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Caicun Zhou
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Lunch & Poster Display session (ID 58)
- Event: ELCC 2019
- Type: Poster Display session
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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168P - Dynamic changes of patelet-to-lymphocyte ratio predict efficacy of PD-1/PD-L1 inhibitors in NSCLC (ID 545)
12:30 - 13:00 | Author(s): Caicun Zhou
- Abstract
Background
Baseline neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of host inflammation and have been reported as prognostic factors in advanced cancer patients, but have not been analyzed extensively in lung cancer in the era of immunotherapy, especially the dynamic changes of these markers.
a9ded1e5ce5d75814730bb4caaf49419 Methods
Patients who were treated with immune checkpoint inhibitors (ICIs) either as a standard of care or on a clinical trial at Shanghai Pulmonary Hospital were enrolled. Baseline complete blood count [defined as the results obtained at the time (−3/0 days) of initiating ICIs, including white blood cell (WBC), absolute neutrophil count (ANC), platelet count and absolute lymphocyte count (ALC) to calculate the NLR and PLR] were extracted from medical records. Derived NLR (dNLR) was calculated as dNLR = ANC/(WBC−ALC). C3 complete blood count (defined as the results obtained before Cycle 3 of ICIs) was also collected and calculated.
20c51b5f4e9aeb5334c90ff072e6f928 Results
Ninety-five patients were identified in the present study. 49 (51.6%) of patients received ICI monotherapy, and 46 (48.4%) received ICI-based combination therapy. Baseline NLR, dNLR, PLR were not associated with clinical outcomes of ICI therapy (ORR or PFS). Using 5 as a C3 NLR cut-off value, patients with C3 NLR <5 had better ORR and PFS than those with C3 NLR ≥5. Furthermore, patients who had increased NLR (n = 29) had inferior ORR (17.2% versus 41.0%, P = 0.026) and median PFS (5.5 versus 8.5 months, P = 0.022) than those who had decreased NLR (n = 61). Patients with C3 dNLR <3 had better ORR and median PFS than those with C3 dNLR ≥3. Patients who had increased dNLR (n = 26) had lower ORR (15.4% versus 40.3%, P = 0.027) and inferior median PFS (5.6 versus 8.4 months, P = 0.150) than those who had decreased dNLR. There was a trend towards better ORR and median PFS in patients lower C3 PLR. Interestingly, patients who had decreased PLR (n = 47) had better ORR (42.6% versus 23.3%, P = 0.052) and median PFS (11.8 versus 5.5 months, P = 0.003) than those who had increased PLR (n = 43). Multivariate analysis revealed dynamic changes of PLR as an independent predictive factor for PFS (HR: 2.27, 95% CI, 1.10-4.71, P = 0.027).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
Dynamic change of PLR has a potentially predictive role of the efficacy of ICI therapy.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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171P - Previous exposure to bevacizumab indicated inferior benefits from PD-1/PD-L1 inhibitors in nonsquamous NSCLC (ID 344)
12:30 - 13:00 | Author(s): Caicun Zhou
- Abstract
Background
Bevacizumab is known to enhance the effects of immunotherapy. The landmark IMPOWER150 has demonstrated that the addition of atezolizumab to bevacizumab plus chemotherapy significantly improved survival outcomes among patients with metastatic nonsquamous NSCLC. However, the impact of previous use of bevacizumab on the efficacy of PD-1/PD-L1 inhibitors remained unclear.
a9ded1e5ce5d75814730bb4caaf49419 Methods
Between Oct 2016 to Sep 2019, 113 patients who were treated with PD-1/PD-L1 inhibitors either as a standard of care or on a clinical trial at Shanghai Pulmonary Hospital were identified. Patients who had prior exposure to immunotherapeutic agents, or death within 4 weeks from the first dose of ICIs treatment were excluded from the analysis. The information regarding previous exposure to bevacizumab was reviewed in electronic medical record.
20c51b5f4e9aeb5334c90ff072e6f928 Results
The median age of enrolled patients was 63 years (range, 29 to 82). Regarding histology, 59.2% (67/113) had nonsquamous NSCLC and 40.8% (46/113) had squamous cell carcinoma. Overall, 16 patients (14.2%) previously received bevacizumab therapy, all of whom had nonsquamous NSCLC. Interestingly, patients who were previous exposure to bevacizumab had shorter PFS than those who were not (1.9 versus 4.3 months, P = 0.017). We then divided patients into 3 groups: arm 1 (16 patients, previous exposure to bevacizumab), arm 2 (51 patients, nonsquamous NSCLC who were not previous exposure to bevacizumab), arm 3 (46 patients, squamous cell carcinoma). The PFS was significantly different between arm 1 and arm 2 (1.9 versus 4.3 months, P = 0.023) or arm 3 (1.9 versus 4.2 months, P = 0.045), but not arm 2 and arm 3 (4.3 versus 4.2 months, P = 0.736). Patients in arm 1 also had inferior ORR (14.3% versus 29.4% versus 29.5%, P = 0.342) and DCR (42.9% versus 70.6% versus 68.2%, P = 0.05) compared with arm 2 and arm 3. Multivariate analysis identified previous exposure to bevacizumab as being independently associated with poorer PFS (HR = 1.9, 95%CI, 1.01-3.59, P = 0.048).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
Previous use of bevacizumab indicated inferior benefits from PD-1/PD-L1 inhibitors in nonsquamous NSCLC.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25
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Mini Oral session II (ID 63)
- Event: ELCC 2019
- Type: Mini Oral session
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 4/11/2019, 16:40 - 17:40, Room C
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189O - EGFR-TKIs plus bevacizumab demonstrated survival benefit than EGFR-TKIs alone in EGFR-mutant NSCLC patients with multiple brain metastases (ID 234)
16:40 - 17:40 | Author(s): Caicun Zhou
- Abstract
- Presentation
Background
Brain metastasis (BM) is the intractable disease in patients (Pts) with advanced non-small-cell lung cancer (NSCLC). Previous studies reported that EGFR-TKI plus bevacizumab (Ebe) could result in a significant prolongation of progression-free survival (PFS) than EGFR-TKI (E) alone. This study aimed to investigate whether Ebe could provide survival benefit than E alone in EGFR-mutant NSCLC Pts with BM.
a9ded1e5ce5d75814730bb4caaf49419 Methods
Pts with EGFR-mutant NSCLC and radiologically confirmed BM (number > 3) were included. Pts with liver or leptomeningeal metastases were excluded. Intracranial PFS (iPFS) was defined as the time from the date of initiation of 1st treatment to the date of intracranial progression or death and was censored at the date of last tumor assessment (when carried out). Systemic PFS (sPFS) was defined as the time from the date of initiation of 1st treatment to the date of systemic progression (except intracranial progression) or death and was censored at the date of last tumor assessment (when carried out).
20c51b5f4e9aeb5334c90ff072e6f928 Results
164 Pts were identified. 121 received E and 43 received Ebe as 1st treatment. Response rate was marginally higher in Ebe group than that in monotherapy group (69.7% vs. 52.9%, P = 0.055). Ebe was associated with a significantly longer iPFS (13.5 vs. 7.3 m, P < 0.001) and sPFS (14.4 vs. 8.8 m, P < 0.001) than E monotherapy. Importantly, median OS was markedly longer in Ebe group than in E group (30.1 vs. 22.4 m, P < 0.001). Different types of EGFR-TKIs showed comparable efficacy when combined with bevacizumab. However, erlotinib was associated with a significantly longer iPFS but similar sPFS and OS when compared with gefitinb and icotinib monotherapy. Multivariate analysis revealed that addition of bevacizumab was independently associated with prolonged iPFS (HR = 0.45, P < 0.001), sPFS (HR = 0.47, P < 0.001) and OS (HR = 0.50, P < 0.001).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
The current study indicated that Ebe demonstrated the prolonged survival benefit than E alone in EGFR-mutant NSCLC Pts with multiple BM. These findings suggest that this strategy should be further explored in large-scale, strictly designed clinical trials as a standard treatment option in this clinical scenario.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
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