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Brian Hunis



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    MA01 - Oligometastatic Disease (ID 114)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Now Available
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      MA01.11 - Improving Survival in Lung Cancer Patients with Oligometastatic Disease Progression Using Stereotactic Body Radiation Therapy (Now Available) (ID 1836)

      10:30 - 12:00  |  Author(s): Brian Hunis

      • Abstract
      • Presentation
      • Slides

      Background

      In patients (pts) with stage IV non-small cell lung cancer (NSCLC) receiving systemic therapy, stereotactic body radiation therapy (SBRT) can eliminate oligometastatic disease progression (OMP). This allows NSCLC pts to continue the same systemic therapy, and its is especially important when the therapy is well tolerated as is the case for many pts receiving immunotherapy (IMMUNO) and targeted therapy (TARGET). The purpose of this study is to quantify the progression free survival (PFS) and overall survival (OS) of pts receiving systemic therapy who experience OMP that is treated with SBRT, and subsequently continue the same systemic therapy.

      Method

      Retrospective review of one hundred pts with metastatic NSCLC undergoing chemotherapy (CHEMO), IMMUNO or TARGET that had OMP defined as less than 4 sites of metastasis and underwent SBRT were evaluated for PFS and OS. PFS1: Time between initiation of systemic therapy and development of OMP. PFS2: Time between OMP treated with SBRT and development of further PD requiring a change in systemic therapy. Pts received IMMUNO for second line and beyond. SBRT doses were determined based on the disease site and dose tolerance of the adjacent organs. SBRT was delivered in 1-5 fractions on consecutive days or every other day. Radiation dose was determined by target volume and adjacent dose-limiting organs.

      Result

      OMP presented as brain metastasis (BM) in 45 pts and extracranial metastasis (EM) in 55 pts. 34 pts were receiving CHEMO, 34 TARGET and 32 IMMUNO at the time of OMP. Pts with BM that received SBRT were able to continue the same therapy for a period of 6.5-9 extra months due to the control of BM. Pts with EM that have developed PD were able to continue the same therapy an 17-21 extra months due to the ablation of OMP by SBRT. For the entire cohort PFS was: 16.5m for BM and 34m for EM and the OS were: 31m and 53m respectively.

      Location of oligometastatic progression (OMP)

      Median PFS1

      Median PFS2

      PFS

      Median OS

      Extracranial (N=55)

      13

      21

      34

      53

      chemo

      7

      17

      24

      47

      Immuno

      13.5

      20.5

      34

      49

      Target

      12

      21

      33

      53

      Brain (N=45)

      9

      7.5

      16.5

      31

      Chemo

      5.5

      6.5

      12

      25.5

      Immuno

      7

      8

      15

      27

      Target

      11

      9

      20

      47

      Conclusion

      PFS and OS may be prolonged due to the use of SBRT in pts that develop OMP. This intervention allowed patients to continue with the same systemic treatment. Our CHEMO cohort is composed of long term survivors under therapy and may not represent the average PFS/OS of pts on CHEMO. Prospective trials are needed to verify these results.

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    P1.04 - Immuno-oncology (ID 164)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.04-75 - Immune-Related Adverse Events and the Neutrophil to Lymphocyte Ratio as Predictors of Clinical Response to Immunotherapy (Now Available) (ID 1969)

      09:45 - 18:00  |  Author(s): Brian Hunis

      • Abstract
      • Slides

      Background

      Several immune checkpoint inhibitors (ICPis) have been approved for the treatment of non-small cell lung cancer (NSCLC). PD-L1 expression seems to correlate with activity of ICPis; however, it is not a completely accurate biomarker. Therefore, other clinical or molecular predictors of response are needed.

      Method

      The purpose of this study was to assess the value of immune-related adverse events (irAEs) and the neutrophil to lymphocyte ratio (NLR) in predicting response to ICPis. Furthermore, since Hispanics (H) are often not stratified in clinical trials, we sought to evaluate if incidence of irAEs and the baseline NLR were similar between H and non-Hispanic (NH) patients (pts). This was a retrospective review of 70 pts diagnosed with NSCLC and treated with ICPis at our institution between July 2014 and 2017. The electronic medical record was utilized to collect pt demographics, occurrence of irAEs, baseline NLR (categorized as < 5 or > 5), progression free survival (PFS) and overall survival (OS). The data cutoff date was March 31, 2019.

      Result

      The median age of the pts was 65.5 years (range 51 to 89 years). The male to female ratio was 1.2. There were 19 H and 51 NH pts. Most of the pts were treated with single agent ICPis. The irAEs positive group had increased median PFS (7.5 vs 2.1 months; p-value 0.001) and OS (14.7 vs 4.7 months; p-value 0.001) compared to the irAEs negative group. OS at 12 months was 58.1% in the irAEs positive group compared to 20.5% in the irAEs negative group (p-value 0.001). There was a non-statistically significant trend towards improved outcomes in pts with baseline NLR < 5 vs > 5. The overall incidence of irAEs was similar between H and NH pts; however, hypothyroidism was observed more frequently in H than NH pts (45% vs 20%; p-value 0.020). Baseline NLR < 5 vs > 5 was similar between H and NH pts.

      Conclusion

      Occurrence of irAEs might be useful in identifying potential responders to ICPis. H pts on ICPis might be at a higher risk for developing hypothyroidism. Since our total number of pts is small, these findings should be further evaluated in prospective studies.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • 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: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-15 - Survival and Clinical Immunotherapy Outcomes in Hispanic Patients vs Non-Hispanic White Patients with Non-Small Cell Lung Cancer   (Now Available) (ID 1514)

      10:15 - 18:15  |  Author(s): Brian Hunis

      • Abstract
      • Slides

      Background

      The number of Hispanic (HISP) patients (pts) enrolled in immunotherapy (IMMUNO) trials is minimal or non-existent in non-small cell lung cancer (NSCLC). It’s well known that HISP pts with NSCLC have not only a different genomic profile than Non-Hispanic Whites (NHW)- like higher expression of EGFR mutations- but also better outcomes than NHW (“Hispanic Paradox”); thus the need to validate outcomes in HISP pts treated with IMMUNO.

      Method

      We present data in 436 NSCLC pts treated with IMMUNO at 5 large institutions (3 in the US, 2 in Latin America). The agents evaluated include: nivolumab, pembrolizumab and atezolizumab. 256 pts were HISP and 180 pts were NHW. Most of the pts were treated with single agent therapy as second line or beyond while a small group of pts were treated as first line. The primary endpoints of the study were: response rate (ORR), progression free survival (PFS) and overall survival (OS). Secondary endpoints were disease control rate (DCR), PD-L1 expression and others.

      Result

      The results are consolidated in the table below.

      Hispanics (n=256)

      NHW (n=180)

      p value

      Sex (males)

      52%

      45%

      0.2059

      ORR

      First Line

      35%

      30%

      0.6590

      Second Line

      18%

      19%

      0.3236

      Adeno

      22%

      24%

      0.6714

      SQCC

      24%

      23%

      1.0000

      PDL1 (+)

      29%

      32%

      0.4839

      PDL1 (-)

      5%

      17%

      0.3040

      Disease Control Rate: ORR+SD (DCR)

      Adeno

      68%

      67%

      0.8989

      SQCC

      67%

      46%

      0.0777

      Median PFS

      4m

      4m

      0.7509

      Median OS

      22m

      22m

      0.2004

      There were no statistical significant differences among HISP and NHW pts regarding ORR, DCR, PFS, OS, and responses according to PD-L1 status.

      Conclusion

      No significant differences were found in the clinical outcomes between these 2 ethnic groups despite the “Hispanic Paradox” and expected genomic differences; however pts with actionable mutations were excluded as they usually do not get IMMUNO as first or second line; an approach that might change after IMPOWER 150. This is the largest comparison of NSCLC immunotherapy outcomes in HISP vs NHW pts. These results are comparable to the ones seen in Checkmate and Keynote studies. As expected, higher response rates were seen in first line therapy and pts with PD-L1 (+) status. Further comparisons will be better addressed by a larger prospective study.

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