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Matías Alejandro Cerini
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P2.04 - Immuno-oncology (ID 167)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.04-81 - Non-Small Cell Lung Cancer Treated with Immunotherapy: Multi-Institutional Experience from Argentina (Now Available) (ID 1893)
10:15 - 18:15 | Author(s): Matías Alejandro Cerini
- Abstract
Background
Immunotherapy (IO) has been established as the standard treatment for metastatic non-small cell lung cancer (NSCLC) patients improving survival. It has been approved both in first line and after platinum-treated patients. We aimed to study the efficacy and tolerability of anti PD-(L)1 inhibitors in pts with NSCLC in Argentina providing more evidence about efficacy and toxicity
Method
Metastatic NSCLC patients (pts) treated with immunotherapy in six hospitals between 11/2013 - 2/2019 were included. Data was collected retrospectively by the investigators. Progression-free survival (PFS) and overall survival (OS) were assessed. Cox-regression model was performed for uni- and multivariate analysis. All pts who received at least one dose of immunotherapy were evaluated for efficacy and toxicity.
Result
A total of 269 patients were included. Median age (range) was 66 ys (28-88), 164 (61%) were men, 226 (84%) were current/former smokers and 223 (82.9%) had performance status (PS) 0-1. The predominantly histology was non-squamous (N=239; 88.8%), 158 (58.7%) tumors were evaluable for PD-L1 expression and 9 (3.3%) had EGFR mutations. 86 (32%) pts received IO as first-line and 155(57.6%) as second-line therapy. Anti-PD1 antibodies were most commonly administered (83.3%). Baseline brain and liver metastases were present in 50 (18.6%) and 29 (10. 8%) pts, respectively. The overall response rate was 30.4% (76/256). The most common sites of progression were (N=261) bones 142 (54.4%), lung/lymph nodes 74 (28.4%) and brain 26 (10%), visceral 19 (7.3%). Grade ≥ 3 adverse events occurred in 48 pts (17.8%) and 28 (10.4%) pts discontinued treatment due to toxicity. With a median follow up of 15.88 months (95% CI 12.08-19.68), median PFS was 7.26 (95%CI 5.15-9.38) and OS was 15.18 (95%CI 9.47-20-90). In univariate analysis smoking status (p 0.049), PDL1 (p 0.002), PS (p 0.000), corticoid therapy at beginning of IO (p 0.001), grade≥3 toxicity (p 0.027), first line therapy (p=0.003) and driver mutation (p 0.028) were all associated with PFS. Age (p=0.030), PDL1% (p=0.007), corticoid therapy at beginning of IO (p<0.001), grade≥3 toxicity (p=0.012) and first line therapy (p=0.038) were all associated with OS. In multivariate analysis, PDL1 and PS were independently associated with both, PFS (p=0.011 and p=0.000, respectively) and OS (p=0.036 and p<0.001, respectively).
Conclusion
Treatment with anti PD-(L)1 inhibitors in the real-world is effective and tolerable, supporting the use of immunotherapy in pts with NSCLC. As previously reported, low PDL1 expression and poor PS confer worst clinical outcomes. Other factors such as age, line of treatment, corticoid use, toxicity and driver mutations may impact treatment response.
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P2.04-82 - Discontinuation of Anti-PD-1/PD-L1 Antibody Therapy in the Absence of Disease Progression: Clinical Outcomes in Advanced NSCLC (Now Available) (ID 2024)
10:15 - 18:15 | Author(s): Matías Alejandro Cerini
- Abstract
Background
Treatment with anti PD-1/PD-L1 immune checkpoint inhibitors (ICIs) prolongs survival in patients (pts) with advanced non-small cell lung cancer (NSCLC). Treatment discontinuation in the absence of disease progression rises concern on treatment efficacy in patients and providers. We aim to study the outcomes of patients with NSCLC who discontinued treatment with ICIs.
Method
Retrospective, multicenter descriptive study. Patients diagnosed with advanced NSCLC who discontinued therapy with pembrolizumab, nivolumab or atezolizumab in the absence of disease progression (PD) between 11/2013 - 2/2019 were included. All pts who received at least one dose of immunotherapy were evaluated for efficacy and toxicity.
Result
A total of 269 patients diagnosed with metastatic NSCLC and treated with anti-PD-1 or anti-PD-L1 antibodies were retrospectively studied. Median follow-up for the entire cohort was 15.8 months (95% CI: 12.08-19.68).
Median age 66 ys (r 28-88), 61% men, 83,4% were former or current smokers. Non-squamous NSCLC was the most common histologic subtype (N=239; 89%).
Performance status (PS) was 0-1 in 223 pts (83%), 86 pts (32%) received ICIs in first line, 154 pts (57.4%) in second line and 28 pts (10.6%) in third line or beyond. Pembrolizumab was the most common treatment for pts (N= 129; 48%), followed by nivolumab (N= 113; 42%) and atezolizumab (N=27; 10%).Within the entire cohort, 39 pts (14.5%) discontinued treatment with ICIs for reasons other than PD, 35 pts due to toxicity and 4 pts for other reasons. At the time of treatment discontinuation, 3 pts (7.7%) had achieved a complete response (CR), 10 (25.6%) a partial response (PR), 17 pts (43,5%) a stable disease and 9 (23%) had PD. Median duration of response after discontinuation of ICIs was 6 months (range 0.1-27).
Of the CR + PR + SD subgroup at the time of analysis 76, 9% remain without PD.
If we consider only patients who maintained at least 3 months’ therapeutic benefit when discontinuing treatment in the absence of PD, only 3 patients had PD (at 6, 7 and 17 months of discontinuation) and the median duration of response for this group was 8 months ( 3.74-27).
Conclusion
Patients who discontinue treatment with ICI in the absence of disease progression can achieve sustainable benefit. Further studies are needed to assess the safety and efficacy of reintroducing ICIs in the event of disease progression in this population.
