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Kouzo Yamada
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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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P2.01-88 - C-Reactive Protein (CRP) as a Predictive Marker for Survival in Patients with Advanced NSCLC Treated with First Line Pembrolizumab Monotherapy (ID 13612)
16:45 - 18:00 | Author(s): Kouzo Yamada
- Abstract
Background
Pembrolizumab have shown longer activity in patients with advanced non-small cell lung cancer (NSCLC) especially when PD-L1 expression was high. But even with high PD-L1 expression, more than half of them failed to response. We focused on C-reactive protein (CRP), inflammatory protein measured routinely in clinical practice, to find out its role as predictive biomarker for pembrolizumab.
a9ded1e5ce5d75814730bb4caaf49419 Method
We analyzed advanced NSCLC patients with PD-L1 high expression (EGFR mutation (-), EML-4-ALK fusion (-)) who were treated with pembrolizumab as first-line therapy in our clinical practice. Patients received pembrolizumab (200mg/body, q3W) until progressive disease or unacceptable toxicity. During treatment period we measured serum biochemistry and blood cell count regularly.
We evaluated the association the factors such as serum marker including inflammatory protein, age, performance status, histology, smoking status, prior radiation therapy and presence or absence ofimmune-related adverse events after treatment with the effect such as antitumor response, progression‑free survival (PFS) and overall survival (OS).
4c3880bb027f159e801041b1021e88e8 Result
A total of 31 patients treated with pembrolizumab from March 2017 to February 2018 were analyzed for this research. Their characteristics were: median age 72 (range 37-84),male/female 24/7, adenocarcinoma/squamous cell carcinoma/pleomorphic carcinoma/neuroendocrine carcinoma/NOS 17/5/3/1/5, clinical stage IIIB/IV/recurrence 3/21/7, median CRP level at pretreatment 1.15mg/dL (0.07-15.27). Among the candidate biomarker, there were no association except for CRP. Serum CRP level at pretreatment was not predictive, but change of serum CRP level at 6 weeks after anti-PD-1 therapy initiation was most predictive in the analysis. Depressed CRP group showed longer PFS and OS than elevated group (PFS: p=0.08, HR 0.29, OS: p=0.08, HR 0.28, log-rank test).
8eea62084ca7e541d918e823422bd82e Conclusion
Our analysis suggests that serum CRP elevation at 6 weeks of treatment predict for longer survival when pembrolizumab was given as first-line treatment.This finding might be related to inflammation status of patients and efficacy of anti-PD-1 inhibitor.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.09 - Pathology (Not CME Accredited Session) (ID 958)
- 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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P2.09-27 - Prognostic Significance of Vascular Invasion in Pathological Stage IA Lung Adenocarcinoma According to the 8th Edition of the TNM Classification (ID 12718)
16:45 - 18:00 | Author(s): Kouzo Yamada
- Abstract
Background
Vascular invasion, including blood vessel invasion (v) and lymphatic vessel invasion (ly), is not a prognostic factor according to the 8th Edition of the Tumor-node-metastasis (TNM) Classification, and the prognostic impact of vascular invasion remains unclear. We reported the prognostic significance of vascular invasion classified according to the previous 7th Edition in patients with stage I non-small cell lung cancer (Diagn Pathol. 2015;10:17). The aim of the present study was to clarify whether vascular invasion classified in the 8th Edition has a prognostic impact on patients with pathological stage IA lung adenocarcinoma and should thus be adopted as an upstaging factor.
a9ded1e5ce5d75814730bb4caaf49419 Method
We reviewed 314 patients with pathological IA (T1a-1bN0 according to the UICC-TNM Classification of Malignant Tumours, 7th Edition) lung adenocarcinoma completely resected between 2000 and 2005. We excluded patients with mucinous adenocarcinoma. The pathological invasive size was measured on the maximal cut surface of the primary tumor, stained with hematoxylin-eosin (HE) and elastica van Gieson (EVG), in all cases. We evaluated blood vessel invasion using specimens stained with HE and EVG, and lymphatic vessel invasion using specimens stained with HE and anti-podoplanin antibody. Blood vessel invasion and lymphatic vessel invasion together represented tumor vessel invasion (TVI). Survival curves were plotted using the Kaplan–Meier method, and the statistical significance of differences between the groups was determined by the log-rank test.
4c3880bb027f159e801041b1021e88e8 Result
The patients were stratified according to the 8th edition into Tis (N = 46), T1mi (N = 69), T1a (N = 82), T1b (N = 99), T1c (N = 18). The median follow-up period was 98.0 months. The recurrence-free survival rate at 5 years was 100%, 100%, 88.9%, 94.7%, 80.3%, 66.7%, and 66.7% in stage 0, IA1(TVI-), IA1(TVI+), IA2(TVI-), IA2(TVI+), IA3(TVI-), and IA3(TVI+), respectively. The lung cancer-specific survival rate at 5 years was 100%, 100%, 88.9%, 98.2%, 87.4%, 66.7%, and 66.7% in stage 0, IA1(TVI-), IA1(TVI+), IA2(TVI-), IA2(TVI+), IA3(TVI-) and IA3(TVI+), respectively. The presence of TVI was a poor prognostic factor in stage IA1 and IA2, but not in stage IA3.
8eea62084ca7e541d918e823422bd82e Conclusion
TVI is a prognostic factor in patients with lung adenocarcinoma measuring 20 mm or less in the pathological invasive size. Stage IA1 lung adenocarcinoma without TVI can possibly be classified as minimally invasive, because patients with stage IA1 lung adenocarcinoma have 100% recurrence-free survival and lung cancer-specific survival.
6f8b794f3246b0c1e1780bb4d4d5dc53
