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Naveen Mummudi
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P82 - Immunotherapy (Phase II/III Trials) - Immunotherapy Plus Radiotherapy (ID 259)
- 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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P82.03 - Immunotherapy in Combination with Hypofractionated Radiotherapy for Lung Cancer: A Real-World Experience (ID 2238)
00:00 - 00:00 | Presenting Author(s): Naveen Mummudi
- Abstract
Introduction
A better understanding of immune mechanisms at the molecular and cellular levels has thrown light on the complex interactions between tumor, radiation and the immune system. Clinical studies have confirmed the synergy between immune checkpoint inhibitors and radiation and the resulting ‘immune-priming’ in NSCLC. We report our real-world experience with this novel combination in locally advanced lung cancer.
Methods
Between January 2016 and December 2018, consecutive patients with metastatic or progressive locally advanced NSCLC, who received immunotherapy (ICI) and also had received palliative radiation therapy were studied. Response to treatment was classified as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). Adverse events were measured using the common terminology criteria for adverse events (CTCAE) v4. Progression-free survival and overall survival were measured from the start of immunotherapy till last follow up.
Results
Sixty-eight patients (male – 74% and female – 26%) were available for analysis. Mean age of the population was 55% (range 34-84 years). Adenocarcinoma was the predominant histology (90%); 16 (24%) patients harbored EGFR mutations. Patients had metastatic disease (90%) at the time of starting immunotherapy - lung (75%), bone (38%), adrenal (19%) and brain (13%) were common sites involved with 55% patients having multiple metastatic sites. Thirty-seven patients (54%) had previously received radiation during the course of their disease (primary – 9, brain – 10, bone - 18); mean dose delivered was 26Gy (range 6 to 60Gy). ICI was administered as first-line in 2 patients, second-line in 39 patients and as third-line in the rest. Nivolumab was the commonest agent (96%) used; 3 patients received pembrolizumab; average cycles administered were 11 (range 1-59). Palliative RT was delivered concurrently with ICI in 28 patients (41%), of whom primary was radiated in 15 patients (22%), brain irradiation in 21% and RT to bone in 10%. Mean dose delivered was 19Gy (range 6 to 30Gy), commonest schedule used was 20Gy in 5 fractions (56%), 30Gy in 10 fractions (20%) and 6/8Gy single fraction (24%). Post RT, 43 patients (63%) developed progressive disease; 37 patients (54%) developed new lesions and 39 patients (57%) progressed at previously diseased sites, but none within the radiated field; new brain metastases were observed in 19% patients. At a median follow-up of 9.7 months, 6-month and 1-year OS were 83% and 76% respectively. The median PFS was 4.4 months (95% CI 2.8 – 6 months); 6-month and 1-year PFS were 40% and 21% respectively. Site, timing of RT and previous irradiation did not influence survival. No RT related toxicity was encountered.
Conclusion
We observed modest disease response with the combination of ICI and palliative hypo-fractionated RT in lung cancer. The schedule was generally well tolerated with no additional toxicity observed. A higher total dose and targeting multiple sites for radiation could improve the results and is a subject for future studies.
