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Si-Cong Ma
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P75 - Immunotherapy (Phase II/III Trials) - Misc. Topics (ID 248)
- Event: WCLC 2020
- Type: Posters
- Track: Immunotherapy (Phase II/III Trials)
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P75.05 - Integrative Modeling of Tumor Burden and Metastatic Pattern for Second-Line anti-PD-L1 Therapy of Non–Small Cell Lung Cancer (ID 3217)
00:00 - 00:00 | Presenting Author(s): Si-Cong Ma
- Abstract
Introduction
Clinical benefits of immune-checkpoint blockade (ICB) versus standard chemotherapy have been established in unselected non-small cell lung cancer (NSCLC) in the second-line setting. However, the response to ICB therapy among patients is still heterogeneous in clinical practice.
Methods
We retrospectively assessed the impact of baseline sum of the longest diameters (SLD), number of metastatic sites and specific organ metastases on the efficacy of atezolizumab versus docetaxel in the pooled population from OAK and POPLAR studies. Then, an assistant decision model based on machine learning, incorporating these indicators, termed DSO (Diameter-Site-Organ), was developed and validated in OAK and POPLAR cohorts.
Results
Higher SLD, with the threshold of 38mm, and more metastatic sites (≥ 2) were characterized with pronounced OS benefits derived from atezolizumab versus docetaxel (Figure 1A-C). Specifically, with a systematical analysis of metastatic organs for response, brain and adrenal gland metastases were identified as favorable predictors of atezolizumab treatment (Figure 1D). The DSO decision model for guiding second-line treatment was developed based on SLD and metastatic sites and organs in the discovery cohort (Figure 2A). Remarkably, a general pattern of enhanced efficacy of atezolizumab versus docetaxel was observed along with the increase of the DSO score (Figure 2B). For patients with DSO score > 0, atezolizumab yielded a significantly prolonged OS than docetaxel, whereas OS was generally similar between two treatments in patients with DSO score ≤ 0 (Figure 2C). Equivalent findings were also seen in the internal and external validation cohorts (Figure 2).
Conclusion
Our study for the first time revealed that patients with higher tumor burden were more suitable for ICB compared with standard chemotherapy. More importantly, the integrative DSO decision model might provide promising medication guidance for second-line ICB treatment in unselected NSCLC patients, and offer a research framework for frist-line regimens.
