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Jørn Herrstedt



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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: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-22 - Efficacy and Safety of Immune Checkpoint Inhibitors in a Danish Real Life Non-Small Cell Lung Cancer Population (Now Available) (ID 1220)

      08:00 - 18:00  |  Author(s): Jørn Herrstedt

      • Abstract
      • Slides

      Background

      To investigate effect and toxicity of immune check-point inhibition (ICI) in a Danish unselected real life non-small cell lung cancer (NSCLC) population. By including patients underrepresented in clinical trials, such as those with brain metastasis (BM), higher age, more comorbidity, autoimmunity and poorer performance status (ECOG), comparison to pivotal data on clinical trial populations is possible.

      Method

      Retrospective real life data were gathered from 118 consecutive NSCLC patients with incurable/recurrent disease stage IIIA-C and metastatic stage IV (revised according to the IASLC 8th Edition Lung Cancer TNM Staging) treated with ICI at the Department of Oncology at the University Hospital of Odense, Denmark from September 2015-April 2018. Immune related Adverse Events (irAE) grade 3-5 were registered prospectively during the same period. Patient, tumor and treatment characteristics were obtained from electronic patient records including charlsons comorbidity index score (CCIS). Overall survival (OS), progression free survival (PFS) and best response were assessed using Kaplan Meier estimates and the log-rank test. Cox regression was used for univariate analysis of factors affecting survival. Reasons for termination of ICI including level of irAEs grade 3-5 toxicity leading to termination of ICI was reported as well.

      Result

      Median age for patients was 66 [IQR 59-71] and 62 [range: 55-64] for those with BM. Females 63%; adenocarcinoma/squamous/others 69%/23%/8%; ECOG ≥ 2 10%; bone/brain/liver metastases 36%/18%/15%; PD-L1 (TPS) <1%/ ≥1%≤ 49%/≥50%/NR: 3%/14%/68%/15%; baseline autoimmunity 10%, Charlsons Comorbidity Index Score (CCIS) ≥ 2 39%, treatment line: 1st/2nd/ ≥3rd 39%/30%/31%. Median OS of all patients and patients with BM comprised 16.1 months [95% CI 10.7-21.5] and 8.2 months [95% CI 1.0-15.5], respectively. Twenty-four percent of patients terminated ICI due to irAE grade 3-5 alone (grade 5, n=1). There was no association of age or BM with irAE grade 3-5.

      Conclusion

      OS and PFS were comparable to clinical trial reports. Long-lasting remission is possible in patients with BM. Real life populations have higher rates of irAE grade 3-4 than reported in clinical trials, but it does not seem to impact median OS.

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      EP1.04-29 - Khorana Score: A Potential New Biomarker for Real Life Non-Small Cell Lung Cancer (NSCLC) Patients Treated with Immunotherapy (Now Available) (ID 1242)

      08:00 - 18:00  |  Author(s): Jørn Herrstedt

      • Abstract
      • Slides

      Background

      PD-L1 tumor proportion score is presently the only biomarker used for selecting incurable NSCLC patients for immune check point inhibition (ICI). Performance score (ECOG) and comorbidities are useful, but no specified guidelines exist in this regard. New objective biomarkers are warranted.

      Khorana score (KS) is a validated tool used to predict venous thromboembolisms (VTE) in out-patients with cancer prior to chemotherapy. For NSCLC patients undergoing chemotherapy KS has recently been associated with prediction of early mortality and not VTE. KS has not previously been investigated in patients undergoing ICI.

      Method

      Retrospective data from 118 incurable advanced/metastatic NSCLC patients treated with ICI in a single center during the period of September 2015-April 2018 was gathered. Baseline platelet count (PC), leucocyte count (LC), and hemoglobin count (HC) were registered. Baseline body mass index calculations were performed as well as KS (a minimum of KS ≥ 1 due the primary lung cancer disease). Based on follow-up data Kaplan Meier curve estimates of overall survival (OS) and progression free survival (PFS) were performed.

      Result

      For patient, tumor and treatment characteristics see Table 1. Fourteen percent had known VTE prior to ICI. Two patients died from pulmonary embolisms. KS correlated significantly to OS but not to PFS. A median OS of 18.1 months [CI 12.8-23.4] and 8.4 months [CI 4.3-12-6] was found for groups with KS=1-2 and KS≥3, respectively (log-rank test, p=0.017).

      table_1.jpg

      Conclusion

      Baseline Khorana Score may represent a new clinical applicable prognostic biomarker for incurable NSCLC patients undergoing ICI. A KS ≥ 3 may be a predictor for early mortality but large prospective studies validating or rejecting this are warranted.

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