Virtual Library
Start Your Search
Varsha Jain
Author of
-
+
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
-
+
P1.01-63 - Impact of Prior Radiation Pneumonitis on Incidence of Immunotherapy Related Pneumonitis (ID 662)
09:45 - 18:00 | Author(s): Varsha Jain
- Abstract
Background
Patients with a history of radiation pneumonitis (RP) requiring steroids have generally been excluded from immuno-oncology (IO) trials of PD-1/PDL-1 monoclonal antibodies for safety concerns. The risk of IO-associated pneumonitis (IOP) in this group of patients (pts) is therefore unknown. We evaluated the frequency of IOP in pts who had prior RP.
Method
We evaluated all pts with non-small cell lung carcinoma (NSCLC) treated at our institution between 2011 and 2018 who were diagnosed with RP and at a later point received IO. Demographics, tumor characteristics, steroid use and outcomes were extracted from the electronic medical record. Median overall survival (mOS), median progression free survival (mPFS), and median time to treatment failure (mTTF) from the start of IO were estimated from Kaplan-Meier curves.
Result
We identified 29 pts: median age at diagnosis 63 yrs, 51.7% male, none had received prior targeted therapies. IO treatments were: atezolizumab (2), durvalumab (2), nivolumab (12), and pembrolizumab (13). Median time from RP diagnosis to start of IO was 14.2mo (2.2-75 mo). 23 pts (79%) had experienced prior grade ≥ 2 RP requiring steroids. Only 2 of the 29 pts (6.9%) developed IOP. Both pts had required steroids for prior RP and both received durvalumab; one pt was on prednisone ≥ 10mg at the start of IO. Both required steroid treatment of IOP, are still on IO and have not progressed (censored at 8.3mo and 9.9mo). OS and PFS after IO are similar (Table 1) whether or not pts required treatment for RP or were on prednisone ≥ 10 mg (or steroid equivalent) at the start of IO.
Table 1: IO outcomes based on RP history and steroid use at start of IO
RP Grade ≥ 2
n=23 (95% CI)
RP Grade < 2
n=6 (95% CI)
Prednisone ≥ 10mg
n=7 (95% CI)
Prednisone < 10mg
n=22 (95% CI)
All patients
n = 29 (95% CI)
mPFS (mo)
5.44 (2.1-12.6)
12.95 (0.95-)
6.16 (2-)
5.44 (2.1-)
6.16 (2.4-)
mOS (mo)
6.6 (3.93-13.8)
NR
14.3 (5.3-)
8 (3.4-16.8)
8 (5.3-15)
mTTFa (mo)
2.3 (1.9-4.8)
2.3 (1.9-)
4.4 (2-)
2.3 (1.9-10.9)
2.75a (2-7)
an=28: 1 pt lost to follow up after start of IO
Conclusion
In our cohort, the incidence of IOP after RP is low and similar to the rate of pneumonitis reported with pembrolizumab in pts with prior exposure to thoracic radiation.
-
+
P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.01-65 - Temporal Changes of Radiation-Induced Lung Injury Following Proton Therapy for Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 1715)
10:15 - 18:15 | Author(s): Varsha Jain
- Abstract
Background
Proton therapy (PT) is increasingly being used in locally advanced non-small cell lung cancer (NSCLC), but is there currently a limited understanding of its radiation-induced lung injury pattern that can cofound radiologic interpretation. Here we characterize imaging of radiation-induced lung injury on CT (computed tomography) and FDG-PET (18F-deoxy-glucose-positon emission tomography) following PT.
Method
After institutional IRB approval, longitudinal imaging from adult NSCLC patients undergoing PT over a 5-year period at our institution were retrospectively analyzed by two thoracic radiologists. Tumor size and FDG standard uptake value max (SUVmax) were recorded. In addition, early (<12 months after PT) and late (>12 months) radiation-induced lung injuries were quantified (0-3 Likert score), including consolidation, ground glass, interlobular septal thickening, bronchiectasis and pleural effusion, on all serial imaging.
Result
19 consecutive locally advanced NSCLC patients (mean age 69.3 yrs) had PT during the study period and had serial images available for review. The mean imaging follow-up period from PT start was 30 months. Five patients developed local failure. In the remaining 14 patients, tumor size and FDG avidity steadily decreased over time (mean SUVmax = 10.8 at baseline and 2.5 at 12 months). Ground glass and interlobular septal thickening presented as early changes, increasing through months 6-12 and 9-12 respectively but generally resolved by 24 months. 68% of patients developed a pleural effusion (< 2 years), increasing in severity over the 1st 18 months.
Consolidation consistently increased in severity throughout the observation period (max >48 months) Among 11 tumors, 8 achieved maximum severity in late changes of band-like or mass-like consolidation within 24 months and then typically plateaued. Late development of a pleural effusion, mass-like fibrosis, increased tumor caliber and increased FDG avidity were associated with local tumor recurrence.
Conclusion
Radiation-induced lung injury follows a predictable temporal pattern on CT. Knowledge of expected timeline of the imaging findings may prevent unnecessary imaging and/or biopsies. We are currently analyzing a larger cohort of 100 NSCLC patients to compare post radiation changes in local recurrence and local control.
