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Carolina Dutra



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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
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-32 - Successful Corneal Transplantation in a Patient Treated with Nivolumab for Metastatic Non-Small Cell Lung Cancer (ID 227)

      08:00 - 18:00  |  Presenting Author(s): Carolina Dutra

      • Abstract
      • Slides

      Background

      Survival improvement in metastatic non-small cell lung cancer has been achieved with the use of checkpoint inhibitors. PD1/PD-L1 pathway is related to immune response and tolerance, so its blockage could predispose to graft rejection. In the pivotal studies of novel immunotherapy, patients submitted to organ transplantation were classically excluded, and scarce data on medical literature exits about graft and patient outcomes in a scenario of use of checkpoint inhibitors in this patientes.

      Method

      We report the case of a 58 years old man treated with nivolumab for metastatic non-small cell lung cancer, after received platinum-based doublet chemotherapy, docetaxel and erlotinib and that was submitted to a corneal transplantation during the nivolumab treatment.

      Result

      The patient received Nivolumab 3mg/kg intravenously every two weeks and had stable disease accessed by RECIST 1.1 after 54 cycles and keeped ECOG 0 performance status. This man had a previous history of vision impairment on right eye because of bullous keratopathy after vitrectomy for vitreoretinal disorder, whose treatment of choice is corneal transplantation.

      After multidisciplinary discussion, the nivolumab was stopped 2 weeks before the corneal graft was successfully performed. The patient received systemic corticosteroid treatment with prednisone at 10mg daily dose for 10 days and topical dexamethasone for 45 days after procedure. Nivolumab was initiated 3 weeks later. The patient has currently received 68 cycles of nivolumab, CT scan shows stable disease. In the recent ophthalmologic examinatio, there were no sign of chorneal rejection and ocurred an improvement of visual function on right eye (counts fingers in a 2 metes distance).

      In the literature, there are with few reports of graft outcomes in a scenario of threatment with chekpoint inhibitors, since this patients were not included in clinical trials. Diverse outcomes are reported ,with a substancial risk of rejection, specially with the use of PD-1/PD-L1 inhibitors in comparison with agents anti -CTLA-4.

      In our knowledge, this is the first reported case of a graft transplantation during checkpoint inhibitors therapy.

      Conclusion

      Immunotheray in this special popullation is usually not recommended and under studied.

      In a context of immunotherapy, corneal graft transplantation can be associated with favourable outcomes due to devoid of vasculature and lymphatics in this tissue, that can facilitate immunological tolerance. So, although the risk of rejection must be taken into account, the treatment with anti-PD1 could not be considered an absolute contraindication to corneal transplantation, specially in patients with amaurosis, whose the risk of rejection of a graft cannot induce more damage than is already installed.

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      EP1.04-34 - Imaging Challenges in the Immunotherapy Treatment of Non Small Cell Lung Cancer (NSCLC): Progression vs. Pseudo Progression  (ID 2258)

      08:00 - 18:00  |  Presenting Author(s): Carolina Dutra

      • Abstract
      • Slides

      Background

      Immunotherapy has revolutionized treatment of squamous NSCLC. Along with the superior efficacy physicians have to face new side effects and response criteria. Initial tumor growth or new lesions followed by tumor response is called pseudo progression and can be seen in up to 10 % of patients.

      Method

      This education exhibit aims to show how the treatment response was evaluated in a series of cases of the clinical research of our institution using both RECIST and irRECIST, comparing the two methods and the multidisciplinary team consensus with correlation with the clinical status of the patient. Demonstrate the importance of the concept of unconfirmed progression and pseudo progression in the imaging evaluation of these patients. Illustrate with practical cases the diverse treatment outcomes.

      Result

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      A65 yo female patiente receive atezolizumab in the second line treatment for NSCLC stage IV, after a pulmonar progression with carboplatin + paclitaxel treatment in first line. PD-L1 was unknown. EGFR and ALK was negative. After 3 cicles of treatment wih anti PD-L1 agent (radiological control 1) the RECIST 1.1 evaluation identified a pattern of progression of disease , becouse there was a new pulmonary nodule. The patient was improving clinically, with weigh gain and cough reduction and in the immune-related response criteria (irRC) a stable disease was the response in that moment, besides the new lesion appearance. She does not have any remarkable side effect with the treatment , thas was susteined becouse of the clinical benefit. In order to get a close follow up of the disease, after 2 months she did a new radiologic evaluation ( control 2) , that show the involution of that new lesion in the right inferior lobe as well as happen to other pulmonary lesions at the same time, what could be characterized by a pseudoprogression pattern of response.

      Conclusion

      We need to take care in the radiologic and clinical evaluation of response in immunotherapy. Besides thrue pseudoprogression pattern ir rare in NSCLC and it is not able to be captured by convencional RECIST evaluation, it need to be reminded. Is necessary to combine clinical evaluation and immune-related response criteria (irRC) in doubtful cases in order do not underestimate the benefit of immunotherapy and prevent premature cessation of treatment.

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