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Roula Albadine



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    P3.08 - Oligometastatic NSCLC (Not CME Accredited Session) (ID 974)

    • 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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      P3.08-16 - Prognostic Value of PDL-1 Expression and Correlation Between Primary Tissue and Brain Metastases in Oligometastatic NSCLC (ID 13582)

      12:00 - 13:30  |  Author(s): Roula Albadine

      • Abstract
      • Slides

      Background

      Immunotherapy with anti-PD-1/PDL-1 agents in first-line metastatic non-small cell lung cancer (NSCLC) is chosen based on tumor cell PDL-1 expression. However, the incidence and prognostic value of PDL-1 expression in NSCLC patients with oligometastatic brain disease has never been characterized.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively analyzed in our SARDO clinical database NSCLC patients with only 1-3 brain metastases (oligometastastic) treated in our University Health Care Center CHUM from 2007-2014. Samples were stained with SP263 (Ventana) antibody against PDL-1. A membranous staining of >25% was considered positive, and scoring was performed by an experienced pathologist. Kaplan-Meier survival curves of all clinical data were performed in SPSS 25.

      4c3880bb027f159e801041b1021e88e8 Result

      In our cohort of 39 oligometastatic NSCLC patients treated before 2014, none received immunotherapy. A total of 49 specimens (biopsy or surgical) from either the primary or metastatic site were adequate and included in the study. In 10 cases, both primary and metastatic tissue were available for correlation. Overall PDL-1 positivity was 40.8% (20/49), with a positivity of 54.5% (12/22) in primary site samples and 29.6% (8/27) in metastatic brain tissue. Correlation of PDL-1 status between primary and metastatic site in a sub-group of 10 patients was 80% (8/10). Median overall survival (mOS) was significantly shorter for PDL-1 positive patients (8 mos) compared to PDL-1 negative patients (20 mos, p=0.05). 59% (23/39) of patients were aggressively treated for the primary tumor, and 86% (31/39) were aggressively treated for metastatic brain disease. When we controlled for treatment aggressivity of the primary tumor, mOS of PDL-1 positive patients treated aggressively was significantly shorter than mOS of PDL-1 negative patients treated aggressively (15 vs 22 mos, p=0.046). When the primary lung tumor was not addressed aggressively, mOS was the same regardless of the PDL-1 status (4 vs 4 mos). Median progression free survival (mPFS) tended to be longer in PDL-1 positive patients (6.0 vs 9.8 mos, p=0.254).

      8eea62084ca7e541d918e823422bd82e Conclusion

      PDL-1 status is concordant between primary and metastatic tissue in 80% of cases. PDL-1 expression is an adverse prognostic factor in NSCLC patients with oligometastatic brain disease, despite treating the patients aggressively for their primary lung cancer and their brain metastasis. In the future, giving early PD1/PDL-1 to oligometastatic PDL-1 positive NSCLC patients could significantly improve their outcome.

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