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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
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
EP1.01-47 - Thyroid Related Adverse Events Predict Survival in NSCLC Patients Receiving Anti-PD-1/ PD-L1 Therapy (Now Available) (ID 279)
08:00 - 18:00 | Author(s): J Lee
Immune checkpoint inhibitors (ICI) have altered the therapeutic paradigm of advanced non-small cell lung cancer (NSCLC) and produce antitumor effects by activating host immunity, which also causes immune-related adverse events (irAEs).
Thyroid irAE is the second most common irAEs after dermatological irAEs following ICI and present in 2%-21% of patients s depending upon the immune checkpoint inhibitors used.
It has been reported that irAEs induced by ICI may be associated with possible improvement in survival and better therapeutic outcomes.
The aim of this study is to analyze the relationship between PD-1 inhibitors -induced Thyroid irAE and clinical efficacy in advanced NSCLC patients treated at three regional cancer centres.
Retrospective study was conducted using the Hospitals’ Inpatient Enquiry (HIPE) to identify patients with NSCLC stage IV or inoperable stage IIIB who received at least one dose of PD-1 inhibitors (Nivolumab or pembrolizumab) between Januarys 2017 and December 2018.
Patients who had no baseline Thyroid function tests (TFTs) , abnormal baseline TFT or had a history of thyroid disorder were excluded.
Thyroid irAE were identified and classified according to TSH and free T4 (fT4)
Efficacy was evaluated with progression free survival (PFS) and median overall survival (OS) according to the development Thyroid IrAEsResult
One hundred and eighty-five patients were included, 120 male [64.9%] ,65 female [35.1%] and the median age was median age 66(38-88) years.
A total of 38 (20.5 %) patients on PD-1 inhibitors (nivolumab or pembrolizumab) had new-onset Thyroid IrAEs. 76.3% (29/38) of those patients manifested initially with thyrotoxicosis. The remaining 22.6% (9/38) of patients presented with hypothyroidism as the initial presentation.
The median times to new-onset Thyroid IrAEs was 46 days.
Kaplan Meier survival analysis showed that patients with Thyroid IrAEs had a statistically significant longer median PFS of 9.0 months (95% CI, 9.3–17.1) compared to patients with without Thyroid IrAEs who had a median PFS of 2.0 months (95% CI, 2.0–13.5), hazard ratio = 0.38, (95% CI, 0.20–0.71; P = 0.002). For entire cohort, Thyroid IrAEs was associated with superior survival (median OS 16.0 months for those who developed Thyroid IrAEs compared to 2.9 months of those without Thyroid irAEs (p < 0.0001)
The result of this study emphasizes the association between irAEs and better survival outcomes from anti-PD1 therapy.
Development of grade 2 Thyroid IrAEs was a useful predictor of survival outcomes in NSCLC patients treated with ICI.
These results support previously published retrospective data.
Further prospective studies are required to thoroughly underline the association between ICI induced irAEs, tumor response and long term survival.
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