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Laila C. Roisman
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EP1.12 - Small Cell Lung Cancer/NET (ID 202)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.12-01 - Does PCI Still Have a Role in Limited SCLC? (Now Available) (ID 2721)
08:00 - 18:00 | Author(s): Laila C. Roisman
- Abstract
Background
Prophylactic cranial irradiation (PCI) has long been an integral part of treatment protocols for limited stage small cell lung cancer (SCLC). PCI stands for "prophylactic" while it may be not really prophylactic, rather therapeutic for un-detectable brain disease.
Method
A survey of 39 questions was conducted on the online platform “Survey Monkey” for practicing oncologists, radiotherapists, pulmonologists and thoracic surgeons. The aim of this survey is to establish a practice baseline for a future multicenter study of overall survival (OS) benefits of PCI versus MRI follow-up in limited SCLC.
Result
41 respondents participated from 14 European countries (26 oncology centers) and from 4 US radiotherapy centers: medical oncologists (31%), radiation oncologist (25%), pulmonologists (34%). Brain imaging at diagnosis of SCLC is performed by MRI in 83% and CT with contrast in 49%. Brain follow up after chemotherapy is performed by MRI in 49%, CT with contract in 41%, and no imaging in asymptomatic patients in 20%. PCI is recommended to 67% of patients and performed immediately after the last chemotherapy in 37%, or 2 months after chemotherapy in 49%. The most important criteria whether patient needs PCI are performance status and response to chemotherapy. The most common schedule of PCI is 25Gy in 10 fractions, 41% of respondents. In case of a single brain metastasis after PCI the 1st choice of treatment is SRS, in 93%. Regarding the role of PCI 46% of respondents think that PCI prevents brain metastases from occurring, and 54% think that PCI treats occult brain metastases.
Conclusion
The lack of clinical trials about PCI for limited SCLC patients is undisputed. Our survey shows practice patterns to PCI for patients with limited SCLS depends on Institution and/or specialty. These results establish a practice baseline for a multicentral trial of PCI versus MRI observation, and 93% of our respondents agreed to take part in this trial.
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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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P1.04-47 - Tumor Mutation Burden Through Hybrid Capture – Circulating Tumor DNA May Predict Response to Immunotherapy in NSCLC (ID 3011)
09:45 - 18:00 | Author(s): Laila C. Roisman
- Abstract
Background
Immunotherapy has become the therapy backbone for patients with NSCLC. Currently, prediction to therapy response is based on tissue biopsy biomarkers such as PD-L1 expression, tumor mutation burden (TMB), genomic alterations in EGFR/ALK/ROS1 and KRAS/TP53/STK11 mutations, all competing for limited tissue biopsy samples. Therefore, we investigated whether these biomarkers can be detected from a non-invasive plasma sample. Challenges of assessment of TMB with cell-free DNA next-generation sequencing (NGS) include the limited size of liquid biopsy gene panels and the fact that low shedding of tumor DNA into circulation may fail to detect hypermutated tumors.
Method
In this retrospective study, data was collected from 100 NSCLC patients treated in medical centers in Israel and USA between 2014 and 2018. NGS on ctDNA was used to evaluate whether mutational burden influence the response to immunotherapy in these patients. Response to immunotherapy was defined by a cutoff of four months of progression free survival (PFS). Liquid biopsy tests were obtained three months or less before immunotherapy treatment start.
Result
Overall, 100 NSCLC patients underwent NGS on ctDNA.
Clinical treatment information and full clinical data was available for 66 patients. 23 patients underwent liquid biopsy tests within a range of 3 months or less before immunotherapy initiation. 9 patients were considered responders and 14 patients progressors by a cutoff of 4 months PFS. Preliminary results showed that in the group of responders, the median TMB was 5 with a standard deviation of 5.49. An average TMB of 2.3 was calculated for the group of progressors with a standard deviation of 1.44.
ctDNA signature will be further presented based on a 73-gene ctDNA NGS panel that adjusts for the degree of tumor shedding.
Conclusion
ctDNA collection was feasible in 66 patients, amongst which 23 underwent liquid biopsy testing 3 months or less before immunotherapy treatment initiation. As the preliminary data is promising on this pilot cohort, we are planning on expending the cohort study and presenting a complex analysis that includes multifactorial mutation load approach that integrates TMB and prediction to immunotherapy response.
