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Jae Cheol Lee
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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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EP1.01-03 - Real World Outcome of Crizotinib for Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer Patients (Now Available) (ID 141)
08:00 - 18:00 | Author(s): Jae Cheol Lee
- Abstract
Background
Crizotinib has shown its superiority in clinical trials compared to conventional chemotherapy in patients with anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC) patient, but its use and outcomes in real-world settings are yet to be investigated. This study aimed to assess treatment patterns and outcomes of crizotinib therapy in ALK-positive NSCLC patients, as well as to seek factors associated with progression-free survival and overall survival of ALK-positive NSCLC patients.
Method
A retrospective medical record review of 176 patients who are diagnosed as metastatic or recurred NSCLC from January 1st, 2006 to June 30th, 2018 and treated with crizotinib was performed. Descriptive analyses were conducted to assess treatment patterns and objective response rate (ORR). Survival analysis to estimate progression-free survival (PFS) and overall survival (OS) was performed. Comparison of the treatment outcomes by the setting of crizotinib initiation was done. Cox regression analysis was used to find predictive factors associated with PFS and OS from initiation of crizotinib.
Result
Median age was 55.7 (ranged 20 to 84) years and 85 patients (48.3%) were male. Seventy-two (40.9%) patients died at the time of analysis. Seventy-eight patients initiated crizotinib as first-line therapy. Overall response rate was 54.5% (50.0% for first-line recipients, 58.2% for second-/later-line). Median (95% CI) PFS from crizotinib initiation and OS from first dose of chemotherapeutic agent were 14.3 (11.6-17.0) and 41.7 (25.4-58.1) months, respectively. No significant difference of ORR, OS, and PFS, according to the setting of crizotinib initiation was observed. Multivariate Cox analysis showed poor performance status (HR 3.472, p-value < 0.001) and number of metastatic organs (≥3, HR 1.648, p-value 0.017) were independently associated to shorter PFS and OS, while history of getting pemetrexed before use of crizotinib (HR 0.638, p-value 0.039) was independently related to longer OS.
ConclusionAll patients
Setting of Crizotinib Initiation
(n = 176)
First-Line
(n = 78)
Second- or Later-Line
(n = 98)
P value
Progression-free survival
0.699
Mean (SE)
25.0 (3.1)
28.0 (6.4)
16.6 (1.5)
Median (95% CI)
14.3 (11.6-17.0)
15.8 (10.0-21.6)
13.1 (9.1-17.0)
Q1, Q3
5, 27
5, 22
5, 27
Overall survival
0.137
Mean (SE)
54.1 (4.2)
40.6 (6.1)
57.8 (4.9)
Median (95% CI)
41.7 (25.4-58.1)
26.3 (14.7-37.9)
43.9 (25.7-62.1)
Q1, Q3
18, 109
17, 77
19, 109
1- and 2-year survival rates
Percent still alive at 1 year after diagnosis (95% CI)
87.1 (86.7-87.5)
85.4 (84.3-86.5)
88.5 (87.8-89.2)
0.483
Percent still alive at 2 years after diagnosis (95% CI)
65.7 (65.0-66.4)
55.4 (51.9-58.9)
69.0 (68.0-70.0)
0.213
Outcomes for crizotinib recipients were in line with previous trials, with PFS and OS appearing more favorable. Poor performance status and number of metastatic organs correlated to worse PFS and OS, while history of previous use of pemetrexed before crizotinib correlated to better OS.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-46 - The Efficacy and Safety of 2nd-Line Nivolumab for Non-Small Cell Lung Cancer in Real-World Practice with Emphasis on Hyperprogession (ID 977)
10:15 - 18:15 | Presenting Author(s): Jae Cheol Lee
- Abstract
Background
The efficacy of nivolumab, a PD-1 immune checkpoint inhibitor, has been proven through many clinical trials. However, the data about whether it can be generalized to real-world patients are limited. We investigated the outcomes of non-small cell lung cancer (NSCLC) patients who received nivolumab with emphasis on hyper-progressive disease (HPD).
Method
This retrospective study enrolled stage IV NSCLC patients who received nivolumab following the progression after previous chemotherapy between July 2016 and June 2018 in single center. HPD was defined as the progression by RECIST at the first evaluation with ≥2-fold increase of the tumor growth rate between the prior and the upon nivolumab period.
Result
A total of 83 patients with a median age of 60 years were included (Squamous vs non-squamous; 25[30%] vs 58[70%]). Among 59 patients with available PD-L1 level, 17% of patients showed the negative expression of PD-L1 while 20% of them had more than 50% of expression. The response and disease control rate were 7% and 52% while the median PFS and OS were 2.6 (95% confidence interval [CI], 0.82 to 4.31) and 8.6 months (95% CI, 5.56 to 11.59), respectively. The PD-L1 level ≥ 50% group (n=12) showed the superior outcome with the median OS of 18.1 months. Treatment-related adverse events of grade 3 or 4 occurred in 8.4%. HPD developed in 16 (19.2%). The median OS of HPD group was 2.2 months (95% CI, 0.92 to 3.75) whereas that of other progression group was 4.1 months (95% CI, 1.54 to 6.67). Among patients with pleura or pericardium metastasis, increased effusion was seen in 90% of HPD group (n=9/10) whereas 28.6% of other progression group (n=4/14) (p=0.004). There was no other significant HPD-related factor.
Conclusion
Although the efficacy and safety of nivolumab in real-world patients are comparable to those of clinical trials, clinicians should beware of HPD as it is not uncommon and represents the worst prognosis. The relationship with HPD and effusive metastasis should be further investigated.
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P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.14-37 - Anaplastic Lymphoma Kinase Inhibitor Induced Pneumonitis in Patients with NSCLC: Clinical and Radiologic Characteristics and Risk Factors (ID 1617)
10:15 - 18:15 | Author(s): Jae Cheol Lee
- Abstract
Background
To investigate the clinical and radiologic characteristics and risk factors of anaplastic lymphoma kinase (ALK) inhibitor induced pneumonitis (ALK-IIP) in patients with non-small cell lung cancer (NSCLC).
Method
A total of 250 NSCLC patients who had been treated with ALK inhibitors from January 2015 to January 2018 were retrospectively enrolled. Clinical characteristics and clinical course were reviewed from the medical records. Chest CT of ALK-IIP was analyzed and classified into four CT patterns, i.e. organizing pneumonia (OP), hypersensitivity pneumonitis (HP), diffuse alveolar damage (DAD), and nonspecific interstitial pneumonia (NSIP), using the American Thoracic Society/European Respiratory Society classification of interstitial pneumonia. Clinical characteristics including toxicity grading according to the National Cancer Institute Common Terminology Criteria for Adverse Events and treatment course was analyzed in regarding to the classified CT patterns. Clinical characteristics were compared between patients with ALK-IIP and without ALK-IIP.
Result
Conclusion
ALK-IIP was identified in 11 patients (4.4%). The most common CT pattern was the OP pattern (n = 7, 63.6%) and followed by the HP pattern (n = 2, 18.2%) and the DAD pattern (n = 2, 18.2%). ALK-IIP showed pneumonitis toxicity grade ranged from 1 to 3, and DAD pattern had the highest toxicity grade, followed by HP and OP patterns (median grade: 3.5, 2.5, 1). All of the patients with the OP pattern were successfully treated, while half of patients with the DAD pattern died during treatment. The smoking history and extrathoracic metastasis were more frequent in patients with ALK-IIP (P < 0.005). The smoking history was associated with a higher incidence of ALK-IIP [odds ratio: 3.586, 95% confidence interval: 1.058-13.432, P = 0.049].
ALK-IIP showed a spectrum of chest CT patterns and various toxicity grades, and CT patterns reflected the toxicity grades of ALK-IIP. The OP pattern was the most common CT pattern of ALK-IIP, and patients with ALK-IIP of the OP pattern were successfully treated. ALK inhibitors should be used with caution in NSCLC patients with smoking history.
