Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
MULTIMODALITY TREATMENT –
TUESDAY, DECEMBER 6, 2016
P2.02-041 THE IMPACT OF SURGICAL RESECTION AFTER
CONCURRENT CHEMOTHERAPY AND HIGH DOSE (61 GY)
RADIATION IN STAGE IIIA/N2 NON-SMALL CELL LUNG CANCER
Akif Turna 1 , Osman Yaksi 2 , Hasan Kara 2 , Ezel Ersen 2 , Zeynep Turna 3 , H Fazilet
DinçbaŞ 4 , Serdar Erturan 5 , Günay Aydin 5 , Kamil Kaynak 1
1 Department of Thoracic Surgery, Istanbul University, Cerrahpasa Medical
Faculty, Istanbul/Turkey, 2 Department of Thoracic Surgery, Istanbul University
Cerrahpasa Medical School, Istanbul/Turkey, 3 Department of Medical
Oncology, Istanbul University, Cerrahpasa Medical School, Istanbul/Turkey,
4 Istanbul University,department Ofradiation Oncology, Fatih, Istanbul
University,department Ofradiation Oncology, Fatih, Istanbul/Turkey, 5 Department
of Pulmonary Medicine, Istanbul University Cerrahpasa Medical School, Istanbul/
Turkey
Background: Locally advanced stage IIIA non-small-cell lung cancer with
N2 disease is the most advanced stage at which cure can be achieved, but
more than 60% of patients eventually die from their disease. For patients
with stage IIIA/N2 disease, two standard treatment options are offered:
definitive concurrent chemoradiotherapy or surgery combined with chemo/
radiotherapy. We aimed to investigate the role of surgery after concurrent
chemoterapy and high dose radiation in patients with N2 disease. Methods:
Between January 2011 and December 2015 eligible patients had pathologically
proven, stage IIIA/N2 non-small-cell lung cancer and were prospectively
recorded. Those in the chemoradiotherapy group received three cycles of
neoadjuvant chemotherapy (AUCx2 carpoplatin and docetaxel 85 mg/m 2
docetaxel) and concurrent radiotherapy with 61.2 Gy in 34 fractions over 3
weeks followed by surgical resection, and those in the control group received
definitive chemoradiotherapy alone. All patients in two groups were proven
to have no N2 disease after chemoradiotherapy. Results: A total of 58 patients
were enrolled, of whom 21 received chemoradiotherapy followed by surgical
resection and 37 had chemoradiotherapy only. Median overall survival was
35 months (95% CI 10.5–44.0) in the chemoradiotherapy + surgery group and
20.3 months (4.5–38.6) in the chemotherapy group (p=0.03). Median overall
survival was 37·1 months (95% CI 22·6–50·0) with radiotherapy, compared
with 26·2 months (19·9–52·1) in the control group. One patients died in the
surgery group within 30 days after surgery. Conclusion: Pulmonary resection
after high-dose neoadjuvant chemoradiotherapy is safe and surgical resection
after chemoradiotherapy may provide better survival in histologically proven
N2 stage IIIA non-small cell lung cancer.
Keywords: N2 disease, Stage IIIA, concurrent chemoradiotherapy, Surgical
resection
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
MULTIMODALITY TREATMENT –
TUESDAY, DECEMBER 6, 2016
P2.02-042 SURGICAL MANAGEMENT OF SQUAMOUS CELL
CARCINOMA OF THE LUNG: SURVIVAL AND FUNCTIONAL
OUTCOMES
Jun Chen
Department of Lung Cancer Surgery, Tianjin Medical University General Hospital,
Tianjin/China
Background: Squamous cell carcinoma (SCC) of the lung is a unique clinical
and histologic category of non-small cell lung cancer (NSCLC) and accounts
for about 30% of all lung cancer. Surgical intervention is the principal
treatment for SCC. The purpose of this study was to evaluate the survival
rates for surgical treatment of squamous NSCLC and the prognostic patient
factors. Methods: We retrospectively evaluated the files of 170 patients
with squamous NSCLC who were treated at the department of lung cancer
surgery, Tianjin Medical University General Hospital, between January 2008
and December 2011. Univariate (Cox regression analysis) and multivariate
(likelihood ratio) analyses were carried out for overall survival (OS) and the
median survival duration. A P-value of < 0.05 was defined as significant.
Results: The median OS was 29 months, the 1-year OS was 78.2%, and the
5-year OS was 15.3%. On univariate analysis, the Eastern Cooperative
Oncology Group Performance Status (ECOG-PS) score; tumor (T) stage; node
(N) stage; type of surgery; type of lymphadenectomy; and the presence
of residual carcinoma at the incised margin, intravascular cancer, and
pleural effusion were significantly related to patient survival (P < 0.05). On
multivariate analysis, the smoking index (P = 0.002), ECOG-PS (P = 0.000),
T stage (P = 0.005), and N stage (P = 0.000) were independent prognostic
factors. Conclusion: The OS of patients with squamous lung carcinoma was
low. The survival rates gradually decreased as patients’ ECOG-PS declined.
The patients without lymph-node involvement (N0) had longer survival than
those with N1 and N2 lymph-node involvement. Both OS and disease-free
survival are worse in SCC of the lung than for NSCLC in general. At present, we
still depend on surgical intervention for squamous NSCLC; there is an unmet
need for novel effective therapies.
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
MULTIMODALITY TREATMENT –
TUESDAY, DECEMBER 6, 2016
P2.02-043 RANDOMIZED PH II TRIAL OF ALLOGENEIC DPV-001
CANCER VACCINE ALONE OR WITH ADJUVANT FOR CURATIVELY-
TREATED STAGE III NSCLC
Rachel Sanborn 1 , Brian Boulmay 2 , Rui Li 1 , Kyle Happel 2 , Sachin Puri 1 ,
Christopher Paustian 1 , Christopher Dubay 1 , Sandra Aung 3 , Brenda Fisher 1 ,
Carlo Bifulco 1 , Keith Bahjat 1 , Yoshinobu Koguchi 1 , Augusto Ochoa 2 , Hong-Ming
Hu 1 , Traci Hilton 3 , Bernard Fox 1 , Walter Urba 1
1 Providence Cancer Center, Robert W. Franz Cancer Center, Earle A. Chiles Research
Institute, Portland/OR/United States of America, 2 Stanley S. Scott Cancer Center,
New Orleans/LA/United States of America, 3 Ubivac, Portland/OR/United States of
America
Background: Tumor-derived autophagosomes (DRibbles®) are a novel cancer
immunotherapy providing cross-protection against related tumors and
efficacy against established tumors preclinically. We hypothesize efficacy
is via presentation of short-lived proteins (SLiPs) and defective ribosomal
products (DRiPs) normally not cross-presented by antigen-presenting cells
(APCs). DRibble DPV-001 vaccine packages putative cancer antigens, including
13 from the NCI priority list and TLR 2, 3, 4, 7 and 9 agonist activity into
microvesicles, with molecules targeting DRibbles to CLEC9A+ APCs. NSCLC
overexpresses an average of 176 proteins found in DPV-001. Many of these
antigens have single amino acid variants that may serve as immunogenic
mimetopes, or altered peptide ligands. Methods: Pts completed curativeintent
therapy for stage III NSCLC. Treatment: Induction cyclophosphamide;
DPV-001 vaccine every 3 weeks x7; then every 6-weeks x4. Randomization was
to DPV-001 alone (Arm A), or with an adjuvant; imiquimod (Arm B), or GM-CSF
(Arm C). Peripheral blood mononuclear cells and serum were collected at
baseline and at each vaccination. Serum was analyzed for >15 fold increased
antibody responses to >9000 human proteins (ProtoArray) from baseline to
week 12. 11 pts were to be randomized to each arm, with 15 more enrolled on
the arm with the greatest number of >15 fold antibody responses. Results:
13 pts were enrolled into the randomized phase I portion, when enrollment
was stopped due to end of grant term. Arm A: 5 pts; B: 4; C: 4. Median Age:
60 (range 45-76); Male/Female: 6/7. Median vaccines administered: 6 (range
3-11); 2 pts still receiving treatment. Reasons for discontinuation: Disease
progression (6); 2 toxicity (1 grade 3 dyspnea possibly related, 1 recurrent
grade 1 migratory rash with pruritis, related); 1 noncompliance; 1 for elective
surgery (unrelated). Other toxicities were grade 1/2; 1 additional grade 3
fatigue (possibly related). Analysis was limited due to small sample size.
Median >15 fold antibody responses for Arm A: 8; B: 43.5; C: 50.5 (ranges 0-9;
41-46; 9-162, respectively). There was a significant difference in antibody
response between Arms A and B (P=0.0001). Conclusion: Allogeneic DPV-001
vaccine administration was tolerable, and >15 fold antibody responses were
documented in all but 1 pt. Greatest antibody responses were seen with
vaccine/GM-CSF. For pts who may not respond to anti-PD1 due to lack of
endogenous anti-tumor response, vaccination with DPV-001 could potentiate
checkpoint inhibitors by inducing anti-tumor response. A combination DPV-
001 vaccine with anti-PD1 study in advanced NSCLC is pending. NCT01909752,
NCI sponsored trial R44 CA121612
Keywords: non-small cell lung cancer, Vaccine, stage III
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
Prognostic Factor –
TUESDAY, DECEMBER 6, 2016
P2.02-044 IMPACT OF N2 EXTENT AND NODAL RESPONSE ON
SURVIVAL AFTER TRIMODAL TREATMENT FOR STAGE IIIA-N2 NON-
SMALL CELL LUNG CANCER
Hong Kwan Kim 1 , Jong Ho Cho 1 , Yong Soo Choi 1 , Jae Ill Zo 1 , Young Mog Shim 1 ,
Keunchil Park 2 , Myung-Ju Ahn 3 , Jin Seok Ahn 2 , Yong Chan Ahn 4 , Hong Ryull
Pyo 4 , Joungho Han 5 , Hojoong Kim 6 , Jhingook Kim 1
1 Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul/Korea, Republic of, 2 Division of Hematology/
Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul/Korea, Republic of, 3 Division of Hematology-Oncology, Department
of Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul/Korea, Republic of, 4 Radiation Oncology, Samsung Medical
S456 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017