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Corinne Faivre-Finn
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ES16 - Modern Radiotherapy in Stage III NSCLC (ID 19)
- Event: WCLC 2019
- Type: Educational Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Maria Werner Wasik, Alexandra Giraldo
- Coordinates: 9/09/2019, 11:00 - 12:30, Dublin (1997)
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ES16.01 - Proton Therapy (Now Available) (ID 3242)
11:00 - 12:30 | Presenting Author(s): Corinne Faivre-Finn
- Abstract
- Presentation
Abstract
Proton therapy is an attractive option for the treatment of lung cancer patients due to the physical properties of proton beams. Proton therapy allows a focused delivery of radiation at the Bragg peak, with very steep decline of the radiation dose beyond the target volume. These properties offer the possibility to 1) reduce toxicity by reducing the integral dose and the dose to adjacent normal tissues and 2) escalate the dose to the target in some patients.
In this talk, I will summarise briefly the physics/radiobiology of protons and the need for adaptation. I will also discuss the rationale for the use of protons in patients with lung cancer, including reduction in integral dose, cardiac toxicity and reduction in haematological toxicity. The clinical trial evidence supporting the use of protons will be presented in early stage and locally advanced non-small cell lung cancer as well as in small-cell lung cancer.
Finally I will discuss future research directions, including preclinical and drug-proton combination research, ongoing clinical trials, the model based-approach and the need for biomarkers.
REFERENCES
Liao Z, Lee JJ, Komaki R, eat l. Bayesian Adaptive Randomization Trial of Passive Scattering Proton Therapy and Intensity-Modulated Photon Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer. J Clin Oncol. 2018;36(18):1813-1822
Chang JY, Jabbour SK, De Ruysscher D, et al; International Particle Therapy Co-operative Group Thoracic Subcommittee.Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2016;95(1):505-16.
Vyfhuis MAL, Onyeuku N, Diwanji T, Mossahebi S, Amin NP, Badiyan SN, Mohindra P, Simone CB 2nd. Advances in proton therapy in lung cancer. Ther Adv Respir Dis. 2018 Jan-Dec;12:1753466618783878
C, Pawelke J, Seidlitz A, Peitzsch C, et al; “Radiobiology of Proton Therapy”: Results of an international expert workshop.Lühr A, von Neubeck Radiother Oncol. 2018; 128(1):56-67
Jin, J.Y., et al., Higher Radiation Dose to Immune System is Correlated With Poorer Survival in Patients With Stage III Non-small Cell Lung Cancer: A Secondary Study of a Phase 3 Cooperative Group Trial (NRG Oncology RTOG 0617). International Journal of Radiation Oncology Biology Physics, 2017. 99(2): p. S151-S152.
Joseph, N., et al., Post-treatment lymphocytopaenia, integral body dose and overall survival in lung cancer patients treated with radical radiotherapy. Radiotherapy and Oncology, 2019. 135: p. 115-119.
Durante, M., D.J. Brenner, and S.C. Formenti, Does Heavy Ion Therapy Work Through the Immune System? Int J Radiat Oncol Biol Phys, 2016. 96(5): p. 934-936.
Lee, H.J., Jr., J. Zeng, and R. Rengan, Proton beam therapy and immunotherapy: an emerging partnership for immune activation in non-small cell lung cancer. Translational lung cancer research, 2018. 7(2): p. 180-188.
Dess, R.T., et al., Cardiac Events After Radiation Therapy: Combined Analysis of Prospective Multicenter Trials for Locally Advanced Non-Small-Cell Lung Cancer. J Clin Oncol, 2017. 35(13): p. 1395-1402.
McWilliam, A., et al., Radiation dose to heart base linked with poorer survival in lung cancer patients. Eur J Cancer, 2017. 85: p. 106-113.
Schulz-Ertner, D. and H. Tsujii, Particle radiation therapy using proton and heavier ion beams. J Clin Oncol, 2007. 25(8): p. 953-64.
Gameiro, S.R., et al., Tumor Cells Surviving Exposure to Proton or Photon Radiation Share a Common Immunogenic Modulation Signature, Rendering Them More Sensitive to T Cell-Mediated Killing. Int J Radiat Oncol Biol Phys, 2016. 95(1): p. 120-30.
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MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Simon Ekman, Helena A Yu
- Coordinates: 9/08/2019, 15:15 - 16:45, Tokyo (1982)
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MA08.02 - Durvalumab Impact in the Treatment Strategy of Stage III Non-Small Cell Lung Cancer (NSCLC): An EORTC Young Investigator Lung Cancer Group Survey (Now Available) (ID 608)
15:15 - 16:45 | Author(s): Corinne Faivre-Finn
- Abstract
- Presentation
Background
Stage III NSCLC represents a very heterogeneous population with extremely different treatment modalities including surgery, chemotherapy (CT) and radiotherapy (RT), mostly in combination. The results of the PACIFIC trial have now been reported in full including an overall survival (OS) benefit with durvalumab in addition to concomitant CT-RT. An electronic European survey was circulated to evaluate the impact of durvalumab in the staging and treatment strategy of stage III disease.
Method
A Young Investigator EORTC Lung Cancer Group survey containing 31 questions, was distributed between 31/01/18 and 31/03/19 to EORTC LCG and several European thoracic oncology societies’ members
Result
206 responses were analyzed (radiation oncologist: 50% [n=103], pulmonologist: 26.7% [n=55], medical oncologist: 22.3% [n=46]; 81.5% with >5 years experience in treating NSCLC). Italy (27.7%, n=57), Netherlands (22.8%, n=47), France (13.6%, n=28), and Spain (11.6%, n=24) contributed most. 83.5% (n=172) confirmed that they had access to durvalumab at the time of the survey. 97.6% (n=201) report that treatment decision is made by a multidisciplinary board. Regarding staging, 76.7% (n=158) support the need of a mediastinal pathological staging in case of suspect lymph-nodes, with a preference for EBUS/EUS (61.2%, n=126). 81.6% (n=168) treated more than half of patients with a concomitant CT-RT with the 1st cycle of chemotherapy in 39.7% (n=81). 95.1% consider durvalumab as practice changing, especially given the OS results (77.9%, n=152/195). 30% (n=119/395) will give patients concomitant CT-RT if PD-L1 >1%, and in borderline resectable cases 17.7% (n=70/395) will propose concomitant CT-RT instead of surgery. Durvalumab administration will be given regardless of PDL1 status in 13.1% (n=27) and 28.6% (n=59) would consider the possibility of a rebiopsy after CT-RT in case of negative PD-L1. 38.8% (n=80) foresee some problems with PD-L1 testing in this population due to availability of cytologic or small histologic samples. About 53.8% (n=105/195) normally will start durvalumab within 6 weeks after CT-RT and 48.5% (n=100) would also use durvalumab after sequential CT-RT
Conclusion
Durvalumab results are changing the treatment approach to stage III unresectable (and maybe resectable) NSCLC and planned strict adherence to the patient population as recruited to the PACIFIC study, was not demonstrated. This survey was released after the EMA approval of durvalumab and PD-L1 status seems to play a role in the treatment strategies, but surprisingly almost half of the clinicians will use durvalumab after sequential CT-RT without safety or efficacy data.
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OA12 - Profiling the Multidisciplinary Management of Stage III NSCLC (ID 144)
- Event: WCLC 2019
- Type: Oral Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Dirk De Ruysscher, Bartomeu Massuti
- Coordinates: 9/09/2019, 15:45 - 17:15, Seoul (2007)
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OA12.09 - James D. Cox Lectureship Award for Radiation Oncology (Now Available) (ID 3902)
15:45 - 17:15 | Presenting Author(s): Corinne Faivre-Finn
- Abstract
- Presentation
Abstract not provided
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P1.01 - Advanced NSCLC (ID 158)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-108 - PACIFIC-6: A Phase II Study of Durvalumab Following Sequential Chemoradiotherapy in Patients with Stage III, Unresectable NSCLC (ID 2318)
09:45 - 18:00 | Author(s): Corinne Faivre-Finn
- Abstract
Background
Non-small cell lung cancer (NSCLC) represents 85% of all lung cancers, with ~30% of patients (pts) presenting with Stage III disease. Platinum-based chemoradiotherapy (CRT) has historically been the standard of care (SoC) in this setting, but with poor long-term outcomes. Durvalumab is a selective high-affinity, human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80. The phase III PACIFIC trial assessed durvalumab vs placebo in pts with locally advanced, unresectable, Stage III NSCLC, who did not progress following ≥2 overlapping cycles of platinum-based concurrent CRT (cCRT) (Antonia et al, NEJM 2017; 2018). Significant improvements in progression-free survival (PFS) and overall survival (OS) were observed with durvalumab (HR for PFS, 0.52; 95% CI 0.42–0.65; P<0.001; HR for OS, 0.68; 99.73% CI 0.47–0.997; P=0.0025). This data, along with comparable safety profiles between durvalumab and placebo in PACIFIC, supports the PACIFIC regimen (durvalumab following cCRT) as the new SoC in this setting. However, a proportion of pts are ineligible for cCRT for various reasons, and receive sequential CRT (sCRT) instead. PACIFIC-6 (NCT03693300) will assess the safety, efficacy, and quality of life of durvalumab in NSCLC pts who have not progressed following platinum-based sCRT.
Method
PACIFIC-6 is a phase II, open-label, multi-centre study to be conducted in 6 countries across Europe and North America. Pts ≥18 years old, with histologically or cytologically documented Stage III, unresectable NSCLC who have not progressed following platinum-based sCRT, and are ECOG PS ≤2 are eligible for inclusion; enrolment is not restricted to a biomarker-defined population. Approximately 150 pts will receive durvalumab (1500 mg intravenously) every 4 weeks for 24 months or until disease progression. Pts will be divided into 2 cohorts according to PS status. Pts will be assessed every 12 weeks, until death, withdrawal of consent, or the end of the study. The primary objective is to assess the safety and tolerability of durvalumab, as defined by grade 3 and 4 treatment-related adverse events (TRAEs) occurring within 6 months from initiation of durvalumab. Secondary objectives include investigator-assessed efficacy measurements such as PFS, overall response rate, duration of response (according to RECIST v1.1), as well as OS, lung-cancer mortality, and further safety assessments of all AEs and serious AEs. Exploratory objectives include assessment of pt-reported symptoms and quality of life, as well as evaluation of the association of tumour-based biomarkers (including PD-L1 expression and tumour mutational burden) with efficacy. Recruitment is ongoing.
Result
Section not applicable
Conclusion
Section not applicable
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P1.04 - Immuno-oncology (ID 164)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.04-43 - PD-RAD: A Translational Study Investigating PD-L1 Expression After Radiotherapy for Non-Small Cell Lung Cancer - Trial in Progress (ID 1811)
09:45 - 18:00 | Author(s): Corinne Faivre-Finn
- Abstract
Background
Radiotherapy (RT) is delivered to 30-50% of NSCLC patients. However, over half of patients progress following RT and mechanisms of resistance are poorly understood. RT has immune-modulatory properties such as the ability to upregulate tumour PD-L1 expression and can recalibrate the immune contexture. Blockade of the PD-1/PD-L1 axis has been shown to enhance the efficacy of RT in several pre-clinical models and the recent PACIFIC trial. Exploiting immuno-regulatory effects of RT therefore has the ability to enhance local and distant anti-cancer effects of RT, especially when combining RT with immunotherapies such as anti-PD-1 or costimulatory agonists.
Method
PDRAD is a prospective UK multi-centre feasibility study of paired pre- and post-treatment biopsies in NSCLC patients receiving palliative or radical RT. The study will recruit up to 30 patients with inoperable disease that is accessible to core biopsy by CT or bronchoscopy within the proposed RT field. Patients with archival baseline histology containing sufficient tumour material are eligible. Consented patients undergo a repeat biopsy in the second week of RT (fig.1). Blood samples will be collected at baseline, repeat biopsy, and following RT to assess immune changes that may correlate with the tumour microenvironment (TME). PDRAD opened to recruitment in November 2018 and will continue recruitment over 16 months.
Research aims include investigating:
Feasibility and acceptability of obtaining paired biopsies
Changes in the immune contexture in irradiated tumour and ‘out of field’ sites
Immune changes in the TME and peripheral blood
Interim feasibility results after recruitment of 15 patients will be presented at World Lung.
Result
Section not applicable
Conclusion
We are at a pivotal point in evolving our knowledge of how the TME may influence responses to RT. The PDRAD study will help to influence further clinical trials, including combination studies with immunotherapies and predictive and prognostic biomarker development within the field.
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P1.04-44 - Radiomics for Predicting Response to First-Line Anti-PD1 Therapy in Advanced NSCLC (Now Available) (ID 2172)
09:45 - 18:00 | Author(s): Corinne Faivre-Finn
- Abstract
Background
Radiomics is the high-throughput extraction of quantitative imaging features from medical images that can reflect underlying tumour pathophysiology. Imaging biomarkers have the potential to improve disease characterisation and predict patient outcomes. In this study, the utility of radiomic features to predict response and survival to first-line immune check-point inhibition with pembrolizumab in advanced non-small cell lung cancer (NSCLC) was explored.
Method
Patients with Stage IIIB/IV NSCLC treated with first-line pembrolizumab and PD-L1 ≥50% were retrospectively identified and stratified by Best Overall Response (BOR) by RECIST 1.1. Patients with the primary tumour in situ and a contrast-enhanced CT thorax/abdomen (minimum 5mm CT slice thickness) at baseline were included. The single largest thoracic lesion was segmented in the diagnostic image using the Pinnacle radiotherapy treatment planning system. All tumour delineations were supervised by a highly experienced certified senior radiologist. Lesions <1cm, inflammatory and indeterminate lesions were excluded from delineation. A total of 47 radiomic features including shape, first-order and texture features were extracted from the segmented tumour using PyRadiomics. No pre-processing of the images was performed. Highly correlated features (r>0.85) were removed from further analysis. Least Absolute Shrinkage and Selection Operator (LASSO) feature selection was performed to find informative features that could predict either best overall response or overall survival. Univariate logistic regression and cox proportional hazard models were then used for an initial assessment of the potential of these features in predicting response and survival respectively.
Result
Sixteen patients with evaluable best overall response (partial response n=9, progressive disease n=7) were selected for the initial discovery-cohort. Mean age was 68 years with 63% adenocarcinoma histology. From the 47 features extracted, 32 were highly correlated to each other and were removed from further analysis. For predicting best overall response, LASSO selected 5 features with univariate logistic regression suggesting that tumour surface area to volume ratio might be informative (p=0.057, AUC of 0.83 (95% CI 0.61-1.0)). With respect to overall survival, LASSO selected 3 features with univariate cox regression suggesting the first-order feature skewness might be predictive (HR = 0.27, 95% CI 0.08-0.88, p=0.03). When split on the median skewness value the Kaplan-Meier plot showed a significant survival difference between high and low risk patients (p=0.007).
Conclusion
Radiomic features extracted from baseline contrast-enhanced CT scans may have the potential to predict response and survival in patients treated with first-line pembrolizumab in advanced NSCLC. We emphasize the exploratory nature of these results given the very limited number of patients in the study. We are expanding this discovery cohort to further investigate and validate these results. Updated results will be presented at the meeting.
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-20 - Trial in Progress: Cardiac Toxicity in Patients Undergoing Curative Intent Radiotherapy for Lung Cancer (Now Available) (ID 787)
09:45 - 18:00 | Author(s): Corinne Faivre-Finn
- Abstract
Background
The cardiotoxic effects of radiotherapy (RT) in long term survivors of breast cancer or lymphoma are well documented. Post-mortem studies and animal models have shown that RT causes fibrosis of cardiac structures leading to a wide variety of cardiac pathology. RTOG 0617 has highlighted a link between survival and cardiac dose and has led to a number of studies of cardiac toxicity in lung cancer patients. It is difficult to draw conclusions on cardiac dose constraints from available studies due to their retrospective nature and heterogeneity. We present an ongoing multicentre retrospective data mining study and prospective trial of cardiac biomarkers and imaging in patients undergoing radical lung RT, the aim of which is to define cardiac dose contraints leading to cardiac sparing treatment strategies.
Method
Retrospective Validation
Image based data mining results for heart substructures will be validated using a larger cohort. We will obtain data from Public Health England on cardiac risk factors, hospital admissions and cause of death for these patients to conduct a multivariate survival analysis.
Clinical Trial (NCT03645317)
A prospective study will collect cardiac risk factors (Qrisk 3), detailed cardiac imaging (CT and echocardiogram), ECG and cardiac blood biomarkers to evaluate effect of the radiotherapy on the heart. Figure 1 shows an overview of the clinical trial.
Result
Over 4000 patients treated with curative intent RT from 1/1/2010 to 30/12/206 have been identified. Details on 600 patients have been obtained and will be presented at WCLC 2019. Fifty-two patients (9%) had cardiac events following RT.
The prospective trial is due to open in May 2019
Conclusion
Studies of cardiac toxicity in lung RT have so far mainly been heterogeneous and retrospective. We describe a package of work incorporating large retrospective datasets with prospective imaging and blood biomarker collection to define cardiac dose parameters. This will improve the outcomes of lung cancer patients treated with radical radiotherapy by limiting heart dose and reducing cardiac events.
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P1.17 - Treatment of Early Stage/Localized Disease (ID 188)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-22 - Do Statins Improve Outcomes After Radical Radiotherapy for Lung Cancer? An In-Depth Analysis of Over 1100 Patients (Now Available) (ID 1138)
09:45 - 18:00 | Author(s): Corinne Faivre-Finn
- Abstract
Background
Statins exhibit anti-cancer activity in vitro in addition to cardiovascular protection effects. Trials using statins in lung cancer have shown mixed results. This study investigates statins’ impact on patients treated with curative radiotherapy for lung cancer.
Method
All patients who received radical radiotherapy for lung cancer from 01/01/2010-31/12/2016 at a large cancer centre were included. Individual patient information, including drug history at diagnosis, has been retrieved from hospital electronic database. Pre-existing cardiac conditions, Charlson Co-mobidity index and Qrisk3 scores were calculated.
Result
1181 patients were identified. Patient and treatment demographics are summarised in table 1. Patients in the statin group were older, had more co-morbidities and higher Qrisk3 scores. For the whole patient population, being on stains at the time of diagnosis was not significantly associated with better Overall Survival (OS) or Progression Free Survival (PFS). A ‘High Risk Cohort’(HRC) was identified, which consists of patients with a history of cardiac disease or Qrisk3 score >40. In HRC, statins significantly improved OS and PFS (p=0.016 and p=0.031 respectively), Graph 1.
Table 1
Total
N = 1181
Patients NOT on Statins N = 652
Patients ON statins N = 529
Sex
Male
603
298
305
Female
578
354
224
Age at RT treatment
Median = 73
Range 24 - 97
Median = 71
Range 24 - 92
Median = 74
Range 48 - 97
PS
0
94
67
27
1
578
347
231
2
438
212
226
3
71
26
45
Smoking Status
Unknown
16
7
9
Never smoked
43
28
15
Ex-Smoker <10 PY
14
9
5
Ex-smoker <20 PY
158
76
82
Ex-Smoker 20-40PY
276
132
144
Ex-Smoker >40 PY
259
140
119
Current Smoker(at time of seeing oncologist)
415
260
155
Charlson Score
(2 points for having lung cancer)
Median = 6
(2% estimated 10 year survival)
Median = 5
Median = 6
Qrisk3 Score
(For those without history of MI/IHD/CVA and < 84)
Median = 21% (%risk of stroke/MI in next 10 years)
Median = 18.7
Median = 25.7
Known pre-existing cardiac condition
= 349
101 had previous MI
113 had no MI but IHD/Angina
105
-15 previous MI
-33 IHD/Angina
244
-86 previous MI
-78 IHD/Angina
RT indication
Adjuvant RT
70
46
24
SBRT
478
240
238
Concurrent ChemoRT
202
135
67
Sequential ChemoRT
122
84
38
Radical RT
278
112
166
Consolidation RT after chemo for stage 4
31
10
21
Graph 1
Conclusion
In this retrospective analysis, patients who were on statins in the HRC had better survival outcomes, despite being older and have more comobidities. Mechanism of action of statins in lung cancer remains unclear and may be different in the post radiotherapy setting. Prospective studies would be useful to evaluate statins in this setting.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-08 - Clinical Trial in Progress: CONCORDE - A Phase 1B Study of Novel Agents in Combination with Conventional Radiotherapy in NSCLC (ID 600)
10:15 - 18:15 | Author(s): Corinne Faivre-Finn
- Abstract
Background
The majority of patients with locally advanced non-small cell lung cancer (NSCLC) treated with curative intent receive radiotherapy (RT) as part of their treatment. Despite considerable technological advances in RT delivery, the survival of these patients has barely changed over the last 60 years. A major factor in this failure to improve outcomes is the relative radioresistance of NSCLC. Attempts to overcome radioresistance by escalating RT doses have demonstrated inferior outcome likely secondary to normal tissue toxicity. Therefore an alternate approach is to exploit genetic dependencies in the DNA damage response of NSCLC, using biological inhibitors to selectively radiosensitise tumours whilst sparing normal tissues. The CONCORDE study is a multi-arm phase 1B platform study to investigate the combination of radical RT with DNA damage response inhibitors (DDR-i) targeting five different proteins: PARP, ATR, WEE1, ATM, DNA-PK.
Method
CONCORDE is a hypothesis-driven combination study of novel therapeutics and RT using an innovative adaptive early-phase trial design. The study will address two main research questions:
- What are the recommended phase 2 doses (RP2D) of individual DDR-i in combination with curative RT in patients with stage IIB/III NSCLC?
- What are the safety profiles of individual DDR-i combined with curative RT in this population?
Key inclusion criteria are stage IIB and III NSCLC planned to receive curative intent RT doses (+/- neoadjuvant chemotherapy) and PS 0-1. Participants will be randomised on a 3:1 basis between DDR-i with RT or RT alone. Patients receiving RT alone will be pooled across the arms to provide contemporary data on toxicity. All patients will receive external beam RT with a planned dose of 60 Gy in 30 fractions.
The study will use a Bayesian adaptive model-based approach to dose-escalation, with separate Time-To-Event Continual Reassessment Method (TiTE-CRM) models in each experimental arm. The primary endpoints are dose-limiting toxicities occurring within 12 months of the start of radiotherapy. Secondary endpoints include safety and toxicity (acute and late toxicity up to 2 years including using patient reported outcome (PRO) measures), treatment compliance, and best overall response (using RECIST 1.1, progression-free, and overall survival).
Correlative studies will be carried out to identify biomarkers of toxicity and response. We have secured high-level agreement from leading pharmaceutical partners to invest in 5 treatment arms and funding approval from Cancer Research UK is pending. The first participant is estimated to commence treatment in late 2019
Result
Section not applicable
Conclusion
Section not applicable
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P2.08 - Oligometastatic NSCLC (ID 172)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.08-02 - Outcomes Following Stereotactic Radiosurgery for Syncronous Brain Metastases in Non-Small Cell Lung Cancer (ID 426)
10:15 - 18:15 | Author(s): Corinne Faivre-Finn
- Abstract
Background
Approximately 10% of non-small cell lung cancer (NSCLC) patients have brain metastases at presentation. The use of stereotactic radiosurgery (SRS) has enabled a proportion of patients with oligometastatic brain disease to be offered a radical treatment in conjunction with SRS. We evaluated the outcomes for patients presenting with synchronous brain metastases who received SRS to determine if radical treatment improves survival.
Method
164 patients with NSCLC received SRS for brain metastases between January 2012 and December 2017. This analysis focused on 71 patients who presented synchronously with brain metastases. Electronic patient records were accessed in March 2019 to determine initial extracranial disease treatment and date of death or last follow up.
Result
30 patients received radical treatment (18 radiotherapy alone, 11 chemo-radiotherapy and one surgery) and 24 received palliative treatment (17 chemotherapy, four radiotherapy and three tyrosine kinase inhibitor). 17 patients received no treatment following SRS, either due to death, deterioration in performance status or patient choice. Baseline demographics are presented in table 1.
Median overall survival for the radical, palliative and no treatment groups were; 7.9 (95% CI 5.5-14.0), 9.4 (6.6-14.4) and 1.4 (1.0-2.9) months, respectively. There was no significant difference in survival between the radical and palliative groups (p=0.43). Kaplan-Meier survival estimates at 12 and 24 months were 30.0% (95% CI 17.4- 51.8%) and 10.0% (3.4-29.3%) for the radical and 33.3% (18.9- 58.7%) and 13.0% (4.1-41.4%) in the palliative group, respectively.
Conclusion
Our results did not demonstrate the benefit for radical treatment, as expected based on published data. Potential reasons for this result include a lack of tools to select patients for radical treatment. Prospective studies are needed to identify the optimal treatment for extracranial disease in this patient group.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-02 - Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy (ID 291)
10:15 - 18:15 | Author(s): Corinne Faivre-Finn
- Abstract
Background
International guidelines currently recommend radical radiotherapy for non-small cell lung cancer (NSCLC) patients with ECOG performance status (PS)0-2. Despite a paucity of evidence for treating poorer PS patients, modern advances have allowed patients with PS3 to be offered radical radiotherapy.
Method
PS0-3 NSCLC patients receiving radical radiotherapy at The Christie Hospital, UK between August 2016-October 2017 were retrospectively identified from hospital electronic patient records. Survival was calculated from date of first oncology review to November 2018. Baseline and treatment characteristics for PS3 patients were recorded including adult comorbidity evaluation (ACE)-27 score, pulmonary function, radiation dose volume parameters and radiotherapy regimen (i.e stereotactic ablative radiotherapy (SABR) vs standard radiotherapy (50-55Gy/20 fractions)).
Result
504 patients were identified: 440(87%) PS0-2 and 64(13%) PS3. Six PS3 patients withdrew themselves; four before treatment and two after one fraction. Of 58/64(91%) PS3 patients completing radiotherapy, 43(74%), 4(7%), 10(17%) and 1(2%) were Stage I, II, III and IV at diagnosis, respectively. ACE-27 score was 0, 1, 2 and 3 in 3(5%), 8(14%), 16(28%) and 31(53%) patients, respectively. 31(53%) received SABR and 27(47%) standard radiotherapy. On intention-to-treat analysis, there was no significant difference in survival over 18 months in PS3 patients compared to PS0-2; p=0.858 (Fig.1). There was no significant difference in survival among PS3 patients completing radiotherapy when stratifying by stage(I vs II vs III) (p=0.343), ACE-27 score(1 vs 2 vs 3)(p=0.266), or radiotherapy regimen(p=0.655). Lung function tests(FEV1, FVC) and radiotherapy dose volume parameters(PTV, V5, V10,V20) failed to predict survival of PS3 patients at 6, 12 and 18 months.
Conclusion
This study demonstrates that PS3 patients receiving radical radiotherapy had a similar 18-month survival compared to PS0-2 patients and baseline and treatment characteristics did not predict overall survival in PS3 patients. This suggests more PS3 patients could be considered for radical radiotherapy and further studies with larger cohorts are recommended.
