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Jean Bernard Auliac
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P1.09 - Pathology (Not CME Accredited Session) (ID 941)
- 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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P1.09-02 - PD-L1 Expression Pattern in Large Cell Neuroendocrine Carcinoma of the Lung: The GFPC 03-2017 "EPNEC" Study. (ID 11945)
16:45 - 18:00 | Author(s): Jean Bernard Auliac
- Abstract
Background
Large cell neuroendocrine carcinomas of the lung (LCNECs) are rare neoplasms with few therapeutics options especially for stage IV diseases. Pathological diagnostic of LCNECs may be difficult with low interobserver reproducibility and need immunohistochemical (IHC) staining. Immune checkpoint inhibitors targeting tumoral and immune cells interaction have revolutionized the treatment of NSCLC, but few data's are available on LCNECs immune environment and particulary the expression of PD-L1 on both tumors (TC) and immune infiltrating (IC) cells. The objective of the present study is to determine the pattern of PD-L1 staining in a cohort of LCNECs patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
Clinical files and tumors biopsies of patients (pts) with a LCNEC diagnosed between 01.01.2014 and 31.12.2016 were retrospectively collected (GFPC 03-2017). All histological samples were centrally reviewed by a panel of six independent pathologists, according to the WHO 2015 classification. LCNEC was confirmed and PD-L1 expression was determined both in TC and IC, using the anti-PD-L1 antibody 22C3 (kit and automat Dako). PD-L1 expression was scored on TC as the percentage of PD-L1 positive cells (0 to 100%). PD-L1 expression on IC was determined as follows: IC0: positive IC representing<1% of the tumor surface; IC1: positive IC representing>=1% but<5% of the tumor surface; IC2: positive IC representing>=5% but<10% of the tumor surface; and IC3: positive IC representing>10% of the tumor surface.
4c3880bb027f159e801041b1021e88e8 Result
Eighty-six pts were initially included in the study.Twenty-eight (32%) of them were excluded for non-LCNEC diagnosis after review. Among the 58 remaining pts with confirmed LCNEC, five (8%) had a mixed histology with a NSCLC component.The mean age of the population was 65 years, mainly mens (86%) and former or current heavy smokers (93%). Fifty-five and 51 tumors samples were respectively available for TC and IC PD-L1 IHC expression. PD-L1 expression on TC was found in only 12% of the samples (7/55), while 76% (39/51) of the samples shows IC PD-L1 positive, with respectively 18 (35%) IC3, 8 (14%) IC 2, and 13 (25%) IC1.
8eea62084ca7e541d918e823422bd82e Conclusion
Histological diagnosis of LCNEC remains difficult, and prospective studies concerning patients with LCNEC should include a centrally pathological review of tumors.The PD-L1 expression pattern looks different for LCNEC in comparison to other lung carcinomas, as few TC were found positive although IC were frequently positive, half of the tumors having high PD-L1 IC infiltration (IC3/2). This PD-L1 pattern may suggest a potential effectiveness of therapeutic anti PD-L1 antibodies and this hypothesis have to be adressed in clinical trials.
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P1.13 - Targeted Therapy (Not CME Accredited Session) (ID 945)
- 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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P1.13-09 - Efficacy and Tolerance of Osimertinib in Real Word Setting: Results of the French Early Access Program (EXPLORE T790M GFPC Study). (ID 11335)
16:45 - 18:00 | Presenting Author(s): Jean Bernard Auliac
- Abstract
Background
Based on the Phase III AURA3 trial, osimertinib a third-generation EGFR TKI is approved in France in EGFR T790M-positive advanced NSCLC whose disease have progressed on or after first or second generation EGFR TKI.
Objective: to assess efficacy and tolerance of Osimertinib in real world setting.
a9ded1e5ce5d75814730bb4caaf49419 Method
Retrospective, multicentric study including T790M-positive advanced NSCLC receiving osimertinib from 07 April 2015 to 27 April 2016 in French early access program. Overall survival (OS) and progression free survival PFS) were analyzed in the whole population, in the subgroup of patients with cerebral metastasis at osimertinib initiation and according to the number of previous treatment lines (1 versus 2 or more).
4c3880bb027f159e801041b1021e88e8 Result
The analysis included 205 patients treated in 52 centers; mean age 69.5 ± 11.1 years, female 68.8%, adenocarcinoma 97.5%, EGFR mutations exons 19/21: 66.5%/ 30.5%, never smokers 71.5 %, PS 0-1/2/ 3-4: 54%/18,8%/27.2%, stage IV: 87.4%,presence of cerebral metastasis at osimertinib initiation: 43.7% .
EGFR T790M mutation diagnosis have been done by liquid biopsy in 34.4 % or on tissue re-biopsy in 65.6%. Patients received a median of 2.8 ± 1.5 lines of treatment before osimertinib initiation. All patients received a first or second generation EGFR TKI before osimertinib. Osimertinib has been used in second line setting in 18% of cases and in third line or more setting in 82%.
Median PFS was 12.4 (CI 95%: 10.1-15.1) months in the whole population, 9.7 (CI 95%: 7.7-13.5) in patients with cerebral metastasis and 15.8 (CI 95%: 11.9-17) months in patients without cerebral metastasis, (p : 0.2). PFS was not significantly different according to the use of osimertinib as second or third line of treatment: 12.6 (CI 95%: 6.7-17.5) vs 12.4 (CI 95%: 9.7-15.3) months, respectively.
Median OS since osimertinib initiation was 20.5 (CI 95%: 16.9-24.3) months, 23.06 [18.56;27.83] and 18.00 [12.16;22.21] months in patients without and with cerebral metastasis, respectively. OS was not significantly different according the use of osimertinib as second or third line of treatment: 17.5 (CI 95%: 11.6;27.8) vs 21.7 (CI 95%: 17.3;24.3) months (p=0.4).
A new biopsy was performed at disease progression on osimertinib in 50 patients: data will be presented.
8eea62084ca7e541d918e823422bd82e Conclusion
Efficacy of Osimertinib in real world setting appears similar to that observed in clinical trials in patients with EGFR T790M mutation in ≥2ndline.
Clinical trial information: Supported by an academic grant from Astra Zeneca
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- 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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P2.15-29 - Eligibility for Anti-Angiogenic Treatments in Patients with Squamous Non-Small Cell Lung Cancer (SQ-NSCLC): EPISQUAMAB Study (GFPC 2015-01) (ID 11338)
16:45 - 18:00 | Author(s): Jean Bernard Auliac
- Abstract
Background
Antiangiogenic treatments are today restricted to non-squamous NSCLC. New drugs, like ramucirumab, have been approved in second line setting for advanced NSCLC regardless histology but there is little information about the rate of squamous NSLC eligible to these treatments. This descriptive, prospective, observational study aimed to assess the rate of squamous advanced NSCLC patients eligible to anti-angiogenic treatments.
a9ded1e5ce5d75814730bb4caaf49419 Method
Each participating center had to include consecutive relapsed advanced SQ-NSCLC and to assess the presence of common criteria which restricted the use of antiangiogenic treatments (hemoptysis, cardiovascular diseases, tumoral extension to blood vessels and tumoral cavitation).
4c3880bb027f159e801041b1021e88e8 Result
From july 2016 to july 2017, 317 patients were included: 256 (80.8%) men, PS0/1/2 in 30.5%/54.5%/14.9% patients, stage IV in 74.5% of cases. Ineligibility criteria for anti-angiogenic therapy were found in 53.6% of patients (one single criteria in 29,3%, two criteria in 19,9%, three in 3.5%). The main reasons for ineligibility was as followed: blood vessel extension 39.8%, cavitation 20.5%, hemoptysis 7.2%, cardiovascular diseases 12.1%.
Table described patients characteristics according to the ineligibility criteria: Cavitation had the highest number of metastatic disease, cardiovascular diseases the highest number of men and number of metastatic site.
8eea62084ca7e541d918e823422bd82e Conclusion
In a non-selected advanced SQ-NSCLC population, only half of these patients are ineligible to a second line anti-angiogenic treatments with a wide majority of tumoral blood vessel extensions and cavitations.
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In collaboration with the GFPC* team and supported by an academic grant from Lilly pharmaceuticals.
*GFPC: French Lung Cancer Group
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