluded due to comorbidities. No severe postoperative complications were observed in patients who underwent surgery. Table 1 shows the results.
With a median follow up of 49 (10-84) months, significant differences in terms of OS (p=0,002) and in CSS (p=0,006) were observed between patients with/without surgery, with no difference in LC and DFS. In patients who underwent surgery, there was a trend to a better LC, OS, CSS, DFS when complete pathological response was achieved.
8eea62084ca7e541d918e823422bd82e Conclusion
In patients with pathologically confirmed single-station resectable stage IIIA-N2 NSCLC multimodal treatment with high dose
radiotherapy is feasible and with a trend to better outcome in patients with complete pathological response.
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