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Mary O'Brien
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MA05 - Update on Clinical Trials and Treatments (ID 123)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:Seiki Hasegawa, Enrico Ruffini, Angel Artal
- Coordinates: 9/08/2019, 13:30 - 15:00, Melbourne (1991)
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MA05.01 - Second or Third Line Anti-PD-1 Therapy After Multimodality Therapy Including Total Pleurectomy in Malignant Pleural Mesothelioma (Now Available) (ID 1955)
13:30 - 15:00 | Author(s): Mary O'Brien
- Abstract
- Presentation
Background
Surgical resection plays an important role in the management of selected patients with malignant pleural mesothelioma (MPM). Early experience with anti-PD-1 immunotherapy showed promise in MPM, but it is yet uncertain if it can improve outcomes when tumour relapses following surgical resection, radiotherapy and chemotherapy. We reviewed our experience in patients who received Pembrolizumab or Nivolumab following multimodality therapy.
Method
Retrospective study including patients with histologically-proven MPM having completed multimodality therapy and received anti-PD-1 immunotherapy as 2nd or 3rd line treatment. Data were retrieved from a prospective mesothelioma database. Histopathology, BAP1, MTAP and PD-L1 (22C3) immunohistochemistry were performed on surgical specimens and reported by a senior pathologist. All patients had chest computed tomography and positron emission tomography (PET-CT) as part of their normal follow-up. Response evaluation was determined using RECIST 1.1 criteria.
Result
16 patients received anti-PD-1 immunotherapy between August 2015 and March 2019. All patients had total pleurectomy/decortication, prophylactic radiotherapy (21Gy/3) and systemic chemotherapy based on pemetrexed and platinum. Median age was 68.5 years, with male predominance (13/16). 56% had epithelioid type, 44% had biphasic type. Median time to starting immunotherapy was 20 months (range 11-42) following surgery. Median ECOG performance status was 0. Twelve patients received Pembrolizumab and 4 received Nivolumab. Median number of cycles of anti-PD-1 therapy received was 5 (range 1-33). Disease control rate at 12 weeks was 56.2% and 7 (43.7%) patients had disease progression. Adverse events were observed in 6 patients (one Grade 3). Eight patients were alive by 1st April 2019. Median OS from starting immunotherapy was 13.5 months. Three patients received treatment for 14 months or more. Five patients started further therapy after discontinuing immunotherapy.
Conclusion
In our cohort, second or third-line anti-PD-1 immunotherapy showed efficacy with DCR comparable to non-surgical setting. Further studies are warranted to validate our preliminary findings.
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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): Mary O'Brien
- 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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OA07 - Precision Medicine Involves Biology and Patients (ID 132)
- Event: WCLC 2019
- Type: Oral Session
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:Silvia Novello, Fabrice Barlesi
- Coordinates: 9/09/2019, 11:00 - 12:30, Copenhagen (1980)
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OA07.08 - Discussant - OA07.05, OA07.06, OA07.07 (Now Available) (ID 3759)
11:00 - 12:30 | Presenting Author(s): Mary O'Brien
- Abstract
- Presentation
Abstract not provided
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OA15 - Targeted Agents and Immunotherapy for Small Cell Lung Cancer (ID 152)
- Event: WCLC 2019
- Type: Oral Session
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:Raffaele Califano, Charles M Rudin
- Coordinates: 9/10/2019, 14:30 - 16:00, Hilton Head (1978)
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OA15.03 - Discussant - OA15.01, OA15.02 (Now Available) (ID 3804)
14:30 - 16:00 | Presenting Author(s): Mary O'Brien
- 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
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-79 - G8 Screening Scores in Elderly Advanced Lung Cancer Patients: A Prospective Single Institution Study (Now Available) (ID 1473)
09:45 - 18:00 | Author(s): Mary O'Brien
- Abstract
Background
Standard evaluation of elderly patients based on ECOG performance status (PS) may lead to excessive toxicity or undertreatment and loss of efficacy. We used the G8 score classification to assess the correlations between G8 scores, treatment decisions and clinical outcomes.
Method
Elderly patients (≥ 70 years old) with advanced lung cancer treated at the Royal Marsden hospital between July 2016 and July 2018 were prospectively assessed by standard clinical methods and the G8 questionnaire. The G8 score did not influence the physician decision. Total G8 scores were < 11 low score, 11-14 intermediate group, and > 14 as the high score group. We correlated treatment decisions, relative dose intensity (RDI) of first two cycle, proportion of dose attenuation, ≥G3 toxicity and hospitalisation in each G8 score group.
Result
Patient characteristics and clinical outcomes in each G8 score group are listed as Table 1. The G8 score correlated inversely with PS. More patients in the low score group (56%) had PS ≥2 compared to other two groups. Physicians tended to offer BSC to low score patients; 49%, 12% and 5% patients in low, intermediate and high score group respectively did not receive any systemic treatment. More patients in high score group (53%) received full dose chemotherapy on first cycle. Patients in high score group also tended to tolerate full dose chemotherapy better with relatively high RDI for the first two cycles (0.9) and less frequent (0%) ≥G3 toxicity. Patients in intermediate score group had similar frequency of ≥G3 toxicity and hospitalisation to patients in low score group, who received chemotherapy.
Conclusion
The G8 screening score classification into low, intermediate and high supported clinical treatment decisions on dose and it appeared to correlate with risk of toxicity.
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P2.06 - Mesothelioma (ID 170)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.06-05 - Multimodality Therapy Using Total Pleurectomy in Malignant Pleural Mesothelioma: Long-Term Outcomes in 150 Consecutive Cases (Now Available) (ID 1441)
10:15 - 18:15 | Author(s): Mary O'Brien
- Abstract
Background
We wished to evaluate the long-term outcomes of patients receiving multimodality therapy including total pleurectomy/decortication, radiotherapy and systemic chemotherapy for malignant pleural mesothelioma.
Method
Retrospective analysis of patients treated between September 2004 and April 2019 by a specialised thoracic multidisciplinary team. Treatment involved total pleurectomy and decortication of lung, prophylactic radiotherapy (21 Gy in 3 fractions) and systemic chemotherapy based on pemetrexed and platinum. PET-CT was used routinely to diagnose disease recurrence or progression. Second or third-line therapies were administered when appropriate. Survival and prognostic factors were analysed by the Kaplan-Meier method and Cox regression analysis.
Result
150 patients had multimodality therapy over a 15-year period. Median age at operation was 62 years (range 32-82) and the male/female ratio was 122/28. Thirty-one patients (20.6%) had received chemotherapy before surgery. Thirty-three patients (22%) had extended resections. Sixty-two patients suffered a postoperative complication and 90-day mortality was nil. Eleven patients (7.3%) had reoperation within 30 days. Histological types were epithelioid in 105 patients and non-epithelioid in 45. Pathological stages were: I:86, II: 9, III: 54, and IV:1 (8th TNM classification). All patients but one received prophylactic radiotherapy. Six patients (4%) did not received systemic chemotherapy. Sixty-five patients (43.3%) received second-line or further systemic therapies. Five patients received stereotactic radiotherapy and three patients had late reoperation for focal tumour recurrence. Median survival was 30.5 months overall (95% CI 25.4-35.6), 34 months for epithelioid type (95% CI 25.8-42.2) and 18.3 months for non-epithelioid type (95% CI 14.2-22.4). Histological type and macroscopic complete resection were predictive of extended survival in our analysis.
Conclusion
Total Pleurectomy /Decortication is a safe and well-tolerated procedure associated with no mortality and acceptable morbidity. Most patients can receive prophylactic radiotherapy and systemic chemotherapy in due time. Many can receive second-line or further therapy on progression, resulting in prolonged survival.
