Virtual Library
Start Your Search
Teng Li
Author of
-
+
P16 - Immuno-biology and Novel Immunotherapeutics (Phase I and Translational) - Novel Immunotherapeutics (Translational) (ID 155)
- Event: WCLC 2020
- Type: Posters
- Track: Immuno-biology and Novel Immunotherapeutics (Phase I and Translational)
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P16.06 - Exploration of Efficacy and irAEs of Pembrolizumab Plus Chemotherapy for Advanced NSCLC as 1st Line Treatment in Real World (ID 3089)
00:00 - 00:00 | Presenting Author(s): Teng Li
- Abstract
Introduction
Immune checkpoints inhibitors (ICIs) have dramatically improved the prognosis of non-small-cell lung cancer (NSCLC). While nearly 10% of patients (pts) experience severe immune-related adverse events (irAEs), which could reduce the quality of life and even be life-threatening. Until now, the relationship between irAEs and the efficacy of ICIs remains unclear. Early recognition of pts who might suffer severe irAEs remains a major challenge.
Methods
We retrospectively collected data from NSCLC pts with pembrolizumab plus chemotherapy treated as 1L therapy in our group of a single-center from Jan 2019 to Dec 2019. The overall response rate (ORR) was evaluated according to RECIST 1.1. IrAEs grade(G)were assessed using NCI-CTCAEv4.03. Dynamic monitoring of ctDNA fraction was performed with peripheral blood from patients with G3-4 irAEs.
Results
The 16 NSCLC pts received pembrolizumab plus chemotherapy, of which 9 were adenocarcinoma. The ORR was 56.3% (9/16). 10 (62.5%) pts had G1-4 irAEs, including 1 (6.3%, rash:1) of G1, 5 (31.3%, rash:2, pneumonitis:1, hypothyroidism:1, diarrhea:1) of G2, 2 (12.5%, rash:2) of G3 and 2 of G4 (12.5%, thrombocytopenia: 1, toxic epidermal necrolysis (TEN): 1). For G3 irAEs (pt 1 and pt 2, rash), only potency topical steroids to affected areas were used and they recovered soon. For G4 irAEs (pt 3 and pt 4), we found that they had high tumor burden (both T4 stage) at baseline and the target lesion diameter decreased extremely up to 70% (pt 3) and 47% (pt 4) after two cycles of treatment. Consistent to clinical results, in these two patients, the ctDNA fractions were in extremally high level (57.5% and 21.1%) at baseline and dropped to practically zero (0.4% and 0) at the 1st evaluation. They developed irAEs after 3rd cycles of treatment. Latterly, they stopped ICIs and were hospitalized due to severe thrombocytopenia (Pt 3, PLT 15G/L) and TEN (Pt 4). Interestingly, these two pts were still evaluated as partial response after interruption of any anticancer treatment for 3 months.
ConclusionPatient ID Adverse Event Grade of irAE irAE led to discontinuation Diameter of main target lesion at baseline (cm) Diameter of main target lesion after 2 cycles (cm) ctDNA fraction at baseline(%) ctDNA fraction after 2 cycles (%) Response after 2 cycles Pt 1 rash 3 no 4.7 3 1.9 0.6 PR Pt 2 rash 3 no 5.9 5 0.1 0.3 SD Pt 3 thrombocytopenia 4 yes 7.8 3.2 57.5 0.4 PR Pt 4 toxic epidermal necrolysis 4 yes 9.9 5.2 21.1 0 PR
For pts with obvious early response to immunotherapy, a higher incidence of severe irAEs should be aware. High-grade irAEs should be a concern in pts with extremely high ctDNA fraction at baseline and dramatic ctDNA decrease after treatment. Meanwhile, we also observed continuous survival benefits in patients who stopped treatment due to severe irAEs. Long-term follow-up and large sample size studies are warranted to further confirm these findings.
