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Sebastian Gagatek
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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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EP1.01-15 - Systemic Hyperinflammation Is a Strong Independent Predictor of Early Mortality in Advanced NSCLC (Now Available) (ID 1143)
08:00 - 18:00 | Author(s): Sebastian Gagatek
- Abstract
Background
Prognostic tools in NSCLC are important for treatment decisions and evaluation of new treatment options. Ample evidence support inflammation as a marker of outcome in NSCLC. Our study explores outcome for a population-based real-life cohort of patients in the highest stratum of inflammatory activity.
Method
The source cohort comprised all patients diagnosed with NSCLC between January 2016 – May 2017 at Gävle County Hospital, Sweden (n=155, inclusion rate 95%). Following exclusion of patients with active infection, the subgroup (n=77) in stage IIIB-IV with complete available laboratory parameters were studied further. Blood parameters were examined individually, and cut-offs (ESR>60 mm, CRP>20 mg/L, WBC>10 x10e9/L, PLT>400 x10e9/L) for high inflammation were set with an aim to pin-point the top echelon of hyperinflamed patients. A prognostic score was developed by assigning one point for each parameter above cut-off (0-4 points).
Result
One year survival of patients with an inflammation score of ≥2 (n=23) was 0% compared to 50% and 33% among patients with a score of 0 (n=36) and 1 (n=18), respectively (figure 1). The effect of a high inflammation score on overall survival remained significant in multi-variate analysis adjusted for confounding factors (stage, gender, age, smoking status, ECOG PS). The hazard ratio of an inflammation score ≥2 in multi-variate analysis (HR 3.45, CI 1.62-7.34) was on par with a change of ECOG PS from 0 to 2 (HR 3.67, CI 1.44-9.4).
Conclusion
Inflammation is a well established marker for treatment outcome in solid tumours. Our results show that high level inflammation is a strong independent marker for poor survival in patients with advanced stage NSCLC. This observation may indicate a need to stratify and subgroup patients in clinical studies with regard to systemic hyperinflammation and warrants further research on underlying mechanisms linked to tumour progression.
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EP1.04 - Immuno-oncology (ID 194)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-18 - Real-World Treatment with Checkpoint Inhibitors: The Swedish Experience (Now Available) (ID 2590)
08:00 - 18:00 | Presenting Author(s): Sebastian Gagatek
- Abstract
Background
The introduction of checkpoint inhibitors has fundamentally changed the treatment of advanced NSCLC patients.
Method
In order to evaluate if the encouraging results from clinical trials translates into the clinical routine and to confirm the value of biomarker testing we evaluated NSCLC patients that were treated with a checkpoint inhibitor in the Uppsala-Gävle health care region between Januari 2016 and October 2018. Latest patient follow up was done in March 2019. Patient information, including therapy, response rates and survival were obtained from patient records
Result
In total, 86 patients, were identified (44 female, median age 71 years; performance status 0=18, 1=45; 2-3=23). 28 patients were treated in the first line setting and 58 patients after previous chemotherapy. Checkpoint inhibitors that were given included pembrolizumab (31), nivolumab (36), atezolizumab (7). Two patients received a combination (durvalumab och tremelimumab).
67 of 86 patients were evaluable for response and of these 23 patients showed progressive disease, 17 stable disease, 22 partial response and 5 complete response. However, most patients that were not evaluable for response either had only 1-2 cycles because of severe side effects or died early independent from treatment. Thus, for all patient treated with at least one course of checkpoint inhibitors response rate were lower (SD:20%; PR:26% and CR:6%). PD-L1 analysis was done for 69/86 patients (80%). The response (PR or CR) was numerically higher in the group with PD-L1 positivity ≥1% or ≥50% than with negative PD-L1 expression (54% vs 47% vs 13%), although not statistically significant (p=0.11). Median overall survival for patients with PD-L1 <1% was 2.3 years, for patients PD-L1 ≥1% 2.7 years and PD-L1≥50% 3.9 years (log rank-test, p=0.95).
Conclusion
In conclusion, the response rates to checkpoint inhibitors in the first and second line were comparable to those observed in clinical trials. We confirmed that patients with low PD-L1 expression are unlikely to respond to checkpoint inhibition.
