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ROBERT E Merritt
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-03 - Incidence and Risk Factors of Metachronous Non-Pulmonary Malignancies in Resected Lung Adenocarcinoma (ID 2906)
09:45 - 18:00 | Author(s): ROBERT E Merritt
- Abstract
Background
Patients with non-small cell lung cancers have an increased risk of developing second primary lung cancers (SPLC). However, little is known about the development of non-pulmonary cancers (NPC) in patients with long-term survival after complete resection. We analyzed our experience with resected lung adenocarcinoma patients to assess the incidence and factors associated with metachronous malignancies.
Method
Surveillance records of 326 patients with primary lung adenocarcinoma who underwent complete staging followed by lobectomy between 2011-2017 at a single center were reviewed. Median follow-up time was 42 months. Metachronous NPCs were distinguished from distant metastases by pathologic correlation of histology and immunohistochemistry. The association of patient/tumor factors and mutation status with NPC was assessed.
Result
The cohort included 275 (84.4%) smokers, and 51 (15.6%) never smokers, with a median age of 65 years. The majority of patients were pathologic stage-I (72.4%) or stage-II (19.6%). KRAS (38%) and EGFR (17.8%) were the most commonly observed mutations. Metachronous NPC were detected in 30 patients (9.2%) and SPLC in 13 patients (4%), after a median interval of 14 months [IQR: 6.8–44] and 36 months [IQR: 27–60], respectively. Highest incidence of NPCs was seen in patients having EGFR tumor mutations (EGFR+ 17.2% vs. EGFR- 7.5%, p=0.020) and former smokers (former smokers 14.8% vs. never smokers 7.8% vs. active smokers 3.8%, p=0.005). Metachronous breast and GI cancers were frequently seen in patients with EGFR+ lung cancers (Table). Controlling for age, gender, and smoking status, EGFR mutation in resected lung adenocarcinoma was associated with 2.6 times greater odds (95% CI: 1.1-6.3, p=0.028) of metachronous NPC.
Conclusion
Metachronous non-pulmonary malignancies can be frequently detected in patients during active surveillance of resected lung adenocarcinoma. Besides smoking as a known risk factor, patients with EGFR mutated tumors may be at particular risk. Germline mutations of EGFR positive lung adenocarcinoma patients should be further explored.
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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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P2.04-88 - Surgical Outcomes of a Multicenter Phase II Trial of Neoadjuvant Atezolizumab in Resectable Stages IB-IIIB NSCLC: Update on LCMC3 Clinical Trial (ID 1817)
10:15 - 18:15 | Author(s): ROBERT E Merritt
- Abstract
Background
The role of immune checkpoint inhibitors in resectable NSCLC remains undefined. We report the updated safety results of the first multicenter trial assessing neoadjuvant atezolizumab (a PD-L1 inhibitor) for resectable NSCLC.
Method
Eligible patients with clinical stage IB-IIIB resectable NSCLC received 2 cycles of neoadjuvant atezolizumab (1200 mg, days 1, 22) followed by surgical resection (day 40±10). Pre- and post-treatment PET/CT, pulmonary function tests (PFT), and bio-specimens were obtained. Adverse events (AE) were recorded according to CTCAEv.4.0. Preoperative treatment-related TRAE (preop-TRAE) and postoperative TRAE (postop-TRAE) defined as AE onset on, or after date of surgery, were analyzed.
Result
Follow-up data to post-surgery visit were analyzed for 101 patients out of planned 180: mean age: 64.6 years; male: 47/101(46.5%); current smokers: 23/101(22.8%); non-squamous histology: 66/101(65.3%); and clinical stages IB(10.9%), IIA(15.8%), IIB(27.7%), IIIA(38.6%), and IIIB(6.9%). Two cycles of atezolizumab were not completed in 5/101(5.0%) patients due to grade 1 or 2 AEs. Surgery was not performed in 11/101(10.9%) patients: 5 demonstrated disease progression, and 6 for ‘other’ reasons. 6/101(5.9%) patients were deemed unresectable. Surgery was delayed (outside of 10-day window) in 10/90(11.1%) patients by an average of 11(1-39) days. Two of these delays were due to TRAEs (hypothyroidism and pneumonitis), 3 were patient-elected delays, 2 were surgeon-related, and 3 for ‘other’ reasons. Intraoperative vascular complications occurred in 2/90(2.2%) and extensive hilar fibrosis was noted in 20/90(22.2%) patients. Overall, there was insignificant mean change in the PFTs pre- vs. post-atezolizumab therapy. Only 3/101(3.0%) patients had treatment-related dyspnea, dyspnea on exertion, or pneumonitis.
Table 1
ConclusionTreatment Related Adverse Events
(TRAE)
Preoperative TRAE
(N = 101)
Postoperative TRAE
(N = 90)
All AEs
Any grade
55 (54.5%)
20 (22.2%)
Grade 1
29 (28.7%)
7 (7.8%)
Grade 2
24 (23.8%)
9 (10.0%)
Grade 3
2 (2.0%)
4 (4.4%)
Grade 4
0
0
Grade 5
0
0
Specific AEs
Dyspnea
1 (1.0%; grade 2)
3 (3.3%; grade 1)
Dyspnea on exertion
1 (1.0%; grade 1)
0
Myalgia
4 (4.0%; grade 1 or 2)
0
Hyperthyroidism
3 (3.0%; grade 1 or 2)
1 (1.1%; grade 1)
Hypothyroidism
0
1 (1.1%; grade 2)
Pneumonitis
1 (1.0%; grade 3)
3 (3.3%; grade 2 or 3)
Transaminitis (AST or ALT)
8 (7.9%; grade 1 or 2)
3 (3.3%; grade 1 or 2)
Post-atezolizumab Change in Pulmonary Function Tests
PFT factor
Mean change (95% Confidence Interval)
FEV1 (N = 72)
-0.6% (-2.6% to 1.3%)
FVC (N = 72)
0.0% (-1.8% to 1.8%)
DCLO (N = 64)
-1.2% (-4.1% to 1.7%)
Treatment with neoadjuvant atezolizumab in resectable stage IB-IIIB NSCLC was well tolerated, with minimal delay to surgery, and few treatment associated AEs. This trial continues to accrue and assess MPR, survival, and other long-term endpoints.
