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Daniel Martinez
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P1.01 - Advanced NSCLC (ID 158)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-43 - Programmed-Death Ligand 1 Spectrum in a Large Cohort of Genetically Characterized Non-Small Cell Lung Cancer Patients (ID 1760)
09:45 - 18:00 | Author(s): Daniel Martinez
- Abstract
Background
Programmed-death ligand 1 (PD-L1) expression, assessed by immunohistochemistry (IHC), is used to select patients (pts) for checkpoint inhibitors. However, the pattern of PD-L1 expression across rare oncogenic alterations remains poorly characterized. We aimed to evaluate PD-L1 expression in a large dataset of pts with activating molecular alterations to define the potential responsiveness to immunotherapy.
Method
From 2016 to 2018, we prospectively characterized advanced NSCLC pts from a single institution. Tumor Proportion Score (TPS) for PD-L1 protein expression was evaluated by IHC (22C3 clone) using formalin-fixed paraffin-embedded tumor samples and scored into <1% (negative), 1-49% (weakly positive) and >=50% (high). DNA and RNA were extracted and analysed by Oncomine Solid Tumour panel (22 genes) and a customized nCounter-based panel (ALK, ROS1, RET, NTRK1, MET∆14). Associations between PD-L1 expression and the most prevalent driver alterations were assessed. Smoking habit and its possible relationship with PD-L1 expression was also appraised. Statistical analyses were performed using Kruskal-Wallis and Mann-Whitney tests.
Result
TPS for PD-L1 expression was available for a total of 140 patients (pts) fully genotyped. The cohort included: 36% women; 89% adenocarcinoma; 87% smokers. TPS for PD-L1 expression was negative (<1%), weak (1-49%) and high (>=50%) in 40%, 35% and 25% of pts, respectively. Actionable drivers were found in 84 pts (60%) being KRAS (n=43.31%) the most commonly detected, followed by EGFR (n=22.16%), BRAF (n=7.5%), MET∆14 (n=8.6%), ALK (n=3.2%) and ERBB2 (n=1, 1%). Thirty (21.4%) [ME1] pts harboured TP53 co-mutations. By comparing all genotyped cohorts, MET∆14 alteration was associated with higher PD-L1 expression levels compared with other subgroups (median TPS 58.62 vs 25.26, p=0.017[ME2] ). In addition, PD-L1 expression was also higher in pts harbouring any TP53 co-mutation than those with any alteration but TP53-WT (median TPS 41.53 vs 21.45, p=0.035). When KRAS-mut, BRAF-mut and EGFR-mut were evaluated separately, PD-L1 expression was higher in TP53 mutated tumors compared to TP53 WT only in BRAF-mut (p=0.028). Finally, no significant differences were found regarding patients’ smoking status (p=0.527).
Conclusion
Our results suggest differential expression of PD-L1 based on the presence of MET alterations and TP53 mutations and highlight the need of further characterizing PD-L1 expression across oncogenic alterations.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-19 - Radiological and Pathological Response to the Induction of Surgery in the NSCLC Stage III (Now Available) (ID 438)
10:15 - 18:15 | Author(s): Daniel Martinez
- Abstract
Background
Neoadjuvant treatment (NT) prior to surgical resection is the standard treatment for operable stage III-pN2 NSCLC. Our objective is to compare the response, radiological and pathological, after induction with radio-chemotherapy (RT-Ch) versus chemotherapy alone (Ch).
Method
We develop a retrospective study that included 53 patients from four different centres diagnosed of stage III NSCLC (TNM 8th edition). 34 patients received RT-Ch and 19 received Ch between 2012 and 2018, with a median follow-up of 25 months. The radiological response (RR) was assessed by CT at 3-4 weeks after NT using RECIST criteria. The pathologic response (PR) was evaluated in operated patients (44) through the viable residual cells in the tumor and lymph nodes. pN was taken into account to determine the rate of downstaging. The PR, as well as the surgery, were performed in the same center for all 44 patients
Result
The majority were stage IIIA (33), followed by IIIB (19) and only one was IV (single brain metastasis treated previously with radiosurgery). Comparing the RR in RT-Ch and Ch, we found stable disease and partial response more frequently with a 35.6% vs 52.6% and 61.8% vs 36.9% respectively. A 17.3% and 5.3% of the complete PR was achieved in RT-Ch and Ch respectively. Downstating was feasible in 82.8% of RT-Ch and 40% in Ch. Clinical features and treatment evaluation in Table 1.
Conclusion
In our review we observed that a 45% of the patients treated with Ch had a response of 20% or less in the pN or a local progression after the treatment, in comparison with only a 3.4% in the group of RT-Ch. However, the evaluation of the differences in the PR should be associated with a greater follow-up to assess the impact on overall survival.
