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Michael Oh
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P1.04 - Immunooncology (Not CME Accredited Session) (ID 936)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.04-12 - Mass Spectrometry-Based Serum Proteomic Signature as a Potential Biomarker for Survival in NSCLC Patients with Immunotherapy (ID 13444)
16:45 - 18:00 | Author(s): Michael Oh
- Abstract
Background
The Veristrat test is a serum biomarker using a mass spectrometry (MS)-based proteomic signature derived from machine learning. It is used as a prognostic marker for patients with NSCLC undergoing platinum-based chemotherapy. However, its role in patients undergoing immunotherapy has not been investigated.
a9ded1e5ce5d75814730bb4caaf49419 Method
47 patients with advanced stage NSCLC and no activating EGFR mutation underwent VeriStrat testing from 2016 to 2017. Patients were grouped into Veristrat ‘Good’ risk group (VS-G) or Veristrat ‘Indeterminate’ & Veristrat ‘Poor’ risk group (VS-IP). Kaplan-Meier survival analyses with log rank test were performed to compare the progression-free survival (PFS) and overall survival (OS) between the two groups. PFS of NSCLC patients treated with immunotherapy was derived from the time of the immunotherapy to disease progression or death.
4c3880bb027f159e801041b1021e88e8 Result
47 patients had a mean age of 65.6 (range: 30 to 91). 26 patients were female (55%). 26 patients had diagnosis of adenocarcinoma (55%), while 18 patients had squamous cell carcinoma (38%). 32 patients (68%) underwent treatment with a PD-1 inhibitor (pembrolizumab or nivolumab), whereas 15 patients (32%) did not. 32 patients (68%) demonstrated VS-G trait while 15 patients (32%) demonstrated VS-IP trait (intermediate: 1, poor: 14). Overall, VS-G demonstrated significantly prolonged PFS compared to VS-IP for all NSCLC patients regardless of treatment (median PFS, 12.0 months vs. 6 months, p<0.05), though there was not a significant different in OS between VS-G and VS-IP. Among NSCLC patients treated with immunotherapy, VS-G classification trended towards increased PFS when compared to VS-IP (Figure 1, median PFS, 12.0 vs 4.2 months, p=0.054), while OS was not statistically different. Multivariate analysis revealed that Veristrat was an independent predictor of PFS in this patients, regardless of various clinical factors.
8eea62084ca7e541d918e823422bd82e Conclusion
MS-based serum proteomic signature may serve as a biomarker for survival outcome in patients with NSCLC, including patients undergoing immunotherapy.
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P1.04-19 - Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Survival After Immunotherapy in Non-Small Cell Lung Cancer (ID 13650)
16:45 - 18:00 | Author(s): Michael Oh
- Abstract
Background
Effective use of immune checkpoint inhibitors in non-small cell lung cancer (NSCLC) may be improved by identifying biomarkers that are easily measured and predictive of clinical outcomes. Peripheral complete blood counts are commonly obtained and can be indicative of systemic inflammatory response, which has been associated with poor prognosis in multiple cancer types. Here, we investigated the ability of peripheral cell counts to predict patient survival after treatment with immunotherapy for NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
Complete blood counts were retrospectively collected for 274 patients and analyzed for absolute neutrophil count (ANC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Values were obtained immediately prior to treatment initiation. Overall survival (OS) and progression-free survival (PFS) was assessed using Kaplan-Meier analyses with log-rank test and Cox regression analysis.
4c3880bb027f159e801041b1021e88e8 Result
OS was significantly associated with ANC (HR 1.63, p<0.0001) and NLR>5 (HR 1.62, p<0.0001), as was PFS (HR 1.48, p=0.0008 and HR 1.48, p=0.0012, respectively). PLR>400 was not associated with OS but did have a significant association with PFS (HR 1.39, p=0.0388). Baseline elevation of both NLR and PLR identified a particularly high-risk population, with worse OS (HR 1.69, p=0.0020) and PFS (HR 1.58, p=0.0069) when compared to the patient group with low baseline NLR and PLR (Figure 1). High NLR and PLR as a combined marker remained an independent predictor of OS in multivariate analysis after adjusting for multiple clinical variables (HR 1.91, p=0.008).
8eea62084ca7e541d918e823422bd82e Conclusion
Increased baseline ANC, NLR, and PLR were associated with worse overall and progression-free survival, and the combination of both high NLR and PLR denoted a subgroup with especially poor outcomes. These findings will need to be validated in larger prospective studies to further assess their clinical utility.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- 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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P2.01-82 - Neutrophil-to-Lymphocyte Ratio Complements the Prognostic Ability of PD-L1 in Non-Small Cell Lung Cancer Treated with PD-1/PD-L1 Inhibitors (ID 14091)
16:45 - 18:00 | Author(s): Michael Oh
- Abstract
Background
PD-L1 expression is an imperfect predictor of outcomes for patients (pts) with advanced non-small cell lung cancer (aNSCLC) treated with PD-1/PD-L1 inhibitors (PD-1/L1i). This was demonstrated in the recent ARCTIC trial in which PD-L1 expression did not significantly correlate with outcomes. In the quest for additional markers, a high neutrophil-to-lymphocyte ratio (NLR) has been associated with poor outcomes and may reflect a higher myeloid-to-lymphoid balance. Here we show improved prognostic ability for response to PD-1/L1i when baseline NLR is added to PD-L1 expression.
a9ded1e5ce5d75814730bb4caaf49419 Method
We used a retrospective cohort of 146 aNSCLC pts from the authors’ institutions in the United States and Japan who received single-agent PD-1/L1i. We categorized patients into three groups; favorable: PD-L1 ≥ 1% and NLR < 5, intermediate: PD-L1 ≥ 1% or NLR < 5, and poor: PD-L1 < 1% and NLR ≥ 5. We correlated the outcome of each group with overall survival (OS) and progression free survival (PFS).
4c3880bb027f159e801041b1021e88e8 Result
Median follow-up was 11.1 months (M) (95% Confidence Interval [CI]: 9.1-13.1). 47 pts had PD-L1 <1% and 99 pts ≥1%, 81 pts had NLR <5 and 65 pts ≥5. There were 52, 76, and 18 pts in the favorable, intermediate, and poor groups, respectively. Median OS for the favorable group was not reached and it was 14.7 M (CI: 10.5-19.0) and 3.5 M (CI: 0-13.1), respectively for the intermediate and poor groups. Median PFS was 9.9 M (CI: 3.7-16), 3.2 M (CI: 2.1-4.3), and 1.1 M (CI: 0.8-1.4), respectively. The poor group (PD-L1 < 1% and NLR ≥ 5) was significantly associated with progressive disease (Odds ratio [OR]: 5.0, p=0.01) in comparison to the PD-L1 < 1% group (OR: 2.6, p=0.013).
8eea62084ca7e541d918e823422bd82e Conclusion
Prognostic ability of PD-L1 expression is enhanced when combined with baseline NLR for aNSCLC pts treated with single-agent PD-1/L1i. This study raises the hypothesis that high NLR and low PD-L1 expression could serve to identify those pts less likely to benefit from these therapies.
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