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Alvin Jun Xing Lee



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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
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.04-68 - Retrospective Analysis of Immune Checkpoint Inhibitors in NSCLC: Immune-Related Adverse Events and Outcomes (ID 2244)

      10:15 - 18:15  |  Presenting Author(s): Alvin Jun Xing Lee

      • Abstract
      • Slides

      Background

      In the United Kingdom, immune check-point inhibitors (ICPi) including pembrolizumab, atezolizumab and nivolumab are routinely used in advanced NSCLC. These agents are associated with immune-related adverse events (irAE). We present a single centre experience of a tertiary lung cancer centre on the incidence and severity of irAE, with hospitalisation episodes and duration. Patient outcomes were compared with radiological assessment of response, Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR). High NLR and PLR may predict for poorer outcomes following ICPi treatment .

      Method

      This was a single-centre retrospective analysis of the electronic records of NSCLC patients who received treatment with an ICPi between January 2017 and December 2018. Patients on clinical trials were excluded. NLR and PLR were derived from the most recent pre-treatment peripheral blood sampling. The subjective response as recorded in radiological reports of cross-sectional imaging was noted. The first response was defined as the response reported in the first scan after initiation of treatment and the best response was defined as best recorded response across all scans following treatment. Kaplan Meier survival analyses were performed.

      Result
      Patient characteristics and response
      Patient Characteristics N=46 %
      Median age 64.8 (range 48.1 to 81.9)
      Male 28 60.9
      Female 18 39.1
      Treatment
      Atezolizumab 7 15.2
      Pembrolizumab 39 84.8
      Line of treatment
      First 20 43.5
      Second 20 43.5
      Third 6 13
      Histology
      Adenocarcinoma 34 73.9
      Squamous 8 17.4
      Other NSCLC 4 8.7
      First response to treatment
      Progressive disease 18 39.1
      Stable disease 3 6.5
      Partial response 10 21.7
      Complete response 1 2.2
      Mixed response 10 21.7
      Not assessed 4 8.7
      Best response to treatment
      Progressive disease 17 37
      Stable disease 3 6.5
      Partial response 11 23.9
      Complete response 2 4.3
      Mixed response 9 19.6
      Not assessed 4 8.7
      irAE and grade (54 events)
      Anorexia, G1-2 2 3.7
      Arthritis, G1-2 1 1.9
      Arthritis, G3 1 1.9
      Diarrhoea, G1-2 4 7.4
      Diarrhoea, G3 4 7.4
      Diarrhoea, G5 1 1.9
      Endocrinopathies, G1-2 6 11.1
      Fatigue, G1-2 12 23
      Fatigue, G3 3 5.6
      Liver dysfunction, G1-2 1 1.9
      Nausea/Vomiting, G1-2 6 11.1
      Pneumonitis, G3 1 1.9
      Pruritus/Rash, G1-2 10 18.5
      irAE hospitalisation events 9 19.6
      Median length of hospitalisation 8.5 days (range 1 to 19)
      Mean NLR 5.90 (range 0.98 to 28.04)
      Mean PLR 272.02 (range 83.5 to 893.3)

      First recorded radiological response was a predictor of best radiological response and OS, p=0.003. NLR and PLR above mean were predictive factors for decreased OS (HR 3.99, 95% CI 2.01 to 14.35, p=0.0009; HR 2.09, 95% CI 0.84 to 4.87, p=0.119).

      Conclusion

      Most patients experienced at least 1 irAE. 1 in 5 had irAE grade 3 or above requiring hospitalisation. The burden of irAE and increased hospitalisation time and costs are likely to increase secondary to the increased use of ICPi in combination with platinum-doublet chemotherapy in the first-line setting for advanced NSCLC. Response at first radiological assessment was a predictor of outcome. NLR and PLR are potential readily measurable predictive biomarkers.

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