Author of

• 25949

  +

  P2.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 961)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 27169

    +

    P2.12-16 - Significant Tumor Regression and Toxicity with Nivolumab Plus Ipilimumab in Small Cell Lung Cancer Patients Following Radiation (ID 13928)

    16:45 - 18:00  |  Author(s): Gaurav Marwaha
    • Abstract
    • Slides

    Background
    

    Nivolumab plus ipilimumab demonstrated an approximately 20 percent response rate in patients with Small Cell Lung Cancer (SCLC) who had received 1 or more previous regimen (Antonia et al., 2016). The study did not include data on the clinical response and toxicity in patients who had received previous radiotherapy.

    However, there is pre-clinical (Deng et al., 2015; Dovedi et al., 2017) and clinical evidence (Antonia et al., 2017) that radiation may potentiate effectiveness of anti - PD-1/PDL-1 immune checkpoint inhibitors.

    Tumor responses and toxicities in six patients with progressive SCLC treated with second line nivolumab plus ipilimumab after chest radiotherapy and/or radiotherapy to a metastatic site are described.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    This is a retrospective study of 6 patients who had received radiotherapy within 90 days to at least 1 site of gross disease. Response to immunotherapy was assessed by CT scans approximately 8 weeks after beginning treatment. RECIST criteria was utilized in determining responses. Patients were followed for at least 120 days after initiation of immunotherapy.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Three patients with extensive stage SCLC progressed after chemotherapy at 79, 98, and 125 days prior to starting immunotherapy. Three patients with limited stage SCLC progressed after chemotherapy/radiation at 23, 99, 304 days prior to starting immunotherapy. All six patients had grade 3 or 4 toxicities that required discontinuation or delay of immunotherapy. Toxicities included two patients with myasthenia gravis, two patients with grade 3 rashes, one patient with grade 3 fatigue and one patient with grade 3 stomatitis. At time of initial re-assessment CT scan, four patients had partial response and two patients had stable disease. At 120 days, all six patients had tumor responses.

    Currently, four patients continue with durable responses. One patient has remained progression free at 182 days after receiving one dose of nivolumab plus ipilimumab. One patient has remained progression free at 197 days after two doses of nivolumab plus ipilimumab. Two patients have remained progression free at 183 and 209 days after two doses of nivolumab plus ipilimumab followed by nivolumab maintenance. In two patients, progression occurred at 132 and 192 days after receiving two doses of nivolumab plus ipilimumab without maintenance nivolumab.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    These observations support that combined immune checkpoint inhibitors following radiation are associated with severe immune mediated toxicity in SCLC patients. The rapid tumor responses and relatively long disease control in these patients with aggressive disease suggest that modified versions of this treatment strategy should be considered.

    6f8b794f3246b0c1e1780bb4d4d5dc53

    Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.