Virtual Library
Start Your Search
Niccolo' Giaj Levra
Author of
-
+
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)
-
+
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): Niccolo' Giaj Levra
- 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.
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.
-
+
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
-
+
P1.04-41 - Immunotherapy Concomitant to Radiotherapy: A Multicentric Retrospective Study on 179 Patients with Advanced Non-Small Cell Lung Cancer (Now Available) (ID 647)
09:45 - 18:00 | Author(s): Niccolo' Giaj Levra
- Abstract
Background
Immunotherapy (IT) has enhanced the treatment armamentarium for aNSCLC. Radiobiological studies and initial clinical reports suggest a potential synergistic effect of radiotherapy (RT) and IT. Aim of the study is to investigate the safety of cytoreductive RT (palliative or ablative) delivered in association with Nivolumab (NIVO), Pembrolizumab (PEM) or Atezolizumab (ATE) in aNSCLC setting.
Method
We analyzed 179 consecutive pts affected by aNSCLC treated with a combination of RT and IT with NIVO/PEM or ATE from January 2015 to February 2019. One hundred eighteen patients were male and 61 female. Mean age was 65 (range 38-81). Adenocarcinoma was diagnosed in 101 of patients, while squamous cell carcinoma constituted 43.6% of our population. Eleven patients received IT as first line therapy, while the other 168 pts received at least a first line of systemic therapy before IT. One hundred thirty patients received NIVO, 42 PEM and 7 ATE. Concerning RT, 109 patients were treated before first cycle of IT (within 40 days), 49 pts during IT and the remaining 21 received RT immediately after the last IT session (within 40 days) due to disease progression (DP).
Result
After a mean follow up (FUP) of 24.1 months (range 3-142), 63/179 patients were still alive. During FUP 115 patients (62.4%) experienced DP after RT-IT. One and 3-year Overall Survival were 60.3%±3.8%SE and 26,7%±4,5%SE, respectively. RT was delivered in 96 cases to bone metastasis, in 49 to brain mts, in 11 to lung nodules, in 12 to lymph nodes, in 6 to surrenalic gland and in 5 pts to other sites. RT was delivered to 109 patients as a pure palliative treatment (8-36 Gy in 1-12 fractions), to 49 pts using stereotactic ablative doses (18-54 Gy in 1-5 fractions) and to 21 with high dose moderately-hypofractionated schedules(24-51 Gy in 3-17 fractions) . In 107 patients, RT was planned using a 3D conformal approach, while in 72 an inverse planning system was used (IMRT/VMAT/Tomotherapy). Mean number of IT administrations was 11 (2-58). No patient had an interrumption of systemic therapies during or after RT. Severe acute toxicities (Grade 3 by 4.0 CTCAE scale) were reported only in three cases because of the RT treatment: 1 case of radiodermitis and two lung toxicities. Known systemic side effects from IT were observed in 44 pts, 12 of whom with ≥G3 : 6 pneumonitis, 3 colitis, 2 thyroid toxicities, 1 oesophageal toxicity, 1 pt asthenia.
Conclusion
RT and IT with checkpoint inhibitor NIVO/PEM/ATE represent a safe, well tolerated and efficient multimodal treatment in aNSCLC, with the available data suggesting also potential, synergistic effects on local and systemic disease in aNSCLC pts even when non-radical RT doses are prescribed. Ongoing studies set out to understand the optimal timing, RT doses and ideal combination between RT and IT in aNSCLC.
