Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
most predominant lesion 80.9% (n=55), followed by consolidations 44.1%
(n=30), reticulations 36.7% (n=25) and bronchiectasis in 20.6% (n=14). When
performed, bronchoalveolar lavage (BAL) showed a T-lymphocytic alveolitis
and transbronchial biopsy an inflammatory and lymphocytic infiltration.
Pneumonitis treatment was steroids (86.6%) and/or antibiotics (67.6%).
Immunotherapy was stopped after the pneumonitis for 65 cases (92.9%)
and reintroduced for 12 (9.4%) cases. Twenty-four patients (34.3%) were
dead at the last follow-up and 46 patients (65.7%) were still alive. Among the
living patients, the pneumonitis outcome was a total recovery in 12 patients,
improvement in 22 patients, stability in 10 patients, worsening evolution
in 1 patient (1 unknown). Causality of immunotherapy was evaluated by
investigators as “possible” for 34 patients (49.3%), “probable” for 17 (24.6%),
“certain” for 15 (21.7%) other causes for 3 (4.3%) and 2 unknowns. Median
overall survival from the onset of pneumonitis was 6 months. Conclusion:
This serie, the largest to date, of immune-related pneumonitis demonstrates
that it occurs usually during the first months and displays specific radiologic
features. As there is no clearly identified risk factor, oncologists should be
able to detect, diagnose (with CT-scan and bronchoscopy) and treat this
adverse event. An early management is usually associated with a favourable
outcome and requires a close collaboration between pulmonologists,
radiologists and oncologists.
Keywords: Melanoma, interstitial pneumonitis, Immunotherapy, lung cancer
POSTER SESSION 3 – P3.02C: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
IT –
WEDNESDAY, DECEMBER 7, 2016
P3.02C-033 PATTERNS OF PROGRESSION AND MANAGEMENT OF
ACQUIRED RESISTANCE TO ANTI-PD-1 ANTIBODIES IN ADVANCED
NON-SMALL CELL LUNG CANCER
Antony Mersiades 1 , Megan Crumbaker 1 , Bo Gao 2 , Adnan Nagrial 1 , Rina Hui 3
1 Medical Oncology, Crown Princess Mary Cancer Care Centre, Westmead Hospital,
Wentworthville/NSW/Australia, 2 Medical Oncology, Blacktown Cancer and
Haematology Centre, Blacktown/NSW/Australia, 3 Medical Oncology, Crown
Princess Mary Cancer Care Centre, Westmead Hospital, Wentworthville/Australia
Background: Anti-PD-1 antibodies (pembrolizumab and nivolumab) have
shown improved overall survival in second-line treatment for metastatic
non-small cell lung cancer (NSCLC) with durable responses. We aimed to
assess the pattern of disease progression amongst patients who initially
responded to anti-PD-1 agents and their subsequent management. Methods:
We retrospectively assessed all patients who commenced single-agent
anti-PD-1 antibodies between June 2012 and February 2016 at a single centre.
Radiological responses were assessed by the investigator using RECIST
1.1 and irRC. Progressive disease (PD) patterns were defined as solitary,
oligometastatic (2-3 lesions), generalised (>3 lesions), enlargement of
existing or new lesions, visceral or non-visceral. Management and survival
after progression were examined. Results: A total of 81 patients received
single-agent pembrolizumab (N=43) or nivolumab (N=38). Of the seventeen
(21.3%) patients achieving partial response, three were treatment-naïve,
fifteen (88.2%) were former or current smokers, none had EGFR mutation
or ALK translocation. The median number of disease sites at baseline was
three, and two patients had stable brain metastases after radiotherapy at the
commencement of anti-PD1 treatment. Ten (58.8%) responders developed
acquired resistance, with a median time to progression of 20.2 months.
Nine (90%) had solitary (N=4) or oligometastatic (N=5) progression. Five
(50%) progressed only at existing sites, three (30%) developed new lesions
only, and two (20%) progressed at both existing and new sites. Four (40%)
progressed at non-visceral sites only, and one progressed in the brain at a
previously treated site. Five (50%) patients underwent local treatment to
solitary (N=2) or oligoprogressive disease (N=3) with all five achieving local
control with radiotherapy. Seven(70%) continued anti-PD-1 agents beyond
progression, while the three (30%) remaining patients did not receive any
further therapy. With a median follow-up of 24.8 months, five (50%) of the
patients had died, one from an infective exacerbation of COPD, one from
type 1 respiratory failure, and three from disease progression. The median
duration of treatment was 4.35 months (1.96 to 11.46) and the median overall
survival after progression was 11.44 months. Conclusion: This study suggested
that acquired resistance to anti-PD1 agents could often result in solitary or
oligometastatic progression, and that CNS progression was uncommon. In
a subset of patients, treatment beyond progression with or without local
therapy to oligometastatic disease may provide ongoing and durable clinical
benefit.
POSTER SESSION 3 – P3.02C: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
IT –
WEDNESDAY, DECEMBER 7, 2016
P3.02C-034 A SINGLE INSTITUTION EXPERIENCE WITH
IMMUNOTHERAPY AS AN EFFECTIVE THERAPY APPROACH OF
ADVANCE NON-SMALL CELL LUNG CANCER (NSCLC)
Julia Martínez Pérez, Inmaculada Sanchez, Alejandro Falcon Gonzalez, Miriam
Alonso, Maria Jose Flor Oncala, Jesus Corral
Virgen Del Rocio Hospital, Seville/Spain
Background: Lung cancer is the leading cause of cancer-related mortality
globally. Recent trials results of checkpoint inhibitors have shown that
immunotherapy represents a new standard option of care in pretreated
patients compared with chemotherapy. Eficacy and toxicity data were
assessed in 69 pretreated patients with metastatic NSCLC in our institution.
Methods: A retrospective, non-interventional study was conducted. 69
patients with advanced NSCLC receiving immunotherapy after one or more
prior treatment were enrolled between 2013 and 2015. Patients received
PD1 and PDL1 checkpoints inhibitors as compassionate use treatment or
as clinical trial therapy. Results: 69 patients were analysed with a median
age of 64y, including 82.6% males, 54.3% squamous histology and 8.7%
never-smoker patients. Mutation profile was defined as negative EGFR/
ALK in 95% and positive PDL1 in 30.4%. 68.3% of patients received anti-PD1
therapy vs anti-PDL1 inhibitors (31.7%) as clinical trial therapy (63.8%) vs
compassionate use (36.2%). 40 patients (58%) received immnotherapy after
two o more previous chemotherapy lines. With a median follow-up of 24.9
months, overall objective response rate was 5.8% with a disease control rate
of 58%, with no responses seen at never smokers. Estimated 1year-PFS was
27.5%, with a median of 4.5months. There were no statistically significant
differences according to histology (41.4% squamous vs 36.1% nonsquamous,
P=0.14) or immunotherapy strategie (47.6% with PDL1 vs 38.6% with PDL1
inhibitors, p=0.55). Positive PDL1 was a prognostic factor for 6-month PFS
in nonsquamous histology (64.3 % PDL1+ vs 18.8% PDL1-,p= 0.02, HR:0.24).
OS was not reached as 37.7% of patients remain on treatment nowadays.
The most common grade 1-2 adverse events were fatigue (55%) and anorexia
(26%). 13 patients (17.3%) experienced grade 3 toxicity being pneumonitis
the most common cause (5.8%). Conclusion: Our data are consistent with
recent immunotherapy results, showing a clinically meaningful survival
benefit vs chemotherapy with similar efficacy and toxicity between PD1 and
PDL1 checkpoints inhibitors. PDL1 expression appears to be a prognostic and
predictive factor, only for nonsquamous histology.
Keywords: Inmunotherapy, PDL1, PD1, NSCLC.
POSTER SESSION 3 – P3.02C: ADVANCED NSCLC & CHEMOTHERAPY/TARGETED THERAPY/
IMMUNOTHERAPY
IT –
WEDNESDAY, DECEMBER 7, 2016
P3.02C-035 COMPARISON OF RECIST TO IMMUNE-RELATED
RESPONSE CRITERIA (IRRC) IN PATIENTS WITH NSCLC TREATED
WITH IMMUNE-CHECK POINT INHIBITOR
Hee Kyung Kim, Hansang Lee, Mi Hwa Heo, Jinhyun Cho, Ju Youn Park, Su-Mi
Jeong, Jong-Mu Sun, Se-Hoon Lee, Jin Seok Ahn, Myung-Ju Ahn, Keunchil Park
Hemato-Oncology, Samsung Medical Center, Seoul/Korea, Republic of
Background: Immune check point inhibitor has become essential therapeutic
option for advanced non-small cell lung cancer (NSCLC). Immune-related
response in NSCLC has not been well evaluated, thus we assessed the
tumor response using Response Evaluation Criteria in Solid Tumors,
version 1.1 (RECIST v1.1) and immune-related response criteria (irRC) to
identify atypical response in patients with advanced NSCLC treated with
immunotherapeutic agents. Methods: Patients received immune check point
inhibitors (pembrolizumab, atezolizumab, nivolumab, pembrolizumab plus
tremelimumab) at Samsung Medical Center between July 2014 and October
2015. The tumor response was assessed according to both RECIST v1.1 and
irRC. Pseudoprogression was defined as progressive disease at any time of
assessment and not at next assessment per RECIST v1.1 or irRC. Results:
Keywords: non-small cell lung cancer, Acquired resistance, anti-PD1
Copyright © 2016 by the International Association for the Study of Lung Cancer
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