Author of

• 29486

  +

  IBS21 - Combating Toxicity of IO-Chemotherapy Combinations (Ticketed Session) (ID 52)

  • Event: WCLC 2019
  • Type: Interactive Breakfast Session
  • Track: Treatment in the Real World - Support, Survivorship, Systems Research
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/10/2019, 07:00 - 08:00, Vienna (2016)

  • 29488

    +

    IBS21.02 - Real World Toxicities of Radiation Plus IO in NSCLC (Now Available) (ID 3380)

    07:00 - 08:00  |  Presenting Author(s): Ronan Kelly
    • Abstract
    • Presentation
    • Slides

    Abstract
    

    As the indications for immune checkpoint inhibitors expand in stage III and stage IV non small cell lung cancer, medical and radiation oncologists will need to risk-stratify patients for the development of immune related toxicities most notably checkpoint-inhibitor pneumonitis (CIP) and to differentiate this from radiation induced pneumonitis. Real-world patient data is providing new insights into the epidemiological and clinical characteristics of CIP and emerging data which needs to be validated suggest a higher incidence of CIP approaching 19% in non- trial patients compared to 3-5% reported in clinical trials. A seasonal pattern of CIP with an increase in the number of cases in the Winter months when viral infections are at a high and in patients that may be more susceptible due to existing comorbidities than ECOG 0-1 trial patients need to be further evaluated. Additionally, it appears the risk of developing CIP is histology dependent with a lower risk being seen in nonsquamous lung cancer. A variety of radiographic patterns ranging from organizing pneumonia to ground glass or interstitial patterns are seen and time-to-onset analysis suggest that there may be two differing phenotypes most notably early onset CIP which is high grade and associated with higher mortality and late-onset CIP which is of lower grade and has less mortality. At the present time, no specific radiotherapy-related treatment parameter such as technique (stereotactic body RTor intensity-modulated RT), timing or number of courses have been associated with CIP, however, there is a trend associated with curative-intent radiotherapy compared with palliative intent radiation. Interestingly, the development of non-pulmonary immune related adverse events has been associated with an improved response and overall survival to checkpoint inhibitors. While these phenomena require further investigation it has been suggested that the poor outcomes associated with CIP relate to the fact that hypoxia from pneumonitis is poorly tolerated in patients who already have respiratory compromise as a result of lung cancer and may precipitate multiorgan failure due to decreased oxygenation. The creation of multi-disciplinary teams that have a specific interest in the management of immune related toxicities may help improve patient outcomes due to early identification but a more comprehensive understanding of the underlying biology is needed if we are to refine our existing diagnostic and treatment algorithms to appropriately manage life-threatening complications associated with changing paradigms of care.

    Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

    Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.