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Sook-Hee Hong
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P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)
- 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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P2.06-01 - Short-Term Outcome of Entire Pleural Intensity-Modulated Radiotherapy in a Neoadjuvant Setting for Malignant Mesothelioma (ID 13114)
16:45 - 18:00 | Author(s): Sook-Hee Hong
- Abstract
Background
The purpose of this study is to evaluate the safety and efficacy of the tri-modality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for a resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM).
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of ten malignant mesothelioma patients who received neoadjuvant radiotherapy between March 2016 and April 2018 were reviewed. Patients received 25Gy in five fractions to entire ipsilateral hemithorax including clinically suspicious lymph nodes. All patients were treated with helical tomotherapy.
4c3880bb027f159e801041b1021e88e8 Result
All of the patients were men with a median age of 60 years. Epitheloid subtype was found in nine patients (90%) and type was unknown in one patient (10%). All patients received neoadjuvant chemotherapy with Alimta-cisplatin(AP) regimen. Nine patients (90%) completed 25Gy/5fxs radiotherapy and one (10%) completed 20Gy/4fxs. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed one week (1 - 15 days, median 7.5) after completing IMRT. Extrapleural pneumonectomy (EPP) was performed in three patients (30%), and pleurectomy and decortications (PD) in six (60%). There was no grade 3+ surgical complication except one patient died from septic shock after EPP in one-month. Based on operative findings and pathologic stagings, adjuvant chemotherapy was delivered in six patients (60%), and one (10%) was decided to start adjuvant radiotherapy. After a median follow-up of 10.6 months (range 1.7 - 24.2), there is no evidence of local recurrence or distant metastasis.
8eea62084ca7e541d918e823422bd82e Conclusion
Neoadjuvant intensity-modulated radiotherapy (IMRT) can be safely delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies need to look at long-term outcomes.
6f8b794f3246b0c1e1780bb4d4d5dc53
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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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P2.17-25 - Post-Treatment Neutrophil to Lymphocyte Ratio in Locally Advanced NSCLC Patients Treated with Concurrent Chemoradiotherapy (ID 12815)
16:45 - 18:00 | Author(s): Sook-Hee Hong
- Abstract
Background
We aimed to investigate the relationship between NLR and prognosis in patients with locally advanced NSCLC who received concurrent chemoradiotherapy as the first line treatment.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively analyzed 62 patients with locally advanced NSCLC treated with definitive CCRT between 2008 and 2016 at Seoul St. Mary’s hospital. We excluded patients who received induction chemotherapy to eliminate their influence on NLR. CCRT consisted of weekly chemotherapy using paclitaxel/carboplatin, docetaxel/cisplatin, docetaxel/carboplatin, and etoposide/cisplatin. Radiotherapy was performed with intensity-modulated radiotherapy (IMRT) or three-dimensional conformal RT (3D-CRT). The median radiation dose was 66 Gy in 33 fractions (range, 52 – 70 Gy). The pre-CCRT NLR was calculated from the nearest CBC within 1 week before CCRT and post-CCRT NLR was calculated using CBC 4 weeks after CCRT. Change of NLR before/after CCRT was also analyzed. The maximally selected log rank test was used to acquire the most significant NLR level related with overall survival (OS).
4c3880bb027f159e801041b1021e88e8 Result
The pre-, post-CCRT NLR, and NLR change (post-CCRT NLR/pre-CCRT NLR) cut-off levels were 1.9, 3.15, and 1.6, respectively. The median follow up duration was 11 months (range, 2–71 months). The 3-year OS, loco-regional progression free survival (LRPFS), and distant metastasis free survival (DMFS) were 45.4%, 9.3%, and 6.2%, respectively. The post-CCRT NLR and NLR change were significantly associated with OS and LRPFS. The high post-CCRT NLR group (> 3.15) showed significantly worse OS and LRPFS compared to the low post-CCRT NLR group (≤ 3.15) (3-year OS: 21.2% vs. 46.9%, p=0.005; median LRPFS: 7.7 months vs. 11.3 months, p=0.04). The high NLR change group (> 1.6) had significantly worse OS and LRPFS than the low NLR change group (≤ 1.6) (3-year OS: 32.7% vs. 36.9%, p=0.026; median LRPFS 7.7 months vs. 10.4 months, p=0.025). The pre-CCRT NLR showed a marginally significant difference in OS (3-year OS: 29.1% vs. 56.9%, p=0.062). There was no correlation between NLR and DMFS.
8eea62084ca7e541d918e823422bd82e Conclusion
The pre-, post-CCRT high NLR and increased NLR after CCRT are associated with poor prognosis of survival in patients for locally advanced NSCLC. An elevated NLR after CCRT might be an indicator of an increased risk of loco-regional failure. Further studies are needed to confirm the predictive value of NLR and the treatment strategies using NLR.
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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P3.01-56 - Hyperprogression and Pseudoprogression in Patients with Non-Small Cell Lung Cancer on Checkpoint Blocking Immunotherapy (ID 13837)
12:00 - 13:30 | Author(s): Sook-Hee Hong
- Abstract
Background
Immune checkpoint inhibitors in metastatic non-small cell lung cancer (NSCLC) can result in improved quality of life and survival when compared with cytotoxic chemotherapy. While immune checkpoint inhibitors are disrupting the management of patients with cancer, some patients experienced pseudoprogression,On the other hand there is another special response pattern of occurrences of rapid progression (i.e., hyperprogressive disease or HPD), suggesting potentially effects of these drugs. Due to HPD is not only different from the pseudoprogression, but also tremendous progression, clinicians must evaluate the efficacy of these novel drugs and avoid either premature withdrawal of the treatment or prolonging ineffective treatment
a9ded1e5ce5d75814730bb4caaf49419 Method
We idendified the medical records of all consecutive in non-small cell lung cancer patients (n=118) analyzed retrospectively who treated with monotherapy by anti-PD-1 or an anti-PD-L1 at Seoul & Bucheon St. Mary's Hospital between December 2015 and April 2018.
Tumor size (D) was defined as the sum of the longest diameters of the target lesions as per the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria. We calculated the TGK across clinically relevant treatment periods. As per the RECIST system, patients with nonmeasurable disease only at baseline could not be assessed by TGK. For patients who had disease progression with new lesions, the TGK was computed on the target lesions only (new lesions were not included in the RECIST sum).
4c3880bb027f159e801041b1021e88e8 Result
Median age was 65.4 years with a majority being Male(94.4%) and non current smoker (66.6%, consists in never smoker 11.1% and Ex smoker 55.5%). Their average smoking history was 38.6 pack years
The rate of over-growth was 15.2%(n=18), among them, the rate of hyperprogression was 72.2%(n=13).
The probability of expression of the EGFR gene mutation on the over-growth group was 16.6%.
We found increasing the probability of hyperprogression was seen at the EGFR expression group compared to non-hyperproliferation group(p=0.440)
8eea62084ca7e541d918e823422bd82e Conclusion
While immunotherapy can produce a significant and durable response in patients with NSCLC, physicians must be recognized of the potential for an aggressive pattern of accelerated progression in a subset of patients. Even though the improved recognition of hyperprogression and pseudoprogression, the etiology of HPD remains unclear, apart from the pseudoprogression. However we found that patients with EGFR genetic mutations may show the hyperprogression-excess growth when they used immune checkpoint inhibitors.
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