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Marius Lund-Iversen



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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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      P2.04-74 - Radiotherapy Prior to Immunotherapy Is Associated with Durable Disease Control in Advanced NSCLC (ID 1581)

      10:15 - 18:15  |  Author(s): Marius Lund-Iversen

      • Abstract

      Background

      In an unselected patient cohort response rates for immune checkpoint inhibitors in advanced NSCLC are around 20 %1-3. To enhance this proportion several treatment combinations are under investigation. Radiotherapy combined with immunotherapy has shown promising results in preclinical trials and clinical trials using this combination are in progress, assessing safety and optimal dosage/timing of radiotherapy4.

      Method

      Between May and September 2015 fifty-seven patients with advanced NSCLC were treated with nivolumab (3 mg/kg every 2nd week) at The Norwegian Radium Hospital in a named-patient-use-program. Clinical information, including dosage and timing of radiotherapy given prior to immunotherapy, has been collected and correlated to clinical outcome.

      Result

      figure_1.pngMedian follow-up time for those with no event when data was collected was 43.4 months (range 42.4-44.1 months) and overall survival 14%. Eight patients died of other causes than lung cancer. Radiotherapy administered at different time intervals before the first dose of nivolumab was correlated to progression free survival (PFS) and overall survival (OS) using cox regression analysis. We found poor PFS (HR 3.1 p=0.034) and OS (HR 3.7 p=0.015) for those who received radiotherapy between 1-2 months prior to nivolumab. The indication for radiotherapy in late stage lung cancer is most often symptomatic metastases. Hence, recent radiotherapy is usually associated with more advanced disease and poor prognosis. When patients were divided into groups according to prognosis we found that many in the group with short PFS had received radiotherapy shortly before immunotherapy but the proportion was even higher in the group with durable response (figure 1).

      Conclusion

      Our findings support the hypothesis that radiotherapy can trigger a tumor-directed immune response which can be enhanced by immunotherapy and result in long-lasting disease control. We will validate our results in an additional cohort and will assess and include PD-L1 expression in our analysis.

      1. Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. N Engl J Med 2015;373(2):123-35.

      2. Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. N Engl J Med 2015;373(17):1627-39.

      3. Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med 2015;372(21):2018-28.

      4. Ngwa W, Irabor OC, Schoenfeld JD, et al. Using immunotherapy to boost the abscopal effect. Nat Rev Cancer 2018;18(5):313-22.