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Andreia Cruz
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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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EP1.04-31 - Immunotherapy in Advanced Non-Small Cell Lung Cancer Previously Treated: Real World Data (Now Available) (ID 2716)
08:00 - 18:00 | Presenting Author(s): Andreia Cruz
- Abstract
Background
Immunotherapy has changed the paradigm of the treatment and prognosis of Non-Small Cell Lung Carcinoma (NSCLC). Pembrolizumab and nivolumab are monoclonal antibodies that blocks PD-1, both approved in advanced NSCLC. The aim of this study was to evaluate the demographic, histological characteristics, response and toxicities of these drugs.
Method
This is a retrospective cohort of patients with metastatic NSCLC that had been treated with pembrolizumab or nivolumab in our institution, who began treatment until 12.2018.
Result
60 patients were included in this study. In pembrolizumab group (N27), 81.5% (22/27) were men, 53.8% (14/26) ex-smokers, median age 68 (45-79). Histologically, 81.5% (22/27) were adenocarcinomas, EGFR negative, one with ALK translocation and 48.1% (13/27) with PD-L1 levels > 50. At diagnosis 66.7% (18/27) was in stage IV. 1st line palliative chemotherapy was platinum/pemetrexed in most patients (59.3% 18/27). 81.5%(22/37) were treated with pembrolizumab in 2nd line. ECOG at the start of pembrolizumab was 1 in 74.1% (20/27). Median number of cycles was 8 (1-34). 42.3% (11/26) had toxicity, grade 3 in 4 patients, the most common being asthenia, anorexia and hypothyroidism. Treatment discontinuation occurred due to clinical deterioration in 33.3% (9/27) or 25.9% (7/27) disease progression. 7 patients (25.9%) maintained treatment. 12 patients die due to NSCLC (mortality: 44.4%).
In nivolumab group (N 33), 78.8 % were men (26/33), median age 62 years (46-73), 54.5% (18/23) smokers. Histologically, 69.7% (23/33) were adenocarcinomas, EGFR positive in 2 patients, no ALK translocation and PD-L1 negative in all patients. 60.6% (20/33) were diagnosis in stage IV. 1st line palliative treatment was platinum/pemetrexed in most cases (63.6%, 21/33). 84.8% (28/33) were submitted at least to 2 lines of treatment before nivolumab. 81.8% (27/33) had ECOG1 at the start of nivolumab. Median number of cycles was 9 (1-50). 54.5% (18/33) of patients had toxicity, grade 3 in 5 patients, with asthenia and rash being the most common. Disease progression (42.4%; 14/33) and clinical deterioration (27.3%; 9/33) are the most reason for treatment discontinuation. 21 patients die due to cancer (mortality: 63.6%).
At 12 months, progression-free survival was 33.3% in pembrolizumab and 64% in nivolumab.
Conclusion
Immunotherapy brought higher survival rate to NSCLC, with good tolerability in most cases, maintaining and improving the quality of life. However, given the disparities between responses, acknowledgment of new targets and biomarkers will make the patient selection for immunotherapy more accurate.
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P2.09 - Pathology (ID 174)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.09-22 - Molecular and Immunological Profiles of Lung Carcinoma: Are They Associated? (ID 2673)
10:15 - 18:15 | Presenting Author(s): Andreia Cruz
- Abstract
Background
Lung cancer, usually related to tobacco and other exposures, has also risk factors that suggest a genetic susceptibility. Thus, there has been increasing interest in the definition of oncogenic changes that allow targeted therapy. On the other hand, immunological checkpoint inhibitors have been shown to be increasingly effective, regardless tumor histology or expression of PD-L1. We aimed to characterize the presence of predictive response mutations to target therapies and the immunological profile of non-small cell lung cancer (NSCLC), and to study possible associations between them.
Method
Retrospective study of NSCLC cases submitted to the determination of PD-L1 by the Pathology Service since January 2017 until March 2019 and, in those patients, description of the predictive response mutations in the EGFR, ALK and ROS1 genes. Data were analyzed using simple descriptive statistics methods. To test hypotheses, we used the chi-square test, and the predictive factor search was performed through logistic regression.
Result
A total of 794 patients were identified, 73.8% male (n=586), with a median age of 67 years (IQR, 13). The histological type was classified as adenocarcinoma in 69.3% of cases (n=550) and squamous cell carcinoma in 22.8% (n=181). Among the adenocarcinomas, we found predictive mutations in the EGFR gene in 17.6% of the patients (n=97), translocation in the ALK gene in 4.9% (n=27), and rearrangement in the ROS1 gene in 0.9% (n=5). PD-L1 expression was positive in 54.2% of the cases (n=430), and superior to 50% in 22.9% (n=182). Overall, the association between PD-L1 expression and EGFR status was not statistically significant. However, there was an association between PD-L1 expression and EGFR mutation in females (p=0.013). There was also an overall association between PD-L1 expression and ALK translocation (p<0.001), and this association was maintained in the gender analysis for the male patient group (p=0.003). In the multivariate analysis, the ALK translocation was a predictor of PD-L1 expression.
Conclusion
The molecular profile of lung carcinoma was similiar to what is described in the literature. In our study, there was a statistically significant association between ALK translocation and PD-L1 expression in the global population. It would be interesting to understand the biological behavior of this group of tumors and, in the future, to study the role of eventual therapeutic associations.
