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Yongxing Bao
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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
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-09 - A Cross-Sectional Study of Clinical Trials on Radiotherapy Combined with Immunotherapy for Lung Cancer (ID 1292)
08:00 - 18:00 | Author(s): Yongxing Bao
- Abstract
Background
For patients with lung cancer, remarkable advances have been made in Immune-Oncology (IO) therapy, especially immune checkpoint inhibitors (ICI). However, multi-modality treatment is needed to improve the efficacy or enlarge the beneficial populations of IO treatment. This study is to comprehensively summarize and analyze the clinical trials focusing on radiotherapy (RT) combined with IO therapy, explore the trend of research, as well as provide a view of the latest landscape of combination strategies.
Method
Trials registered on the electronic database（https://clinicaltrials.gov）between Jan.2009 and Jan.2019 were searched using “Radiotherapy AND Immunotherapy | Recruiting, Not yet recruiting, Active, not recruiting, Completed, Enrolling by invitation Studies | Interventional Studies | Lung Cancer”. SPSS 20.0 was used to analyze the data.
Result
Totally 69 clinical trials of RT and IO combination therapy for lung cancer were recorded, including 54 active and 15 completed. Geographically, most of the trials were carried out in the USA (n=47, 68.1%), followed by the European countries (n=18, 26.1%). From timeline, the past 2 years has seen a soaring number of 40 clinical trials accounting for 58.0% of the total. The combination therapy trials were more often in non-small cell lung cancer (NSCLC) (n=52, 75.4%) than small cell lung cancer (SCLC) (n=10, 14.5%), with the remaining 7 trials unspecified. As for combination strategies, trials of tumor vaccine combined with RT were the most frequent before 2016. But at present, ICI has exceeded tumor vaccine in the combination with RT and makes up the absolute most (n=62, 89.9%). On the whole, most of the combination therapy trials are in phase I/II (n=64, 92.8%). Although most trials are set for advanced or metastatic cancers (n=43, 62.3%), there are a few exploring the safety and effectiveness of combination therapy for early stage cancers or as adjuvant therapy (n=9, 13.0%). One trial was set as neo-adjuvant therapy. As for RT details, 22 trials were SBRT combined with IO therapy. Two trials were exploring the optimal sequence of RT and IO therapy. And one trial is to compare high versus low dose RT in the combination with ICI in NSCLC.
Conclusion
From the trials of RT and IO combination therapy for lung cancer, those of ICI combined with RT are increasing rapidly, although most are in phase I/II. Further studies are needed to explore the more detailed rational combination strategies, such as the sequencing, fractionation and dose of RT, and the optimal IO agent.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-05 - Patients with ypN2 NSCLC After Neoadjuvant Chemotherapy Followed by Surgery Can Benefit from PORT – A Retrospective Study of SEER Database (Now Available) (ID 2390)
10:15 - 18:15 | Presenting Author(s): Yongxing Bao
- Abstract
Background
Neoadjuvant chemotherapy followed by surgery (NCS) is a common therapy pattern of resectable non-small cell lung cancer (NSCLC). However, for patients with ypN2 disease after aforementioned treatment, there is no evidence that postoperative radiotherapy (PORT) should be adopted or not. Our study is to evaluate the effect of PORT on survival of patients with ypN2 NSCLC after NCS from Surveillance, Epidemiology, and End Results (SEER) database.
Method
We filtrated data from SEER database by the inclusion criteria of patients with NSCLC diagnosed at 2004-2015, treated with NCS, and with ypN2 disease (2004-2009 AJCC 6th, 2010-2015 AJCC 7th). We excluded patients with unclear basic information (such as sex, histology or cause of death), multiple primary malignant tumor and M1 disease. All data were analyzed using the SPSS Statistics (version 25) and propensity-score matched analysis was used to match the base-line characteristics between PORT group and non-PORT group. Kaplan-Meier method was used to estimate overall survival (OS) and cancer specific survival (CSS). Univariable and multivariable Cox proportional hazards models were adopted to estimate hazard ratios (HR) of predictors of survival.
Result
From 331 patients receiving NCS, 215 meeting the criteria were included in the final analysis. There were 112 patients (52.1%) with PORT. The baseline characteristics of majority were as follows: age≤65 (55.3%), white (82.3%), female (54.4%), grade 3-4 (63.3%), adenocarcinoma (60.0%), tumor size of 3-5 cm (38.6%), lobectomy (80.0%) and positive lymph nodes≥4 (51.2%). There were 200 patients remained after the prosperity score matching between the PORT group and the non-PORT group, with 100 cases in each. The median OS of the two groups were 36 months vs 26 months and 5-year OS rates were 36.2% vs 20.3%, respectively (P=0.011). The median CSS were 36 months versus 27 months and 5-year CSS were 38.5% vs 21.1%, respectively (P=0.010). Univariable analysis showed that only PORT significantly improved OS (HR=0.648, P=0.013) and CSS (HR=0.639, P=0.012). Multivariable analysis confirmed that PORT was the only significant predictor of OS (HR=0.615, P=0.011) and CSS (HR=0.614, P=0.013).
Conclusion
For patients with ypN2 NSCLC after NCS, PORT can significantly improve the OS and CSS . However, the result needs to be clarified by prospective randomized clinical trials.
