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Tiffany L George
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EP1.12 - Small Cell Lung Cancer/NET (ID 202)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.12-38 - Retrospective Analysis of Immunotherapy Utilization in Advanced Small Cell Carcinoma at an Academic Cancer Center (Now Available) (ID 2520)
08:00 - 18:00 | Presenting Author(s): Tiffany L George
- Abstract
Background
Small-cell carcinoma (SCC) is an aggressive neuroendocrine carcinoma which commonly originates in the lung (SCLC). In contrast to non-small cell lung cancer (NSCLC), immunotherapy (IO) utilization has been limited for SCLC. Nivolumab was approved as a single agent in 2018 for third-line therapy. In 2019, the IMpower133 trial led to approval of first-line chemo-IO (atezolizumab plus carboplatin and etoposide) for extensive-stage SCLC. Despite these approvals, there is limited data about experience utilizing IO in SCC outside of clinical trials, including patterns of care, survival, and incidence of brain metastases. We therefore conducted a retrospective review of IO utilization at an academic cancer center in the United States.
Method
Institutional pharmacy database was used to perform an unstructured data collection of medical record numbers based on SCC diagnosis and IO treatment codes between January 1, 2008 and October 1, 2018 at The Ohio State University Medical Center. Patient data was then abstracted from the electronic medical record. Variables included demographics, co-morbidities, stage, metastatic sites (including brain), treatment history (including chemotherapy, IO and radiation), and treatment response. Survival from the start of IO to death and median overall survival (OS) from diagnosis to death were calculated.
Result
Forty patients, 17 women and 23 men, were eligible for evaluation. The median age was 64 years (30-91 yo); 36 patients were current/former smokers. At diagnosis, most were extensive-stage (65%). Common metastatic sites at diagnosis included brain (20%), bone (35%) and liver (33%). Overall, 22 patients (55%) developed brain metastases over the course of disease. Median line of IO was 2nd line (range 2nd-5th line); nivolumab-ipilimumab was the most common regimen (43%), followed by nivolumab (38%), then pembrolizumab (20%). Patients received an average of 4 cycles of IO (range 1-35). Nine patients were treated on clinical trial. Median survival after IO was 4.2 months and median OS of 17.3 months. Median survival for patients with brain metastases was 2.2 months vs. 10.3 months without (P=.01). Most patients had no durable response to IO; however, responses were observed in 7 patients (1 CR, 6 PR) and 8 patients had stable disease.
Table 1: Treatment Summary Treatment
Patients – no.
Chemotherapy – any line
Carboplatin
28
Cisplatin
15
Etoposide
40
Topotecan
19
Irinotecan
23
Paclitaxel
11
Gemcitabine
1
Immunotherapy
Nivolumab-ipilimumab
17
Nivolumab
15
Pembrolizumab
9
Radiation Therapy
Radiation (non-CNS site)
36
Radiation (CNS)
24
Type of CNS radiation
Prophylactic Cranial Irradiation
8
Whole brain radiation (therapeutic)
16
Gamma knife/stereotactic radiation
6
Conclusion
This retrospective review describes our experience utilizing IO in advanced SCLC at our academic institution. Although treatment patterns are changing with first-line IO, this data reflects the variability of patient responses. Several patients had prolonged responses, indicating potential areas of further investigation. This data will also be used to evaluate IO activity in CNS disease.
