Author of

• 30601

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  P2.01 - Advanced NSCLC (ID 159)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 30649

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    P2.01-46 - The Efficacy and Safety of 2nd-Line Nivolumab for Non-Small Cell Lung Cancer in Real-World Practice with Emphasis on Hyperprogession (ID 977)

    10:15 - 18:15  |  Author(s): Soo Han Kim
    • Abstract
    • Slides

    Background
    

    The efficacy of nivolumab, a PD-1 immune checkpoint inhibitor, has been proven through many clinical trials. However, the data about whether it can be generalized to real-world patients are limited. We investigated the outcomes of non-small cell lung cancer (NSCLC) patients who received nivolumab with emphasis on hyper-progressive disease (HPD).

    Method
    

    This retrospective study enrolled stage IV NSCLC patients who received nivolumab following the progression after previous chemotherapy between July 2016 and June 2018 in single center. HPD was defined as the progression by RECIST at the first evaluation with ≥2-fold increase of the tumor growth rate between the prior and the upon nivolumab period.

    Result
    

    A total of 83 patients with a median age of 60 years were included (Squamous vs non-squamous; 25[30%] vs 58[70%]). Among 59 patients with available PD-L1 level, 17% of patients showed the negative expression of PD-L1 while 20% of them had more than 50% of expression. The response and disease control rate were 7% and 52% while the median PFS and OS were 2.6 (95% confidence interval [CI], 0.82 to 4.31) and 8.6 months (95% CI, 5.56 to 11.59), respectively. The PD-L1 level ≥ 50% group (n=12) showed the superior outcome with the median OS of 18.1 months. Treatment-related adverse events of grade 3 or 4 occurred in 8.4%. HPD developed in 16 (19.2%). The median OS of HPD group was 2.2 months (95% CI, 0.92 to 3.75) whereas that of other progression group was 4.1 months (95% CI, 1.54 to 6.67). Among patients with pleura or pericardium metastasis, increased effusion was seen in 90% of HPD group (n=9/10) whereas 28.6% of other progression group (n=4/14) (p=0.004). There was no other significant HPD-related factor.

    Conclusion
    

    Although the efficacy and safety of nivolumab in real-world patients are comparable to those of clinical trials, clinicians should beware of HPD as it is not uncommon and represents the worst prognosis. The relationship with HPD and effusive metastasis should be further investigated.

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