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Nicolaus Ansratschke



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    P3.04 - Immunooncology (Not CME Accredited Session) (ID 970)

    • 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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      P3.04-22 - Response of Brain Metastases in Patients with Non-Small Cell Lung Cancer Treated with Immunotherapy and Brain Directed Radiotherapy (ID 13407)

      12:00 - 13:30  |  Author(s): Nicolaus Ansratschke

      • Abstract
      • Slides

      Background

      The phase III trials of nivolumab, pembrolizumab or atezolizumab in comparison to standard chemotherapy for advanced non-small cell lung cancer (NSCLC) included a small number of patients with brain metastases. The aim of this study was to evaluate the radiological features of brain metastases after treatment with radiotherapy (RT) and immunotherapy (IT) in combination, as IT may synergize with RT.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed the clinical data and radiological findings from 27 patients with NSCLC receiving IT (nivolumab or pembrolizumab) and RT of brain metastases from June 2015 until August 2017 at the University Hospital of Zürich. Response to RT was assessed with magnetic resonance imaging in all patients and in case of non-unequivocal findings with 18F-Fluorethyltyrosin PET (FET-PET) in 6 patients.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 33 treatments with RT were applied (22 patients received one treatment, 4 patients 2, and 1 patient 3 treatments) of which 16 consisted of radiosurgery, 7 of hypofractionated stereotactic radiotherapy and 10 of whole brain radiotherapy. 23(85.2%) patients received nivolumab and 4 (11.1%) pembrolizumab. RT was performed in 36% of the cases (12 out of 33) during IT, in 61% (20 out of 33) before, and 3% (1 out of 33) after IT. In cases where RT was performed before, the median time to IT was 6.5 months. 22 (81.5%) patients had an adenocarcinoma and 5(18.5%) sqamous cell histology. Response of brain metastases was assessed after completion of treatment: in 6 out of 33 treatments (18.2%) a complete response was achieved, in 14 (42.4%) a partial response, in 2(6.1%) a mixed response, in 2 patients (6.1%) a progression of disease and in 4 (12.1%) a pseudoprogression was observed. FET-PET was performed when pseudoprogression was suspected (6 patients) and perfusion curves helped differentiating between pseudoprogression (4 out of 6 patients) and true progression (2 out of 6 patients). Median overall survival was 17.8 months (95%CI: 2.9-32.6).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Peudoprogression of brain metastases, defined as initial enlargement of tumor lesions and then decrease in size, should be considered in patients treated with immunotherapy and radiotherapy of brain metastases from NSCLC. Dynamic FET-PET patterns may help differentiating pseudoprogression and true progression. In cases of pseudoprogression, immunotherapy can be safely continued without additional interventions on brain metastases.

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