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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
P3.01-20 - Advanced NSCLC Treatment and Outcomes After Nivolumab (ID 13086)
12:00 - 13:30 | Presenting Author(s): Girish Mallesara
Nivolumab is now often used in the second line in non-small cell lung cancer (NSCLC). Fitness for further treatment and outcomes in clinical practice, after discontinuation of nivolumab, are not well documented.a9ded1e5ce5d75814730bb4caaf49419 Method
A single centre retrospective analysis was conducted on all patients who had received and ceased nivolumab between July 2015 and February 2018. 61 patients were identified. Management after nivolumab and survival outcomes were reviewed.4c3880bb027f159e801041b1021e88e8 Result
The median age of patients was 66 years (range 28-82). 31 patients were male (51%). 71% had adenocarcinoma (n=43), 21% had squamous carcinoma (n=13), and 8% other NSCLC (n=5).
33 received nivolumab as second line therapy, 18 as third line, 9 as fourth line, and 1 as fifth line. 79% of patients ceased nivolumab due to progressive disease (n=48) and 16% due to toxicity (n=10). 3 patients discontinued treatment after developing unrelated medical issues.
36% of patients (n=22) underwent further treatment. Next line treatments included pemetrexed (n=10), platinum doublet rechallenge (n=4), docetaxel (n=4), vinorelbine (n=2), weekly gemcitabine (n=1), and crizotinib (n=1). Of those who received further treatment, 9 were alive at censoring and 13 were deceased.
In Australia, carboplatin/gemcitabine is more likely to be used in first line treatment of metastatic adenocarcinomas because of Medicare restriction on reimbursement. Nivolumab and pemetrexed are used subsequently after progression. The efficacy of pemetrexed when used after nivolumab is not well documented. In our cohort, 10 patients received pemetrexed after nivolumab, and showed a median survival of 10.6 months after discontinuation of nivolumab. The median duration of pemetrexed therapy was 5.4 months.
Median overall survival, from last nivolumab dose, of all patients was 4.4 months (n=61). The median survival in patients who received any treatment after nivolumab was 10.5 months (n=22). Those who received nivolumab as a 2nd line treatment after platinum doublet therapy (n=33) had a median overall survival of 8.0 months.8eea62084ca7e541d918e823422bd82e Conclusion
In a heavily pre treated heterogeneous population, median survival after nivolumab was 4.4 months. 36% commenced further treatment and this population had an increased median survival of 10.5 months. Pemetrexed has efficacy in the 3rd line setting after platinum doublet and nivolumab therapy.6f8b794f3246b0c1e1780bb4d4d5dc53