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Alvin Seng Cheong Wong



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    P2.04 - Immuno-oncology (ID 167)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.04-36 - Immune Checkpoint Inhibition for Non-Small Cell Lung Cancer (NSCLC) in Patients with Pulmonary Tuberculosis or Hepatitis B (Now Available) (ID 869)

      10:15 - 18:15  |  Author(s): Alvin Seng Cheong Wong

      • Abstract
      • Slides

      Background

      Pulmonary tuberculosis (pTB) and Hepatitis B (HepB) are endemic in Asia. Multiple trials have shown a survival benefit of immune-checkpoint inhibitors (ICI), either as monotherapy or in combination with chemotherapy over chemotherapy in the treatment of NSCLC in first or second-line setting. However, patients with chronic infections are routinely excluded from such studies, and the safety and efficacy of ICI in this population is scarce.

      Method

      A retrospective review of clinical records of patients with advanced NSCLC with pTB and/or HepB, treated with ICI from January 2014 to March 2019 at a single Asian centre was conducted. The diagnosis of pTB was based on isolation of m. tuberculosis from sputum culture or nuclei acid amplification.

      Result

      13 patients were analysed. 12 (92.3%) were male, with a median age of 67 years (range 41 – 86) and 10 (76.9%) patients had an Eastern Cooperative Oncology Group performance status of 0-1. Nine (69.2%) patients received anti-PD-1/PD-L1 monotherapy, and four received ICI in combination with chemotherapy. Seven (53.8%) patients were treatment-naïve and six received ICI in the second-line and beyond. Seven patients had a history of pTB and ten patients had HepB. Four patients had a history of both HepB and pTB. The median progression-free survival (PFS) of the entire cohort was 6.7 months (95% CI: 3.3 – 10.2 months). The median overall survival (OS) was 13.3 months (95% CI: 0.0 – 31.2 months). Five patients had an objective response, and nine patients had disease control (complete/partial response or disease control). Immune-related adverse events (irAE) occurred in four patients – one patient each with endocrinopathy (G2), pneumonitis (G3), arthritis (G3) and hepatitis (G3). There were no treatment-related deaths. Four patients had pTB prior to initiation of ICI, and three patients developed pTB after. Two patients received anti-TB therapy on ICI and developed G3 transaminases which resolved after omission of anti-TB therapy. For all the patients who had completed treatment for pTB, none experienced re-activation. Of the 10 patients with HepB, four were chronic carriers (HepB surface-antigen (HBsAg) positive and detectable viral load), and six were previously exposed (HBsAg negative, anti-hepB core-antibody positive). Only one of the patients who had previous exposure to HepB received anti-viral prophylaxis and there were no incidences of re-activation.

      Conclusion

      Based on our findings, the risks of ICI therapy do not appear to be increased in patients with pTB or HepB. Further studies identifying those who are at risk of reactivation are essential.

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