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Sanjib Basu
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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: 2
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.01-34 - Prognostic Value of Neutrophil to Lymphocyte Ratio for Metastatic NSCLC Patients Treated with Immunotherapy and Ramucirumab Plus Docetaxel. (ID 14081)
16:45 - 18:00 | Author(s): Sanjib Basu
- Abstract
Background
High NLR has been associated with inferior OS in metastatic NSCLC patients. We previously demonstrated a significant relationship between a high NLR at baseline and at follow-up and poorer OS in patients with metastatic NSCLC. Case series suggest potentially improved benefits of cytotoxic chemotherapy administration post immunotherapy but little is known about whether high NLR is associated with inferior outcomes in patients receiving salvage ramucirumab plus docetaxel (RD). We evaluated the potential predictive value of NLR in pts with metastatic NSCLC who received at least one cycle of immunotherapy and treated with RD regimen.
a9ded1e5ce5d75814730bb4caaf49419 Method
Retrospective analysis of patients with metastatic NSCLC who received at least one cycle of nivolumab or pembrolizumab and treated with RD regimen between April 2015 and May 2017. Patient demographics including NLR, RD and immunotherapy starting dates, and date of progression were recorded. Associations between NLR and both PFS and OS were assessed using Mann-Whitney-Wilcoxon tests. Cutoffs of NLR of 5.0 (based on published data) were analyzed for differences in median OS and PFS.
4c3880bb027f159e801041b1021e88e8 Result
Of 62 patients analyzed, 47% were male, 81% former smoker, 76% Caucasian and 76% patients who were treated with RD regimen also received immunotherapy during their treatment course. For entire cohort, baseline NLR ≤ 5 was associated with superior survival (median OS 20.86 mos for NLR ≤ 5 vs 5.78 mos for NLR >5, p=0.01) and superior PFS (median PFS 6.01 mos for NLR ≤ 5 vs 2.76 mos for NLR >5, p=0.03). Another significant predictor of OS was albumin at baseline (HR= 0.44, p = 0.01) and at 6 weeks (HR= 0.38, (p = 0.01). Patients who received immunotherapy had significantly superior OS than those who did not receive immunotherapy (median not reached vs 7.43 mos, p =0.03) within one-year follow-up.
8eea62084ca7e541d918e823422bd82e Conclusion
Low NLRs and higher albumins at baseline & 6 weeks were associated with a prolonged PFS and OS in patients with metastatic NSCLC who were treated with RD regimen. In this small retrospective study, longer OS was observed in pts treated with RD regimen and immunotherapy. Pts who did not receive immunotherapy had shorter OS. Additional data are needed to evaluate the impact of treatment sequence.
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P2.01-61 - Body Mass Index over Time is Associated with Overall Survival in Advanced NSCLC Patients Treated with Immunotherapy. (ID 13880)
16:45 - 18:00 | Author(s): Sanjib Basu
- Abstract
Background
Cachexia has been associated with inferior outcomes for patients with stage III/IV NSCLC (aNSCLC). This study evaluates the potential relationship between baseline and longitudinal body mass index (BMI) with progression free survival (PFS) and overall survival (OS) in aNSCLC patients on nivolumab or pembrolizumab.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with aNSCLC who received at least once cycle of nivolumab or pembrolizumab between January 2015 and January 2017 were identified in our pharmacy database. Patient demographics, longitudinal BMIs, treatment start date, date of progression, and last follow-up were recorded. OS and PFS were assessed by log-rank tests and Cox proportional hazard analysis. Time-dependent Cox model based analyses were used to assess the association between time dependent BMIs.
4c3880bb027f159e801041b1021e88e8 Result
The study included 162 aNSCLC patients. Median age 68 yrs, male/female 40.1%/59.9%. BMI values were obtained longitudinally at baseline, 6 wks, and 12 wks. Median BMI: baseline 24.69, at 6 wks 24.75, and at 12 wks 24.89. Median change in BMI: baseline to 6 wks = -0.50 (range: -5.79 to +2.92), baseline to 12 wks = -0.33 (range: -6.52 to +3.41), and 6 wks to 12 wks = -0.21 (range: -4.56 to +2.73). Hazard ratios for change in BMI with OS: baseline to 6 wks HR 0.7198 (p=0.0010), baseline to 12 wks HR 0.8703 (p=0.0553), and 6 wks to 12 wks HR 0.8284 (p=0.0668).
8eea62084ca7e541d918e823422bd82e Conclusion
Change in BMI over time is associated with OS in aNSCLC patients treated with nivolumab or pembrolizumab. Although decrease in BMI may simply be a prognostic marker for treatment with immune checkpoint inhibitors, it is possible that understanding potential relationships between cachexia and the immune system may be useful in developing strategies to improve response to immunotherapy.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.01-05 - Mature Progression-Free Survival in Stage IV Non-Small Cell Lung Cancer Patients Treated With Pemetrexed Maintenance Therapy (ID 12667)
12:00 - 13:30 | Author(s): Sanjib Basu
- Abstract
Background
Pemetrexed maintenance therapy is associated with superior survival in stage IV Non-Squamous, Non-small Cell Lung Cancer patients. We have observed long term disease control in real world patients treated with Pemetrexed(Pem)/Platinum(Plat) +/- Bevacizumab(Bev) followed by Pem +/- Bev maintenance therapy. To our knowledge, there is no mature data regarding the tail of the Progression Free Survival (PFS) curve in these patients. The objectives of this retrospective analysis are to determine the frequency of long term disease control on Pem+/- Bev maintenance and to identify parameters associated with absence of disease progression.
a9ded1e5ce5d75814730bb4caaf49419 Method
Our study looked at patients with Stage IV nsqNSCLC who received first line Pem/Plat followed by Pem maintenance between May 2010 and December 2017. We identified 241 patients from our database and analyzed their demographics, lab values, dates of therapy, and dates of progression. PFS was estimated by the Kaplan-Meier method and associations with patient characteristics were assessed by log-rank tests and Cox proportional hazards analysis.
4c3880bb027f159e801041b1021e88e8 Result
Median age was 66 years, 60% female, and 72% Caucasian. Baseline ECOG performance status (PS) was 0(22%), 1(50%) and ≥ 2(22%). Disease progression was observed in 233 of 241 pts. with median PFS of 6.2 months. Absence of disease progression was observed in 34 pts. (14.2%) at 2 years, 19 pts. (7.9%) at 3 years, and 3 pts. (1.2%) at 5 years. Improved PFS was strongly associated with lower baseline neutrophil: lymphocyte ratio (NLR) when using NLR≤3.5 vs >3.5 (median PFS 9.7 mo vs 5.2 mo, p =0.004) as well as in a continuous scale (HR=1.04, p < 0.001). ECOG PS of 0/1 was also associated with superior PFS (p<.001).
8eea62084ca7e541d918e823422bd82e Conclusion
The similarity in median PFS in our patients (6.2 mo) and clinical trial data suggests that our group of real world patients did not have uniquely favorable baseline characteristics. Although long term absence of progression may have been solely due to favorable natural history of disease, we believe that it was also due to Pem maintenance. As a result, continued development of Pem plus immunotherapy regimens in nsqNSCLC may result in a higher rate of long term disease control.
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