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Pablo Alan Barragán Castillo
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MA07 - Clinical Questions and Potential Blood Markers for Immunotherapy (ID 125)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:David R Spigel, Roberto Ferrara
- Coordinates: 9/08/2019, 13:30 - 15:00, Vancouver (2003)
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MA07.08 - The Role of a Cachexia Grading System in Patients with NSCLC Treated with Immunotherapy: Implications for Response and Survival (Now Available) (ID 2046)
13:30 - 15:00 | Author(s): Pablo Alan Barragán Castillo
- Abstract
- Presentation
Background
The association between cancer-induced weight-loss (CIWL) and poor clinical outcomes is well established. However, many of these studies were performed in the chemotherapy era. Meanwhile, current standard of care for NSCLC patients has shifted towards the more efficacious immunotherapy agents (IO). IO has improved survival outcomes, nonetheless clinicians face the challenge of identifying who will derive substantial clinical benefit from these more costly agents. Response to IO is influenced by several patient-related factors, including microbiome, medications, and nutritional status.
Method
In this study we sought to evaluate the effect of cachexia in survival of NSCLC patients undergoing treatment with IO. Included patients had advanced NSCLC (IIIB, IV), who received IO agents in any line of therapy, and had a good performance status. All the patients were evaluated by the nutritionist specialist and were graded according to a previously documented cachexia scale which takes into consideration body mass index (BMI) and weight loss in order to stratify patients into 5 risk categories (0 [pre-cachexia] - 4 [refractory cachexia]). Primary endpoint was overall survival (OS), secondary endpoints included objective response rate (ORR) and progression-free survival.
Result
A total of 181 patients met the inclusion criteria and were included in the analysis. Among these 82 (45%) were classified in the first category (risk grade 0-1 [low risk]), 83 (46%) were classified in the second category (risk grade 2-3[intermediate risk]) and 9% were in the third category (risk grade 4 [high risk]). Patients classified as low-risk had a significantly longer OS compared to those with intermediate or high risk (22.4 months [95%CI: 18.7-26.1] vs. 15.7 [95%CI: 10.8-20.7] vs. 3.9 [0.0-7.8]; p<0.001; Hazard ratio: 1.81 [1.29-2.53]; p<0.001). In the multivariate analysis ORR, hemoglobin and risk category were independent factors associated with OS. Grade of cachexia was also significantly associated with ORR, with low-risk patients having a significantly higher ORR compared to intermediate and high-risk patients (36.6% vs. 17.3% vs. 25%; p=0.021). PFS was also influenced by risk category, with low risk patients having a longer PFS compared with intermediate and high-risk patients.
Conclusion
Cachexia is independently associated with worse OS in NSCLC patients who receive IO, while better nutritional status is related to higher ORR, highlighting a potential role for nutritional assessment in the selection of patients who are candidates for IO. Early assessment of nutritional status in these patients is imperative in order to timely diagnose and treat anorexia-cachexia and improve outcomes.
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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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P1.01-117 - Pulmonary Function Monitoring in Patients with Oligometastatic NSCLC Who Receive Stereotactic Body Radiation Therapy (ID 2044)
09:45 - 18:00 | Author(s): Pablo Alan Barragán Castillo
- Abstract
Background
Patients with early and oligometastatic stage Non-small cell lung cancer (NSCLC) who are non-surgical candidates benefit from new radiation treatment modalities, such as stereotactic body radiotherapy (SBRT). Previously we reported the correlation of lung function decline and the presence of lung toxicity related to concomitant chemo-radiotherapy. This work aims to evaluate lung function performance after SBRT in patients with oligometastatic NSCLC.
Method
A one-year prospective multicentric study was conducted at the Instituto Nacional de Cancerología in Mexico. Twenty-six patients with stage IV NSCLC with a single metastasis considered non-operable were treated with SBRT. Lung function was assessed at the baseline and at one, six, twelve, twenty-four and fifty-two weeks after SBRT, using forced spirometry with a bronchodilator, a carbon monoxide diffusing capacity (DLCO) test and oxygen saturation (SpO2) measurement. The study was registered in clinicaltrials.gov (NCT01580579).
Result
Fourteen patients were evaluated with lung function tests, the results were adjusted for the Mexican population. At baseline, the mean for post-bronchodilator (post-BD) FVC (l) was 2.16 (±1.09), for FEV1 2.25 (±1.06), DLCO (ml/min/mmHg) 20.22 (±8.44) and SpO2 of 94% (±2.81). A reduction of <10% of relative change (max. 294 ml) was observed in lung volume in FEV1 and FVC (l) post-BD follow-up with non-significant results. A statistically significant reduction in DLCO 18% (p=0.03) at week 12 was observed, Fig.1. All patients maintained an oxygen saturation level over 90% during the study. Quality of life reduces significantly at week six after SBRT (p=0.03), while respiratory symptoms were non-considerable in the first 12 weeks after receiving SBRT.
Conclusion
Although lung function tests showed a reduction trend, no statistically significant differences were found. The magnitude of lung volume reduction had no significant impact on respiratory symptoms, these findings could suggest that there is less damage in the surrounding tissue after SBRT. This research is an ongoing prospective study of one-year follow-up where several patients continue the be monitored; therefore, we expect to strength our findings by the end of the study.
