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Nan Bi
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OA02 - Updates in Locally Advanced NSCLC (ID 125)
- Event: WCLC 2020
- Type: Oral
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 09:15 - 10:15, Scientific Program Auditorium
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OA02.06 - PSM Analysis Results from REFRACT: A Multi-Center Cohort Study Investigating the Treatment Patterns in EGFR-Mutant Unresectable LA- NSCLC (ID 3533)
09:15 - 10:15 | Presenting Author(s): Nan Bi
- Abstract
- Presentation
Introduction
Recognizing the paucity of data for patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) harboring EGFR mutations, we conducted a pooled, retrospective analysis using collaboration data from 12 major academic cancer institutions in China (REFRACT study) to address this evidence gap. We found that combined RT and EGFR--tyrosine kinase inhibitors (TKIs) with or without chemotherapy (TKI+RT) was independently associated with improved PFS and OS relative to EGFR-TKI treatment alone until tumor progression; TKI+RT was independently associated with improved PFS relative to chemoradiotherapy (CRT), but not OS. Results of propensity score matching analysis are now available.
Methods
2137 patients with LA-lung adenocarcinoma who were genotyped for EGFR mutations between 2012 and 2018 were enrolled in the REFRACT study (NCT04304638), among whom 516 patients with EGFR mutations (24.1%). 440 patients (85.3%) with enough covariable and follow-up data were included in the efficacy analysis. Patients were categorized according to the primary treatment [RT+TKI: combined radiation therapy (RT) and EGFR-TKIs with/without chemotherapy (CT); CRT; or TKI: upfront EGFR-TKIs alone until tumor progression]. PFS and OS were calculated from the date of diagnosis. Formal test and Scaled Schoenfeld residuals were used to assess the proportional hazards assumptions when necessary. To further minimize the effects of potential confounding factors in the comparison of different clinical outcomes among the three treatment groups while maximize the effective sample sizes, inverse-probability of treatment weighting (IPTW) based on a multinomial propensity score model was used. The multinomial propensity score model included the following potential confounders: age, sex, smoking status, AJCC stages, PET-CT staging, and mutation type.
Results
There were 104 patients (23.6%) in the CRT group, 105 (23.9%) in the RT+TKI group, and 231 (52.5%) in the TKI group. Patient and treatment variables were well balanced after IPTW adjustment. Consistent with the results in the overall study population, RT+TKI was associated with improved progression PFS relative to CRT (HR=0.42, 95% CI: 0.29-0.61, P<0.001), or TKI (HR=0.65, 95% CI: 0.47-0.90, P=0.008). RT+TKI was associated with significantly improved OS relative to CRT (HR=0.60, 95% CI: 0.37-0.99, P=0.045)，and marginally better OS relative to TKI (HR=0.67, 95% CI: 0.41-1.11, P=0.12).
Conclusion
In patients with EGFR-mutant unresectable LA-NSCLC, first-line use of RT+TKI with or without chemotherapy was associated with the longest PFS and OS, which requires further prospective, randomized evaluation.
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P18 - Locoregional and Oligometastatic Disease - Misc. Topics (ID 128)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P18.01 - Prognostic Value of the LIPI in Patients with LA-NSCLC Receiving Definitive RT: A Retrospective Study of 1079 Patients (ID 1898)
00:00 - 00:00 | Author(s): Nan Bi
- Abstract
Introduction
Previous study demonstrated that the baseline lung immune prognostic index (LIPI) was a potential biomarker which can identify advanced non-small cell lung cancer (NSCLC) patients who will benefit from treatment with immune checkpoint inhibitor (ICI). However, a recent study found that the LIPI might be an important prognostic biomarker irrespective of treatment modality for patients with metastatic NSCLC. It remains unclear whether LIPI is associated with long-term outcomes in unresected stage III NSCLC.
Methods
Patients with LA-NSCLC treated with definitive radiotherapy (RT) between 2000 to 2017 were retrospectively reviewed. The pretreatment derived neutrophils/ (leukocytes minus neutrophils) ratio (dNLR) and lactate dehydrogenase (LDH) made up the LIPI and divided it into two groups (good, 0 score; poor, 1 to 2 scores). Overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were calculated from the date of diagnosis. Kaplan-Meier method and Cox hazards regression analysis were used to explore associations between the LIPI and LA-NSCLC prognosis. Propensity score matching (PSM) was conducted to balance the confounding variables.
Results
A total of 1079 patients were eligible for analysis. Patients with a poor pretreatment LIPI had significantly inferior OS, PFS, LRRFS, and DMFS than those with a good LIPI (median OS, 19.0 vs 25.0 months, Log-rank P < 0.001; median PFS, 10.0 vs 13.0 months, Log-rank P = 0.001; median LRRFS, 13.0 vs 18.0 months, Log-rank P < 0.001; median DMFS, 15.0 vs 17.0 months, Log-rank P = 0.002). According to multivariate analysis, it was also found that the LIPI was an independent prognostic marker for OS (P = 0.026, HR = 1.19, 95% CI: 1.02-1.40), PFS (P = 0.024, HR = 1.18, 95% CI: 1.02-1.36), and LRRFS (P = 0.009, HR = 1.22, 95% CI: 1.05-1.41) in patients with inoperable LA-NSCLC. PSM analysis further verified that poor LIPI was an independent prognostic factor for shorter survivals (OS, PFS, and LRRFS). In subgroup analyses, the poor LIPI was remained significantly associated with increased risks of death in male patients (HR = 1.44, 95% CI: 1.22-1.69), who had smoking history (HR = 1.40, 95% CI: 1.18-1.65), with KPS ≥ 80 (HR = 1.32, 95% CI: 1.12-1.57). Similar results were also observed in PFS except for the subgroup of histological type and era of diagnosis.
Conclusion
To our knowledge, this study first revealed that the LIPI is a simple and promising prognostic marker for patients with unresectable LA-NSCLC. Further prospected studies are warranted to validate these findings.
