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Pinar Gursoy



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    P1.14 - Targeted Therapy (ID 182)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.14-01 - Are Pretreatment Inflammation-Based Prognostic Scores Useful in Predicting the Outcomes of Patients with ALK-Positive NSCLC?  (ID 1439)

      09:45 - 18:00  |  Author(s): Pinar Gursoy

      • Abstract

      Background

      Approximately 5% of all diagnosed non-small cell lung cancer (NSCLC) patients harbor a genetic rearrangement between the ALK and EML4 genes, representing a specific molecular and clinical subgroup (ALK+ NSCLC). To date, upfront treatment with ALK-tyrosine-kinase inhibitors (ALK-TKIs) has replaced chemotherapy in the first line setting for this subset of patients with excellent results, but reliable prognostic markers are lacking. An increased systemic inflammatory response has been shown to be associated with a poor prognosis, and some of the parameters used to characterize this response can easily be measured in clinical practice in several tumor types, but have not been analyzed extensively in ALK+ lung cancer in the era of crizotinib.

      Method

      We reviewed the medical records of all patients with previously treated advanced ALK-positive NSCLC who received crizotinib between January 2013 and March 2018 outside of a clinical trial. Pre-treatment modified Glasgow prognostic score (mGPS), Prognostic Nutritional Index (PNI) and Systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI and SII on overall survival (OS), progression-free survival (PFS), and overall response rate (ORR).

      Result

      82 patients were treated. Median age was 52.5 years (range; 20–77 years); 42.7% were female. Eighty-four point two percent of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥1; 17.1% had received ≥2 prior systemic therapies. The objective response rate was 77.2% (CR+PR).The optimal cutoff levels were 0.09 for mGPS and PNI, 934.7 for SII by ROC curves analysis. Patients in the SII ≥ 934.7 grous was significantly correlated with worse PFS and OS by univariate analysis (Figure 1).In multivariate analyses, pretreatment prognostic nutritional index (PNI) ≥ 0.09 was independently associated with inferior OS (1 year OS rates, 90.2% vs. 73.7%; HR 2.46, 95% CI 0.88-4.85; p = 0.035). Additionally, we evaluated the effects of these markers on response prediction. The logistic regression analysis of the predictive factors for the response to crizotinib demonstrated that the mGPS and PNI were associated with inferior ORR (OR: 0.1, 95% CI 0.16-1.04; p = 0.009 and OR: 0.16, 95% CI 0.02-0.55; p = 0.035, respectively).

      figure-1.jpg

      Conclusion

      In a cohort of patients with ALK positive NSCLC treated with crizotinib in routine practice,elevated pre-treatment SII was associated with shorter OS and PFS in univariate analysisand PNI was associated with shorter OS in multivariate analyses. Moreover the mGPS and PNI were associated with lower response rates.

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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
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      P2.01-64 - Systemic Inflammatory Markers as a Predictors of Response to Crizotinib in Patients with ALK-Positive Non-Small-Cell Lung Cancer (ID 1131)

      10:15 - 18:15  |  Author(s): Pinar Gursoy

      • Abstract

      Background

      The significance of the presence of a systemic inflammatory response (SIR) in predicting survival has been demonstrated in patients with cancer. Moreover, neutrophil-to-lymphocyte ratio (NLR),lymphocyteratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) have been also investegated in patients with both early and advanced non-small-cell lung cancer (NSCLC). However, determination of SIR predicting outcomes of patients who are likely to response to crizotinib in ALK-positive NSCLC patients has not been clearly demonstrated. The aim of this study was to investigate the prognostic and predictive value of NLR, LMR and PLR in patients with ALK-positive NSCLC treated with crizotinib.

      Method

      Eighty-two patients with ALK-positive NSCLC who were treated with crizotinib were retrospectively analyzed. The cutoff values for NLR, LMR and PLR were defined by the receiver operating characteristic (ROC) curve analysis.Univariate and multivariate analyses were used to evaluate the prognostic significance of NLR, LMR and PLR. Logistic regression analysis was also performed to determine predictive indicators of response to crizotinib.

      Result

      Among 82 patients, 35 (42.7%) were male and 47 (57.3%) were female, with a median age of 52.5 years (range; 20–77 years). Crizotinib treatment was administered as a first-line in 26.8% of patients, second-line in 56.1%, third-line in 12.2% and forth-line and later in 4.9%. The objective response rate was 77.2% (CR+PR) and stable disease was obtained in 7.6% of patients. According to the ROC curve, the recommended cutoff values of NLR, LMR and PLR were 3.14, 2.31 and 185,5 respectively. The median follow-up time was 19.3 months. ECOG performance status (PS) (p=0.014) and response to crizotinib (p=0.001) for progression-free survival (PFS) and ECOG PS (p<0.001), response to crizotinib (p<0.001), NLR (p=0.029) and LMR (p=0.028) for overall survival (OS) were found to be prognostic factors by univariate analysis. On the other hand, multivariate analysis showed that only ECOG PS and response to crizotinib were independent prognostic indicators for both PFS and OS.A logistic regression analysis indicated that NLR and LMR was found to bean independent factor for predicting response to crizotinib (p=0.007, OR:0.10 and p=0.044, OR: 0.20, respectively).

      Conclusion

      Our findings showed that NLR and LMR are readily feasible and simple and also inexpensive biomarkers predicting response of crizotinib for patients with ALK-positive advanced NSCLC.