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Xuwei Cai
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EP1.04 - Immuno-oncology (ID 194)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-28 - The Abscopal Effects of the Combination of Radiotherapy and GM-CSF for Patients with Metastatic Thoracic Cancers (Now Available) (ID 1097)
08:00 - 18:00 | Author(s): Xuwei Cai
- Abstract
Background
An absopal response was defined as distal tumor regression out of irradiated field induced by radiotherapy and mediated by immune system. Golden EB et al reported a benefit with the use of Granulocyte-macrophage colony-stimulating factor (GM-CSF) with local radiotherapy in a subset of chemotherapy or hormone therapy in patients with metastatic solid tumors. However, the contribution of systemic therapy to abscopal effects couldn’t be defined. Therefore, we conducted the study aiming to evaluate the abscopal effects of the pure combination of local radiotherapy and GM-CSF in patients with metastatic thoracic cancers.
Method
Patients who met the following criteria were included for this study: (1) Pathologic confirmation of thoracic cancer by histology; (2) at least three distinct measurable sites of metastatic disease; (3) received at least one line of previous chemotherapy and had stable or progressing disease to the last chemotherapy or refused to receive chemotherapy; (4) received the combination of GM-CSF and radiotherapy; (5) no previous malignancies; (6) no previous immunotherapy.
Result
A total of 30 consecutive patients who were treated between March 31, 2016 and March 31, 2019 were included in this study. In the 16 patients with lung cancer, 2 partial abscopal responses, 9 stable and 5 progress were observed. In the 10 patients with thymic cancer or thymoma, 2 partial abscopal responses (thymic cancer), 6 stable and 2 progress were seen. Neither of the two patients with esophageal cancer had progressive diseases within 3 months. The patient with tracheal adenoid cystic carcinoma had partial response to the treatment, whereas the other patient with malignant pleural mesothelioma had stable disease. Twenty-four patients (80%) received GM-CSF of 125ug/m2 d8-22, which was the same as Golden EB et al reported. However, 8 patients had high fever (33.3%), 4 patients (16.7%) had edema (Grade 2: 3, Grade 3: 1), 4 patients (16.7%) had dyspnea of Grade 2, and one patient had dermatitis of Grade 3. Another one patient underwent cerebral infarction during the third day of GM-CSF injection. The other 6 patients who had GM-CSF of 70% dosage (87.5ug/m2) had no obvious side effects. No evidence showed that the reduced dosage of GM-CSF may have negative influence on the effect of the treatment.
Conclusion
In conclusion, pure combination of local radiotherapy and GM-CSF may increase the incidence of abscopal responses, and bring benefits to patients with thoracic cancers except esophageal cancer. Lower dosage of GM-CSF is recommended to Asian patients.
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P1.12 - Small Cell Lung Cancer/NET (ID 179)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-24 - Comparison of Four Prognostic Scores for Patients with Brain Metastases from Small-Cell Lung Cancer (Now Available) (ID 1851)
09:45 - 18:00 | Author(s): Xuwei Cai
- Abstract
Background
Prognostic indexes are useful to guide tailored treatment strategies for cancer patients with brain metastases(BMs). Primary tumors have different biological behavior justifying separate scoring systems for different tumors. The purpose of this study was to compare four prognostic scores [recursive partitioning analysis(RPA), graded prognostic assessment(GPA), score index for radiosurgery(SIR), and basic score for brain metastases(BSBM)] for patients with BMs from small-cell lung cancer(SCLC).
Method
Pathological diagnosis of SCLC patients with radiologically confirmed BMs were enrolled except those who received surgery of primary lesion. Clinical data, including age, KPS, primary tumor control, extracranial disease status, number of BMs, systemic disease status, and the largest lesion volume were recorded. The score of RPA, GPA, SIR and BSBM were calculated separately. Overall Survival(OS) was calculated from the date of diagnosis of BMs to the date of death from any case, or the last follow-up. OS was estimated by the Kaplan-Meier method. Cox’s regression analysis was performed using a backward elimination approach to determine the best model predicting survival. P<0.05 was considered statistically significant.
Result
From Jan 2011 to Oct 2014, 224 patients were eligible for the study. For the entire cohort, median OS was 9 months (95%CI, 7.7-10.3). The median survival was 10 months for RPA Class I, 9 months for RPA Class II, and 4 months for RPA Class III(P=0.039). Using the SIR, the median survival was 11, 9, and 6 months for a score of 8-10, 4-7, and 0-3, respectively(P=0.008). In addition, the median survival was 10 months for GPA Class I, 12 months for GPA Class II, 8 months for GPA Class III, and 6 months for GPA Class IV(P=0.136). Using the BSBM, the median survival was 10, 8, 9, and 4 months for a score of 3, 2, 1, and 0, respectively(P=0.099). The backward elimination model in multivariate Cox analysis identified SIR as the only variable significantly associated with survival(P=0.012).
Number of patients OS P RPA I 31 10±1.4 0.039 RPA II 184 9±0.7 RPA III 9 4±0.4 GPA I 22 10±1.4 0.136 GPA II 30 12±2.2 GPA III 136 8±0.8 GPA IV 36 6±1.3 BSBM 0 6 4±1.2 0.099 BSBM 1 85 9±1.3 BSBM 2 88 8±0.7 BSBM 3 45 10±0.7 SIR I 14 11±2.5 0.008 SIR II 182 9±0.7 SIR III 28 6±1.3
Conclusion
The SIR score was more prognostic than the RPA, GPA, and BSBM scores. For patients with BMs from SCLC, SIR was the most accurate for estimating survival. As it was mainly used for radiosurgery in BMs, maybe a new disease-specific prognostic score should be generated in this particular population.
