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Sung Shim Cho



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    P1.04 - Immuno-oncology (ID 164)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.04-64 - The Opposite Role of PD-L1 Expression in EGFR Mutant Lung Cancer Treated with PD-1 Inhibitor Before and After EGFR TKI: Pilot Study (ID 3018)

      09:45 - 18:00  |  Author(s): Sung Shim Cho

      • Abstract

      Background

      Standard treatment of EGFR mutant lung cancer is EGFR tyrosine kinase inhibitor (TKI). But PD-1 inhibitor in EGFR mutant lung cancer is also effective treatment option. PD-L1 expression is suggested as predictive biomarker for drug efficacy, but in EGFR mutant lung cancer, PD-L1 expression change after TKI have not been established and their role in PD-1 inhibitor treatment was not studied well.

      Method

      This study evaluated 18 EGFR mutant lung cancer patients treated with PD-1 inhibitor at St. Vincent hospital from April 2016 to January 2019. Following baseline data were recorded at the time of PD-1 inhibitor treatment: Age, Sex, ECOG performance status, PD-1 inhibitor type, line of treatment, lymphopenia, NLR (neutrophil-lymphocyte ratio), hyponatremia, presence of brain, liver and bone metastasis, EGFR status, PD-L1 expression. Progression free survival (PFS) and overall survival (OS) was evaluated and Cox survival analysis was used for these analyses.

      Result

      Median age was 61 years old and female was predominant (66.7%). Nivolumab and pembrolizumab was treated in 11 (61.1%) and 7 (38.9%) patients, respectively. Lymphopenia (<1,000/microleter) was 8 (44.4%) and high NLR (≥ 3) was 9 (50.0%). Hyponatremia (135 mEq/L) was noted in 5 (27.8%) and metastasis of brain, liver and bone were 9 (50%), 5 (27.8%) and 8 (44.4%). Median PFS and OS were 42 days and 102 days, respectively. Although high PD-L1 expression (SP263 ≥10%) before EGFR TKI is not significant predictive factor (Hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.09-2.45, P-value: 0.368) for PFS, high expression of PD-L1 before EGFR TKI tend to have favorable outcome. But, high PD-L1 expression (SP263 ≥10%) after EGFR TKI is associated with poor PFS outcome (HR: 2.20, 95% CI: 0.42-11.53). Regarding OS, high PD-L1 expression (SP263 ≥10%) before EGFR TKI is associated with prolonged survival (HR: 0.47, 95% CI, 0.09-2.41, P-value: 0.362), although it is not statistically significant. But, high PD-L1 expression after EGFR TKI tend to have shorter survival (HR: 3.34, 95% CI: 0.64-17.51, P-value: 0.154).

      Conclusion

      The role of PD-L1 expression between before EGFR TKI and after EGFR TKI is opposite. This study is small study as a pilot setting and further studies are needed to evaluate these findings.

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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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      P2.01-68 - High NLR Is Poor Predictive Biomarker for NSCLC Treated with PD-1 Inhibitor in Real World Practice (ID 2392)

      10:15 - 18:15  |  Presenting Author(s): Sung Shim Cho

      • Abstract

      Background

      PD-1 inhibitor in NSCLC is effective treatment option. PD-L1 expression and tumor mutation burden (TMB) is suggested as predictive biomarker for drug efficacy, but especially in the real-world, predictive factors have not been established. Therefore, we evaluated predictive biomarker for NSCLC treated with PD-1 inhibitor in real world practice.

      Method

      This study evaluated 73 NSCLC patients treated with PD-1 inhibitor at St. Vincent hospital from April 2016 to January 2019. Following baseline data were recorded at the time of PD-1 inhibitor treatment: Age, Sex, ECOG performance status, PD-1 inhibitor type, line of treatment, lymphopenia, NLR (neutrophil-lymphocyte ratio), hyponatremia, presence of brain, liver and bone metastasis, EGFR status, PD-L1 expression. Progression free survival (PFS) and overall survival (OS) was evaluated and Cox survival analysis was used for these analyses.

      Result

      Median age was 66 years old and male was predominant (67.1%). Nivolumab and pembrolizumab was treated in 34 (46.6%) and 39 (53.4%) patients, respectively. Lymphopenia (<1,000/microleter) was 20 (27.4%) and high NLR (≥ 3) was 41 (56.2%). Hyponatremia (135 mEq/L) was noted in 18 (24.7%) and metastasis of brain, liver and bone were 19 (26%), 12 (16.4%) and 28 (38.4%). Median PFS and OS were 84 days and 180 days, respectively. For PFS, ECOG performance status, presence of brain, liver, bone metastasis, PD-L1 (22C3), presence of EGFR mutation, lymphopenia and NLR was significant predictive factors in univariate analysis. As independent factors, presence of liver (Hazard ratio (HR): 3.32, 95% confidence interval (CI): 1.13-9.75, P-value: 0.029), bone metastasis (HR: 2.90, 95% CI: 1.25-6.75, P-value: 0.013), high PD-L1 expression (50%) (HR: 0.32, 95% CI: 0.14-0.72, P-value: 0.006) and high NLR ( 3) (HR: 2.58, 95% CI: 1.16-5.77, P-value: 0.021) were remained in multivariate analysis. Regarding OS, ECOG performance status, presence of bone metastasis, hyponatremia, lymphopenia and NLR were significant predictive factor for PD-1 inhibitor. In multivariate analysis, poor ECOG status (2 or 3 compared to 0 or 1) (HR: 2.95, 95% CI 1.54-5.64, P-value: 0.001) and high NLR ( 3) (HR: 3.29, 95% CI: 1.68-6.47, P-value: 0.001) were significant predictive factors.

      Conclusion

      High NLR is significant predictive biomarker for both PFS and OS in this real world study. Further studies are needed to evaluate these findings.