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Ioannis Tourkantonis
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P33 - Pathology - Immunotherapy Biomarker (ID 101)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P33.13 - Prognostic and Predictive Value of Complete Blood Count Parameters in Patients with NSCLC Treated with PD-1 Inhibitors (ID 3584)
00:00 - 00:00 | Presenting Author(s): Ioannis Tourkantonis
- Abstract
Introduction
The advent of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis has revolutionized the treatment landscape of non-small cell lung cancer (NSCLC), improving outcomes both in the first- and subsequent-line treatment setting. Nevertheless, only a relatively small fraction (15-25%) of patients with advanced NSCLC demonstrates durable and clinically meaningful responses to these agents. As of yet, there remains an urgent need of more accurate and cost-efficient biomarkers of treatment response and prognosis in this challenging population. We herein aimed to investigate the potential value of baseline (pretreatment) values of complete blood count (CBC) levels and indices, including absolute lymphocyte, neutrophil, monocyte, eosinophil and platelet counts (ALC, ANC, AMC, AEC and PLT, respectively), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and myeloid to lymphoid ratio (M:L), as predictors of treatment response and prognosis in patients with advanced NSCLC treated with ICIs.
Methods
The medical records of patients with advanced-stage NSCLC eligible to receive PD-1 inhibitors (nivolumab or pembrolizumab), diagnosed and treated at the Oncology Unit of Sotiria Athens General Hospital from November 2019 until March 2020, were retrospectively reviewed. Baseline demographics, clinicopathological features, molecular profiling results, pretreatment ALC, ANC, AMC, AEC, PLT, NLR, PLR and M:L levels and treatment data were correlated to the following endpoints: treatment response (evaluated at 8-12 weeks after treatment initiation), durable clinical benefit (DCB), defined as absence of disease progression at 6 months, and progression-free survival (PFS).
Results
117 patients were included; mean age (SD) was 66 (9.9) years and the majority of patients were male (78.6%), with positive smoking history (95.7%), performance status (PS) 0-1 (83.8%), adenocarcinoma (54.7%) and stage IV disease (86.1%). 59.8% of patients received nivolumab. Increased PLR (as a continuous variable) and elevated PLT (>400 × 109/L) were both associated with lack of DCB (p=0.033 and p=0.01, respectively). Increased PLR and PLT were also correlated with reduced PFS [HR (95% CI): 1.24 (1.01-1.52); p=0.037 and HR (95% CI): 2.29 (1.19-4.4); p=0.013, respectively]. The significance of increased baseline levels of PLR as an indicator of a worse prognosis was further confirmed in multivariate analysis [HR (95% CI): 0.79 (0.63-0.99); p=0.040].
Conclusion
Higher pre-treatment levels of PLR may independently predict a worse prognosis in advanced NSCLC patients treated with PD-1 inhibitors. Furthermore, lower PLT and PLR values may be useful as predictors of DCB in this setting. Further prospective studies are warranted to confirm these findings.
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P36 - Pathology - Prognosis (ID 106)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P36.11 - Clinicopathological Features of Long-Term Survivors in Lung Cancer (ID 3730)
00:00 - 00:00 | Presenting Author(s): Ioannis Tourkantonis
- Abstract
Introduction
Lung cancer (LC) is the leading cause of cancer-related death worldwide. Despite recent progress in the diagnosis and treatment of this lethal disease, the majority of patients are diagnosed at an advanced and inoperable disease stage, which portends a poor prognosis. Although two-year survival rates of advanced-stage LC remain disappointingly low, a small group of patients manage to survive for a longer period. The goal of this study was to reveal potential clinicopathological predictors of long-term survival in this setting.
Methods
The medical records of 45 patients with advanced LC, diagnosed and treated at the Oncology Unit of Sotiria Athens General Hospital between January 1st 2015 and December 31st 2018 were retrospectively reviewed. Twenty-five (25) of these patients presented an overall survival (OS) of at least two years since diagnosis and were described as long-term survivors (LTS). Their demographic, clinicopathological and treatment data were compared with those of twenty (20) short-term survivors (STS), who died in less than 2 years.
Results
The majority of patients in both groups were male (27/45, 60%), with stage IV disease (84.4%). Mean age of LTS and STS was 66,4 years (SD: 7,4 years) and 66,2 years (SD: 8,8 years), respectively. Gender, age, smoking history, co-morbidities, disease stage, number and location of metastases and histological type of tumor were all similarly distributed between STS and LTS groups. In contrast, statistically significant differences were observed with regard to performance status (PS) (p=0.002), number of treatment lines received (p<0.001), administration of immunotherapy (p=0,01) and radiotherapy (p=0,002) and response to first-line treatment (p=0,020).
Conclusion
Long-tern survival in our study was associated with good PS at baseline and administration of more aggressive treatment. The independent prognostic value of the above parameters remains to be confirmed in larger prospective studies. Notably, given the rarity of LTS in LC, prospective validation of their clinicopathological features may be a challenging task.
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P38 - Pathology - Pathology/Staging (ID 108)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P38.13 - Cytology-Histology Concordance for Diagnosis, Histological Subtyping and Molecular Profiling of Lung Cancer (ID 3721)
00:00 - 00:00 | Presenting Author(s): Ioannis Tourkantonis
- Abstract
Introduction
Cytological samples are often the only diagnostic material available for confirmation of lung cancer (LC) diagnosis. The aim of the present study was to evaluate cytology-histology concordance for diagnosis, histological subtyping and molecular profiling of LC, and to determine the factors which may affect sample adequacy or diagnostic concordance.
Methods
118 patients with histologically or cytologically confirmed LC were retrospectively studied. Clinicopathological features of patients were correlated with the type of biological samples obtained (histological or cytological) and the sampling methods used. Concordance between histological and cytological diagnosis and adequacy of samples were also correlated with the above parameters.
Results
The majority of patients were male (58.5%), with positive smoking history (82.2%), non-small cell histological subtype of tumor (72%) και advanced disease stage (66.9%). Histological and cytological samples were adequate for evaluation in 94/100 (94%) and 85/88 cases (96.6%), respectively and were positive for malignancy in 87/100 (87%) and 57/88 cases (64.8%), respectively. Cytology-histology concordance with regard to the diagnosis of malignancy was 52.9%. In the positive for malignancy subgroup, high cytology-histology concordance (96.9%) was observed with regard to histological subtyping of tumor. Molecular testing was performed in 30/118 cases (25.4%), most commonly using histological samples (23/30, 76.7%); 28/30 of these samples (93.3%) were adequate for evaluation. Cytology-histology concordance for a positive for malignancy diagnosis was correlated with small cell histological subtype (p=0.047) in univariate but not in multivariate analysis.
Conclusion
Cytology-histology concordance for histological subtyping of tumor among cases positive for malignancy was high, despite the relatively low overall concordance. No independent correlation was observed between any of the clinicopathological parameters evaluated and the presence of inadequate samples or diagnostic discordance.
