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Andrea Modrego
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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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P18.05 - Immunotherapy Beyond First-Line in NSCLC, Still An Option. (ID 3220)
00:00 - 00:00 | Presenting Author(s): Andrea Modrego
- Abstract
Introduction
Atezolizumab and nivolumab are approved in patients with advanced previously treated non-small cell lung cancers (NSCLC) irrespective of programmed death-ligand 1 (PD-L1) expression, while pembrolizumab is only approved if PD-L1 ≥1%. At present, immunotherapy alone or in combination with chemotherapy is the treatment of choice for first-line NSCLC, however treatment with anti-PD-1/PD-L1 agents should be reconsidered after progression to chemotherapy in patients which did not receive immunotherapy at first time.
Methods
In this retrospective analysis, we analysed the impact of immunotherapy in second and subsequent lines in terms of median progression-free survival (mPFS) and median overall survival (mOS) in patients with advanced NSCLC treated in University Hospital 12 Octubre from October, 2015 to March, 2020.
Results
We identified 87 patients with NSCLC treated with immunotherapy in second or posterior lines (42 received nivolumab, 32 atezolizumab and 13 pembrolizumab). 79.32% were men, median age was 67.6 years and 67.8% of them received at least 3 doses of treatment. In the total population, mPFS was 4 months and mOS was 10 months. Significant differences were observed when divided by histology subtypes: mPFS 2 months for adenocarcinoma vs 5 months for squamous (HR: 1.85 [95% CI: 1.08-3.15], p=0.01). Nevertheless, in terms of survival no significant differences were observed, mOS was 9 vs 11 months, respectively (HR: 1.36, [95% CI: 0.73 - 2.53], p=0.29). Among patients with stage III at diagnosis, mPFS and mOS were significantly longer than those with stage IV. mPFS was 7 vs 2 months (HR: 0.53 [95% CI: 0.31–0.90], p=0.009), and mOS was 15 vs 9 months (HR: 0.49, [95% CI: 0.28-0.91], p=0.02). The expression of PD-L1 was not predictive of immunotherapy benefit, although 45% patients were unknown. We also observed a benefit for those patients with ECOG 0-1 compared with ≥2 (mOS: 11 vs 5.5 months; HR: 0.49 [95% CI: 0.23-1.05], p= 0.01).
mPFS (months)
mOS (months)
Histology
Adenocarcinoma
2
HR: 1.85 [95% CI: 1.08-3.15],
p=0.01).
9
HR: 1.36, [95% CI: 0.73-2.53],
p=0.29).
Squamous
5
11
Stage
III
7
HR: 0.53 [95% CI: 0.31–0.90], p=0.009
15
HR: 0.49, [95% CI: 0.28-0.91], p=0.02
IV
2
9
ECOG
0-1
3
HR 0.62 (95% CI 0.31 - 1.24)
P = 0.08
11
HR: 0.49 [95% CI: 0.23-1.05], p= 0.01
≥2
2
5.5
Conclusion
Patients with NSCLC not suitable to receive chemoimmunotherapy in first-line setting must be reconsider in second or posterior lines due to the important benefit observed. These results based on our clinical practice seem to be similar to those observed in previous clinical trials.
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P21 - Locoregional and Oligometastatic Disease - Treatment of Locally Advanced NSCLC (ID 131)
- 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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P21.14 - The Promising role of Chemo-Immunotherapy in Non-Small Cell Lung Cancer Neoadjuvant Setting (ID 3551)
00:00 - 00:00 | Author(s): Andrea Modrego
- Abstract
Introduction
Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease which includes patients with different prognosis depending on resectable, potentially resectable or unresectable tumours. Chemo-immunotherapy in neoadjuvant setting is currently under evaluation in clinical trials. We present two case reports of patients who received this therapeutic approach due to tumour unresectability at diagnosis.
Methods
Data were collected from electronic history and clinical records. All procedures performed were in accordance with ethical standards of the institutional research Committee and the treatment strategy was approved as compassionate use in both cases.
Results
A 56-year old male and a 48-year old female (37 and 45 pack-year history, respectively) presented with two-month history of productive cough and moderate progressive dyspnoea. In Case 1, the 18F-FDG PET/CT showed a 12 cm (diameter greater) necrotic mass (SUVmax 18.43) and non-metabolic ipsilateral pleural effusion (Figure 1A), staging cT4N0M0 (IIIA). On the other hand, a 5.8 cm (diameter greater) right hilar mass (SUVmax 20.25), ipsilateral pleural effusion (SUVmax 6.45) and a right subcarinal suspicious adenopathy were shown in Case 2 (Figure 1C). Bronchoscopic biopsy revealed a primary pulmonary squamous cell carcinoma with PD-L1 expression 90% (22C3) in both cases and they were presented in Multidisciplinary Tumour Board. In Case 1, the mass was considered unresectable and the patient was not eligible for radical chemo-radiotherapy, so systemic therapy was finally decided. Otherwise, pleural effusion cytological assessment was performed several times without showing malignant cells in Case 2 (staging cT3N2Mx) and systemic treatment was started too due to the tumour unresectability. Chemo-immunotherapy combination with carboplatin AUC 5mg/ml/min, paclitaxel 175mg/m2 and pembrolizumab 200mg every three weeks according to the results of KEYNOTE-407 was given in both cases. Favourable response was achieved after four cycles (Case 1, Figure 1B; Case 2, Figure 1D), therefore both cases were discussed again in Multidisciplinary Session in order to reevaluate surgical indication. After mediastinoscopy, Case 1 underwent right pneumonectomy in December 2019 (postoperative staging ypT1cN0M0) and Case 2 underwent middle and lower bilobectomy in June 2019, with major pathological response (MPR). At present, both patients are asymptomatic, with no evidence disease and no antineoplastic treatment.
Conclusion
Radiological response achieved with chemo-immunotherapy allowed a surgical approach in patients with non-resectable tumours at diagnosis. MPR is a surrogate of overall survival in resectable NSCLC, so results of ongoing clinical trials exploring this combination strategy are expected with much interest because they could change the therapeutic paradigm of these patients.
