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B. Pang
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P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.11-002 - The Impact of Gastric Acid Suppressive Therapy on Treatment Outcomes of EGFR Tyrosine Kinase Inhibitors in Non-Small Cell Lung Cancer (ID 804)
09:30 - 09:30 | Author(s): B. Pang
- Abstract
Background:
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors such as gefitinib and erlotinib are dependent on gastric pH for absorption which may be affected by concomitant gastric acid suppressive therapy (AS) with proton pump inhibitors and histamine 2 antagonists. We sought to determine the effect of gastric acid suppressive therapy on overall survival (OS) in patients treated with EGFR tyrosine kinase inhibitors.
Methods:
Patients with advanced stage non-small cell lung cancer harboring EGFR mutations treated with EGFR tyrosine kinase inhibitors were retrospectively identified. Medical records in our single institution were reviewed from 1[st] January 2008 to 30[th] December 2013. Patient clinico-pathological characteristics,use of gastric acid suppressive therapy and the overall survival were obtained. Statistical analysis was performed using chi[2], log rank test and cox regression where indicated
Results:
We identified 191 patients. The median age of patients was 64 years (range: 30-89) ,109 (57.1%) were female, 117(61.3%) were never smokers, 91 (47.6%) harbored EGFR exon 19 deletion and 144 (75.4%) received EGFR tyrosine kinase inhibitors as first line treatment. 55 (28.8%) patients received gastric acid suppressive therapy The groups of patients who received gastric acid suppressive therapy and those who did not receive gastric acid suppressive therapy were similar with regards to gender, smoking status, and type of EGFR mutations, Charlson co-morbidity score and Kanorfsky performance status. Brain metastasis at the time of diagnosis was more frequent in the group who received gastric acid suppressive therapy compared with the group who did not receive gastric acid suppressive therapy (61.8% v 35.3% respectively, p= 0.001). The median overall survival in the total patient population was 13.1 months (95%CI 11.7-15.2 months). On multivariate analysis, presence of visceral metastasis at diagnosis was associated with a worse overall survival (HR: 1.53, 95% CI:1.10-2.13 p value: 0.012). However a Karnofsky performance score of 90-100 was associated with an improved overall survival (HR: 0.69, 95% CI; 0.49-0.97 p value: 0.031). The median overall survival OS in patients with gastric acid suppressive therapy was 11.9 months (95%CI: 9.90-16.94 months) and 14.5 months (95%CI: 11.74-15.95 months) in the group not receiving gastric acid suppressive therapy. (HR: 0.98, 95% CI: 0.69-1.40 p value: 0.934)
Conclusion:
Although the group of patients who were treated with gastric acid suppressive therapy had a numerically poorer overall survival compared to the group who did not receive gastric acid suppressive therapy, this difference was not statistically significant. Based on the our analysis, the use of gastric acid suppressive therapy concurrent with EGFR tyrosine kinase inhibitors in patients with advanced non-small cell lung cancer harboring EGFR mutations did not affect overall survival.
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P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.04-068 - PD-L1 Expression in Tumor Infiltrating Immune Cells Determined by Digital Imaging Is Associated with Poor Survival in NSCLC Patients (ID 1138)
09:30 - 09:30 | Author(s): B. Pang
- Abstract
Background:
Programmed Death-Ligand 1 (PD-L1) has emerged as a potential prognostic marker and as an effective target for therapeutic inhibition in cancer. Using digital slide imaging, we evaluated the clinical, molecular and survival associations of PD-L1 expression in non-small cell lung cancer (NSCLC) according to cell type (tumor and immune cell) and tissue localization (tumor and stroma).
Methods:
Tumor samples from 199 NSCLC patients were stained for PD-L1 by immunohistochemistry (IHC) and quantitatively assessed using the Vectra slide imaging system for PD-L1 tumor membrane expression (TME), PD-L1 positive (+) tumor immune cell density (TICD) and PD-L1+ stroma immune cell density (SICD). Assessment of gene mutation and anaplastic lymphoma kinase rearrangement were performed using the AmpliSeq Cancer Hotspot V2 assay and IHC, respectively.
Results:
High PD-L1 TME correlated with larger tumor size, squamous cell histology and poor differentiation. PD-L1+ TICD was associated with male gender and wild-type EGFR. Univariate analysis revealed that stage (p=0.001), PD-L1 TME (p=0.007) and PD-L1+ TICD (p=0.006) were associated with worse survival. Iterative p-value analysis indicated the optimal thresholds for PD-L1 TME were 30 (p=0.003, 73% of cases) or 160 (p<0.001, 7%), while for PD-L1+ TICD they were 6.9% (p=0.022, 33%) or 20% (p=0.001, 5%). In multivariate analysis, stage (p=0.018), PD-L1 TME≥160 (p=0.040) and PD-L1+ TICD≥6.9% (p=0.015) were independently associated with survival.
Conclusion:
PD-L1 Tumor Membrane Expression (TME) and PD-L1+ Tumor Immune Cell Density (TICD) expression determined by digital analysis have prognostic value in NSCLC.
