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Lizza Hendriks
Moderator of
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YI03 - Scientific Mentoring (ID 109)
- Event: WCLC 2019
- Type: Young Investigator Session
- Track: Young Investigators
- Presentations: 4
- Now Available
- Moderators:Lizza Hendriks, Carme Obiols
- Coordinates: 9/08/2019, 10:30 - 12:00, Dublin (1997)
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YI03.01 - Why to Apply for International Fellowship? (Now Available) (ID 3703)
10:30 - 12:00 | Presenting Author(s): Celine Mascaux
- Abstract
- Presentation
Abstract
First of all, if you aim for an academic career, the international fellowship is a requirement in most countries. If you are not choosing an academic career, the international fellowship will be very useful anyway. This fellowship can be clinical, scientific or both, depending on your wish. Be aware of choosing an appropriate destination and team based on what you are looking for. Depending on the country where you trained and the country that you are choosing for your fellowship, you may or may not be fulfill the requirement for clinical practice. You must make sure that your salary will be funded and that your income is sufficient for leaving in the city of your fellowship. A fellowship needs to be planned several months in advance for the administrative preparation.
Overall, international fellowship will be a uniquely rich experience. It will open new perspectives in your career. You will learn from the new team and modulate your clinical/scientific interpretations and your decisions. It will diversify your clinical/scientific interests, increase and diversify your knowledge and you expertise. The international fellowship will also allow you to built an international network and collaborations, and increase your visibility.
In addition of being a very valuable professional experience, it will be a very rich personal challenge, from which you will enjoy and learn as well, by discovering and experiencing a different context of life, different culture and also perhaps a different language.
Both for the professional and the personal side of your life, the international fellowship will open your mind and will be an unforgettable experience
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YI03.02 - How to Apply for International Fellowship? (Now Available) (ID 3704)
10:30 - 12:00 | Presenting Author(s): Ming Sound Tsao
- Abstract
- Presentation
Abstract
International fellowship to pursue further training is an important part of career development for junior clinicians and investigators. International fellowship will not only increase the clinical and/or research skill of the fellow, it also offers an important opportunity to establish interaction network with senior investigators and peer young investigators across the world. When applying for international fellowship, several aspects should be considered: (1) choosing the field for further training, (2) application procedure, and (3) funding availability. The choice of field for further training will largely determine the future career of the candidate and should be in line with one’s scientific or career passion and clinical/research interest. Prior experience with a role model and mentorship during earlier formative years usually has great influence on one’s decision to pursue career choice. Fellowship training can be limited to clinical only, research only or combined clinical and research training; the latter for a candidate who wishes to pursue clinician-scientist career. Once a decision to pursue further training is made, the candidate should look for fellowship opportunities. This is often through discussion with local mentors or colleagues with prior international fellowship experience, or via familiarity with potential mentors who have published extensively in the area of candidate’s interest or have lectured at international meetings. On-line searches for institutions with established fellowship program may also be useful, but many training programs may not be openly advertised, thus personal approaches and recommendations are often more fruitful. Writing an application letter that demonstrates strong background, qualification, prior track record, commitment and clear post-fellowship career pathway are key elements to win an opportunity for further interview. Availability of secured partial/full funding from local Institution or independent funding agency is a great asset for an application. While one year fellowship that involves only clinical training may be sufficient, training that involves laboratory research will usually require a minimum of 2 years tenure, as the latter usually requires more time to accomplish specific research projects. In such case, preliminary data obtained during first fellowship year may greatly contribute to applications for fellowship offered by international societies (e.g., IASLC, ASCO, AACR) or funding agencies.
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YI03.03 - Scientific Mentorship: What Should You Expect? (Now Available) (ID 3705)
10:30 - 12:00 | Presenting Author(s): Rafael Rosell
- Abstract
- Presentation
Abstract
Scientific Mentorship: What Should You Expect?
I am honored to speak to young investigators on mentorship. Over several decades I have had the opportunity to serve as mentor of many clinical investigators, both local and worldwide. Throughout the years, most of my mentors have been involved in translational research and laboratory work, which, on many occasions, has resulted in fruitful research, culminating in theses and publications in relevant journals. One of the key points in assuming the responsibility of training is to work very closely, as friends, standing side by side, studying the relevant research project and its progress. There are several emotions among the mentor and young investigators. The mentor feels joy and delights in seeing the young investigators progress, converting in an overall happiness at the project accomplishment. The mentors joy comes once every young investigator achieves the main objective of his/her work in process.
Transparency is the fuel of friendship between the mentor and young investigator. The mentor should be fully involved and open, in order to build a strong mentor/investigator relationship. The mentor must show emotional honesty, even if there is the possibility of someone taking advantage of his/her vulnerabilities. Unmasking oneself is the only means to building successful scientific relationships. The mentor should apply an open policy of collaboration, assuming the young investigators could have an even greater capacity for research, than the mentor himself. Most of the time, this behavior will be a benefit for the investigators. There have been many examples of investigators contributing to important findings in a plethora of different research areas. Cancer biology was recognized as an important cancer field in the late 90’s, and many investigators have made exciting contributions in tumors, such as, non-Hodgkin’s lymphomas (Calvo et al JNCI 1998), gastric cancer (Wei et al JNCI 2011) and many others, culminating in salient publications in the field of lung cancer (Karachaliou et al JAMA Oncol 2015). The principal contributions will be included in the presentation.
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YI03.04 - Oncology Fellows' Career Plans and Expectations (Now Available) (ID 3706)
10:30 - 12:00 | Presenting Author(s): Masaoki Ito
- Abstract
- Presentation
Abstract
I will discuss how I planned my fellow career and tips for achieving based on my own experience. My own career is short, at around 10 years, but I would be glad if my presentation could be of some service to fellows in the same position.
If you want to achieve something different than your current situation for your own career, then you gain qualifications, earn achievements such as publishing papers, participate in the academic community, or organize projects, but it is difficult to decide on the ultimate goal at an early stage. For young fellows to build a career, the process is more crucial than setting the outcome, therefore it is essential to know oneself, in addition to learning the latest information on thoracic oncology. Read articles, participate in academic conferences and train at other facilities as a means of understanding your own knowledge and competencies, rather than simply as a means of learning about thoracic oncology.
Although training at special facility will provide the smallest amount of information about thoracic oncology at one time, I believe it is the most efficient means of learning about oneself. This type of learning enables you to directly and simultaneously understand your disadvantages, advantages and characteristics. I have worked and researched at several hospitals and research institutes both in Japan and overseas. I made use of the scholarship system in the past to conduct clinical training in Spain, which enabled me to gain a wealth of clinical experience that I would not have been able to experience in Japan. I am currently affiliated with a research institute in Barcelona and have been involved in research there since 2017 under world-renowned supervisors. I contribute to joint research between Japan and Spain, and Spain and the US, and this, among other opportunities, has enabled me to learn a great deal at my current facility. This experience has not only strengthened my resolve about the new goals I want to achieve, it has also made me fully aware of areas where I am lacking.
For the training at a special facility, getting the grant is crucial. I have received some grant support from several academic associations including IASLC. The financial supports allowed me to gain and achieve ambitious aims. Through the project, I have been inspired and it brought me new ambitions. Although there are more and more opportunities of the grant in these days, winning is getting more competitive. Fortunately, I could receive grant support several times. However, I failed many times to get the support. To get the grant, I will show tips based on my own experience at my presentation.
If training at a special facility or getting the grant is difficult, I recommend continuing to participate at international conferences. This is also particularly important for learning the latest information about thoracic oncology. I have participated 13 times in international conferences to date, and have participated in the World Conference on Lung Cancer (WCLC) since the 13th congress held in 2009. I strongly recommend checking all the abstracts before attending the conference, preparing questions and discussing matters with as many people as possible during the conference. WCLC has research in all fields related to thoracic oncology, so it is relatively easy to make new acquaintances and partnership in your own field of research or interest. In this instance also, it is important to make presentations and receive as much input as possible, to clarify areas where you may be lacking and you have advantage, thus using this opportunity as efficiently as you can. Attending congress also gives you chances to get informed the grant opportunity and which facility is attractive for you to make training.
In summary, it is not easy to make decisions about your career, and often we are unaware when we are at a turning point. No one knows the correct answer. Building a career involves not only your own intentions, but also your situation and funds. The important thing is to focus on the quality of the process to ensure that you do not waste time, and to always be aware of your own strengths and weaknesses, and using or supplementing these characteristics to discover what you want to achieve and what you can achieve in your career.
Training at a special facility and keeping to join academic congress clearly enhance our academic career. It will give you new confidence to find or continue on your mission for thoracic oncology.
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Author of
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MA07 - Clinical Questions and Potential Blood Markers for Immunotherapy (ID 125)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:David R Spigel, Roberto Ferrara
- Coordinates: 9/08/2019, 13:30 - 15:00, Vancouver (2003)
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MA07.02 - Early Change of dNLR Is Correlated with Outcomes in Advanced NSCLC Patients Treated with Immunotherapy (Now Available) (ID 2676)
13:30 - 15:00 | Author(s): Lizza Hendriks
- Abstract
- Presentation
Background
The [neutrophils/[leucocytes-neutrophils] ratio (dNLR) correlates with immune checkpoint inhibitors (ICI) outcomes in advanced non-small cell lung cancer (aNSCLC) patients. Significance of early dNLR change after the first course of ICI is unknown.
Method
Patients with NSCLC treated with ICI (PD(L)1+/-CTLA4) between Nov. 2012 and Jun. 2018 at 16 EU/US centers were included. A control group treated with chemotherapy (CT) only was also evaluated (NCT02105168). dNLR was collected at baseline (B) and at cycle 2 (C2). Patients were categorized as low vs high dNLR at each timepoint (defined as < vs > 3, as previously done), and the change between B and C2 (good = low at both timepoints, poor = high at both timepoints, mixed = different at each timepoint).
Result
1485 patients treated with ICI were analyzed. PDL1 was negative in 162 (11%), 1-49% in 178 (12%), ≥50% in 201 (14%), and missing in 944 (64%). dNLR at B and C2 did not associate with PD-L1 status.
At baseline, dNLR was high in 509 (34%) patients and associated with worse PFS compared to those patients with low dNLR at baseline (HR 1.56, P<0.0001) and OS (HR 2.02, P<0.0001). At C2, dNLR was high in 484 (34%) and similarly associated with worse outcomes compared to patients with low dNLR at C2 (PFS HR 1.64, P<0.0001; OS HR 2.13, P<0.0001).
Between B and C2, dNLR remained low in 804 (56%, « good ») or high in 327 (23%, « poor ») or changed in 310 pts (22%, « intermediate »). Those with a good dNLR demonstrated mPFS 5.3, mOS 18.6 mo), followed by those intermediate with mixed dNLR (mPFS 3, mOS 9.2 mo), and finally poor dNLR (mPFS 2, mOS 5mo). Outcomes were independant of PD-L1 expression (adjusted HR for PFS 1.94 for intermediate and 3.16 for poor groups, compared to good dNLR group, P<.001; adjusted HR for OS was 2.08 for intermediate and 3.67 for poor groups, P<0.001).A bootstrap tested the stability of OS/PFS prediction (P<0.001).
In the chemo-cohort (n=173), high C1-dNLR (n=81, 47%) was not associated with OS (P=0.84).
Conclusion
dNLR at baseline, at cycle 2, and the change between these two timepoints associated with outcomes in patients treated with immunotherapy independent of PD-L1, but not in patients treated with chemotherapy alone. dNLR is specifically prognostic in the context of immunotherapy.
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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): Lizza Hendriks
- 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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MA11 - Immunotherapy in Special Populations and Predictive Markers (ID 135)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:Frank Griesinger, Lecia Sequist
- Coordinates: 9/09/2019, 14:00 - 15:30, Hilton Head (1978)
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MA11.05 - Discussant - MA11.01, MA11.02, MA11.03, MA11.04 (Now Available) (ID 3764)
14:00 - 15:30 | Presenting Author(s): Lizza Hendriks
- Abstract
- Presentation
Abstract not provided
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MA25 - Precision Medicine in Advanced NSCLC (ID 352)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:Sebastian Defranchi, Karen Kelly
- Coordinates: 9/10/2019, 14:30 - 16:00, Dublin (1997)
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MA25.03 - Tumor-Infiltrating Lymphocytes (TIL) and Outcomes with Immunotherapy (ICI) or Chemotherapy in Advanced NSCLC (aNSCLC) Patients (Now Available) (ID 1374)
14:30 - 16:00 | Author(s): Lizza Hendriks
- Abstract
- Presentation
Background
Tumor infiltrating lymphocytes (TIL) morphologically assessed is prognostic in early stages in several tumors. We previously reported the correlation of TIL with immune checkpoint inhibitors (ICI) outcomes in 98 advanced (a) NSCLC patients treated with ICI. We aimed to assess the role of TIL in a larger cohort treated with ICI, and in patients exclusively treated with chemotherapy (CT).
Method
aNSCLC patients with treated with single-agent ICI, with H&E stained sample available, were included between 11/2012 and 02/2017 in 3 cancer centers (immuno-cohort). Patient’s characteristics, biological data were retrospectively collected. The CT-cohort was extracted from the prospective MSN study (NCT02105168), between 06/2009 and 10/2016, enrolling aNSCLC patients treated with platinum-based CT, and tissue available. TIL in the stroma was evaluated in archival samples. High-TIL was defined as ≥10% density. Multivariate Cox model was used to study its prognostic values on overall and progression-free survival (OS, PFS).
Result
A total of 221 patients were included in the immuno-cohort: 142 (64%) male, with median (m) age of 63, 182 (84%) smokers, 161 (77%) PS≤1, 162 (63%) adenocarcinoma; 125 (57%) received ICI as second-line. High-TIL was observed in 49/221 (28%), non-assessable in 46. High-TIL had independent impact on OS and PFS (HR 0.40; 95% CI 0.25-0.63, P<0.0001). The mPFS and OS were 3.1months (mo.) (2.5-4.9) and 11mo. (7.0-13.2) respectively. The high-TIL group had mPFS of 13mo. (5.0-NR) vs. 2.2mo. (1.7-3.0) in low-TIL group (P<0.0001). High-TIL group had mOS not reached (NR) (12.2-NR) vs. 8.4 mo. (5.0-11.6) in low-TIL (P=0.007). The CT-cohort (N=189) had high-TIL in 103/189 (54%). The mPFS and mOS were 5.7mo. (4.9-6.7) and 11.7mo. (9.3-13.0) respectively, with no association with TIL.
OS, Immuno-cohort (n=221) OS, Chemo-cohort (n=188) Hazard ratio (HR)
95% confidence interval (CI)P-value HR
95% CIP-value TIL
≥10% (high)0.46 (0.28-0.81) 0.006 1.03 (0.76-1.41) 0.84 Age
≥65 y0.86 (0.50-1.46) 0.57 0.99 (0.72-1.38) 0.99 Line of treatment*
≥ second line0.69 (0.44-1.09) 0.11 0.84 (0.60-1.16) 0.29 N# metastatic sites
>21.40 (0.88-2.20) 0.16 1.50 (1.07-2.12) 0.02 Performance status
≥22.75 (1.73-4.37) <0.0001 1.94 (1.23-3.04) 0.004 Histology
Squamous1.13 (0.70-1.81) 0.62 1.09 (0.65-1.83) 0.75 *Line of treatment: lines of immunotherapy for the Immuno-cohort; lines of chemotherapy for the Chemo-cohort.
Conclusion
High-TIL (≥10%) is a simple and accessible marker associated with better ICI outcomes, but not with CT. This suggests a potential predictive value that must be validated in larger prospectively studies.
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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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P1.01-120 - Immune Checkpoint Inhibitors Versus Second Line Chemotherapy for Patients with Lung Cancer Refractory to First Line Chemotherapy (Now Available) (ID 2662)
09:45 - 18:00 | Author(s): Lizza Hendriks
- Abstract
Background
Anti Programmed Death-ligand (PD1/PD-L1) directed immune-checkpoint-inhibitors (ICI) are widely used to treat patients with advanced non-small cell lung cancer (NSCLC) who progress after first line chemotherapy. The best strategy after early progression under first line has not been specifically studied
Method
We conducted a multicenter, retrospective study including all consecutive NSCLC patients progressing within the first 3 months following introduction of first-line chemotherapy and being treated with second line ICI monotherapy or chemotherapy between March 2010 and November 2017. We analysed the clinicopathological data and outcome under second line chemotherapy vs. second line ICI: progression-free survival (PFS), overall survival (OS), and objective response rate (ORR).
Result
We identified 176 patients with refractory disease, 99 who received subsequent immunotherapy and 77 undergoing chemotherapy. The 2 populations were comparable regarding the main prognostic criteria, median age was 60, main histology was adenocarcimoma (68,2%). Compared to chemotherapy, ICI treated patients had a superior OS (logrank test, p=0.03) (Median [95% CI] OS 4.6 [2.8-6.7] versus 4.2 months [3.4-5.9] and a non-significant improvement in ORR (17.2% and 7.9%, respectively, p = 0.072). PFS was not significantly different (1.9 [1.8-2.1] versus 1.6 months [1.4- ; 2.0] (p=0.125). Poor performance status (ECOG PS≥2) and a higher number of metastatic sites (≥3) were associated with poorer prognosis. KRAS-mutated patients did not seem to benefit more from ICI than chemotherapy.
Table 1 Multivariable analysis of characteristics associated
n= 175
OS
PFS
Variable
HR [CI 95%]
p value
HR [CI 95%]
p value
Treatment
0.045
0.040
Chemotherapy (ref)
1.00
1.00
Immunotherapy
0.70 [0.49 ; 0.99]
0.71 [0.51 ; 0.98]
Number of metastatic location before 2nd line
0.005
0.011
0-1-2 (ref)
1.00
1.00
3 or +
1.64 [1.16 ; 2.31]
1.52 [1.10 ; 2.10]
Performance Status
0.038
0 -1
1.00
2 - 3 - 4
1.46 [1.02 ; 2.09]
Figure 1 : Kaplan Meier curves for Overall Survival for ICI group and CT group
Conclusion
ICI appears to be the preferred second-line treatment for patients who are refractory to first line chemotherapy
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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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P1.04-31 - Immunosenescence Correlates with Poor Outcome from PD-(L)1 Blockade but Not Chemotherapy in Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 2268)
09:45 - 18:00 | Author(s): Lizza Hendriks
- Abstract
Background
CD28, CD57 and KLRG1 on circulating T-lymphocytes have been identified as markers of immunosenescence. The characterization of a senescent immune phenotype (SIP) in advanced NSCLC (aNSCLC) and its impact on anti-PD(L)-1 (IO) or platinum-based chemotherapy (PCT) treatments are unknown.
Method
The percentage of circulating CD8+CD28-CD57+KLRG1+ T-lymphocytes (SIP) was assessed by flow cytometry on fresh blood from aNSCLC patients treated with IO or PCT. A SIP cut-off was identified by log-rank maximation method. Correlations with categorical or continuous variables were performed by logistic regression or t-test. Survival curves were estimated with Kaplan Meier and compared with log-rank.
Result
In the IO cohort, 43 patients were evaluated for SIP: 32% ≥ 65 years, 92% non-squamous, 51% with tumoral PD-L1 expression ≥1%, 93% chemotherapy pretreated. Disease control rate (DCR), median PFS and OS and FU were 57%, 4.6 (95% CI 0.5; 8.8) months, 13 (95% CI 2.8-23.2) months, and 14 (95% CI 8.8-19.8) months, respectively.
SIP median value was 15.4% (min 1.6%, max 57.7%). 32% of patients had >21.72% CD28-CD57+KLRG1+CD8+ lymphocytes (SIP+). SIP was not significantly associated with clinical characteristics. SIP changed according to IO response by T-sne algorithm (Figure 1A). Compared to SIP-, SIP+ patients had significantly lower DCR (81% vs 28%, p=0.002), PFS [7.3 (95% CI 4.1; 10.4) vs 1.7 (95% CI 1.2; 2.3), p=0.02] and OS [NR (95% CI 6.04; NR) vs 2.4 (95% CI 1.7; 3.1), p=0.01].
SIP was significantly associated with specific immune populations [higher peripheral activated (Ox40+ICOS+PD1+) T-regulatory (CD25highCD127low) cells, TEMRA (CCR7-CD45RA+) CD8+ and T-helper 1 (CXCR5-CXCR3+CCR4-CCR6-CCR10-) CD4+] (Figure 1B). The PCT cohort included 61 patients, 43% SIP+. No significant difference in DCR, PFS or OS were observed according to SIP.
Conclusion
Immunosenescence is observed in 32% of aNSCLC patients before IO and correlates with specific immune phenotypes. Immunosenescence predicts lower DCR, PFS and OS from IO but not from PCT.
