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Diego Gonzalez



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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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      P2.04-77 - Hyperprogression with Immunotherapy in Metastatic Non-Small Cell Lung Cancer: Hôpital Charles-LeMoyne Experience (Now Available) (ID 2916)

      10:15 - 18:15  |  Author(s): Diego Gonzalez

      • Abstract
      • Slides

      Background

      Immunotherapy has revolutionized cancer treatment and particularly the perspectives of metastatic lung cancer, with durable response rates and overall survival at 5 years of up to 16%. Nevertheless, in addition to the already known immune events related to these new treatments, retrospective studies and case reports describing a rapid progression of the disease related to the beginning of immunotherapy have been published recently, reporting a rate of hyperprogression of 9 to 16%, comparable to the response rate. This phenomenon recently described deserves directed investigations to better characterize, confirm or deny its existence.

      Method

      The present study is a retrospective analysis of medical records and medical imaging documents of patients with metastatic lung cancer receiving immunotherapy (nivolumab or pembrolizumab) between July 2015 and July 2017 at Charles-Lemoyne Hospital. Imaging was retrospectively reviewed to categorize patients into 3 groups: hyperprogressors, usual progressors, and non-progressers. Clinical, pathological and molecular characteristics as well as overall survival data were analyzed according to the 3 groups. The definition by Bouzid, et al1. was used to define Hyperprogressive disease as a Tumor Growth Kinetics (TGK) Ratio of 2 or more, with the addition of post progressionTGK and the inclussion of patients with non messurable disease if the time to treatment failure was less than 2 months with an increase of the tumoral burden of 50% or more.

      1Bouzid, et al. Annals of Oncology 28: 1605–1611, 2017

      Result

      A total of 42 files were included with 137 images evaluated. Hyperprogression rates were similar to those reported in the recent literature (14%), and patients with demonstrated hyperprogression had decreased survival. The clinical features analyzed as the presence of recent irradiation, advanced age, and high metastatic burden were not predictive of hyperprogression.

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      Conclusion

      In the era of immunotherapy, the identification of different patterns of progression and the sharing of institutional experiences with unexpected results following a therapy still under development becomes of major importance. This is the experience in our center with hyperprogressive disease to generate hypotheses on the evaluation of the phenomenon, the causes and risk factors. We believe, after constant reports of this finding in retrospective studies, efforts should be done in the prospective trials to actively look for and better characterize this pattern of abnormal progression as it could give us some clues in the resistance to immunotherapy.

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