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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): Joori Kim

      • Abstract
      • Slides


      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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