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Filiz Oezkan
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-43 - Immunotherapy and Radiotherapy - A Useful Combination? (Now Available) (ID 2984)
08:00 - 18:00 | Author(s): Filiz Oezkan
- Abstract
Background
Immunotherapy has emerged as a major and effective therapeutic modality in non-small cell lung cancer (NSCLC). With expanding indications for immunotherapy, therapeutic modalities in progressive disease under immunotherapy are needed.
Method
In a retrospective single center analysis patients treated with immunotherapy and radiation for progressive lesions were identified. Both patients with acquired and primary resistance to immunotherapy were included in the analysis.
Result
In eight patients (2 adenocarcinoma, 6 SCC) immunotherapy was continued (5 Nivolumab, 1 Pembrolizumab, 2 Atezolizumab) despite disease progression due to good tolerance and missing therapeutic alternatives because of multiple pretreatment regimens and their toxicities. We observed that all 8 patients had a clinical benefit without developing a disseminating disease, we only observed a growth in the previously existing lesions. In 5/8 patients the disease could be stabilized. An abscopal effect could be excluded.
In five patients local metastatic growth was treated with radiation to manage pain and local complications. Three additional patients with asymptomatic, progressive lesions were treated with radiotherapy to prevent organ complications.
Conclusion
Immunotherapy has revolutionized NSCLC treatment. However there are therapeutic modalities questioned in progressive disease under immunotherapy. By maintaining immunotherapy during and after radiotherapy localized progression might be effectively treated.
Therefore we summarize that in a number of patients further metastatic evolution might be preventable. Whether peritumoral or systemic prognostic determinants can be identified should be a matter of further research.
Either benefits of local ablative techniques or perpetuation of immunotherapy despite of disease progression were recently reported (Gandara et al. 2018, Gettinger et al. 2018). This also suggests a differentiative perspective of local ablative therapy in metastatic NSCLC.
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OA13 - Ideal Approach to Lung Resection and Novel Perioperative Therapy (ID 146)
- Event: WCLC 2019
- Type: Oral Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:Tomasz Grodzki, Kenji Suzuki
- Coordinates: 9/10/2019, 11:30 - 13:00, Toronto (1985)
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OA13.07 - Neoadjuvant Atezolizumab in Resectable NSCLC Patients: Immunophenotyping Results from the Interim Analysis of the Multicenter Trial LCMC3 (Now Available) (ID 1755)
11:30 - 13:00 | Presenting Author(s): Filiz Oezkan
- Abstract
- Presentation
Background
The immune mechanisms dictating response and resistance to PD-(L)1 blockade are not well understood in early stage non-small cell lung cancer (NSCLC). Understanding these mechanisms will be key to improve outcomes and identify the next generation of predictive biomarkers of response to these therapies. Here, we present updated immunophenotyping at time of interim analysis of LCMC3, a multicenter trial of neoadjuvant atezolizumab in resectable NSCLC (NCT02927301).
Method
Patients received 2 cycles of atezolizumab before resection. Tumor, LN biopsies and PB were obtained pre-atezolizumab and at surgery. Paired PB, screening and surgical LN were analyzed using IMMUNOME flow cytometry. Plasma-based cytokine arrays were performed on a subset of patients. Immunophenotypic analyses were correlated with treatment effect, major pathologic response (MPR, primary endpoint) and preoperative treatment-related adverse events (preop-TRAE).
Result
We report on 55 patients with paired PB samples (analyzed within 72h after collection) and completed surgery. We observed preop-TRAE in 32/55 patients (18 grade 1, 13 grade 2, 1 grade 3). CD1c+ and CD141+ myeloid cells (MC) were lower at baseline in patients developing preop-TRAEs, while monocytic M-MDSCs were higher in those patients. Senescent T cells decreased in patients with preop-TRAE and increased in patients with non-preop-TRAE. After treatment, the absolute cell counts of late activated CD4+and CD8+T cells decreased in patients achieving MPR. LN IMMUNOME data, cytokine data and 12-month follow-up (DFS, OS) will be reported.
Conclusion
Preliminary immunophenotyping data from the interim analysis showed significantly lower baseline immunosuppressive cell subsets in patients with preop-TRAE and decreased late activated CD4+and CD8+T cells from PB in patients with MPR.These results, together with additional LN IMMUNOME and cytokine analyses, may improve our understanding of immunophenotypic features associated with outcome, and changes induced by neoadjuvant atezolizumab in early stage NSCLC patients.
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