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M. Mussap



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    P2.01 - Poster Session with Presenters Present (ID 461)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P2.01-067 - The Relevance of CEA and CYFRA21-1 as Predictive Factors in Nivolumab Treated Advanced Non-Small Cell Lung Cancer (NSCLC) Patients (ID 6121)

      14:30 - 14:30  |  Author(s): M. Mussap

      • Abstract

      Background:
      CEA, CYFRA21-1 and NSE are tumor markers acknowledged as useful predictors of response to chemotherapy for advanced adenocarcinoma, squamous and small-cell lung cancer, respectively. However, their role in cancer immunotherapy needs to be investigated.

      Methods:
      We analyzed 56 patients with advanced NSCLC treated with nivolumab (3 mg/kg) every 14 days within a single-institutional translational research study. Blood samples were collected at baseline and at each cycle up to 5 cycles, and then every two cycles. All patients underwent a CT-scan every 4 cycles and responses were classified according to RECIST and Immune-Related Response Criteria (irRC). The serum level of CEA was measured with a Chemiluminescent Microparticle Immunoassay while CYFRA21-1 and NSE with an Immuno Radiometric Assay. The markers levels at baseline and after 4 cycles were used to analyze the relationship between their median variation and the objective response rate (ORR). The performance of tumor markers in predicting ORR was analyzed by ROC analysis and a reduction of 20% was used as cut-off level.

      Results:
      Forty-eight patients were evaluated: median age: 71 years (44-85); male/female: 73%/27%; current or former smokers: 87.5%; non-squamous/squamous histology: 79%/21%. Baseline median levels were 4.8 ng/ml for CEA, 3.47 ng/ml for CYFRA21-1 and 7.51 ng/ml for NSE. At baseline, values over the upper normal limit of CEA, CYFRA21-1 and NSE were detected in 23 (48%), 26 (54%), and 7 (14%) patients respectively. Significant differences were observed between responders and non-responders and CEA variation (-9% vs.+41%, p=0.003 for RECIST; -10% vs.+31%, p=0.015 for irRC), CYFRA21-1variation (-39% vs.+92%, p<0.001 for RECIST; -35% vs.+72%, p=0.003 for irRC) and NSE variation (-30% vs.+23%, p=0.005 for RECIST; -23% vs.+36%, p=0.004 for irRC). Significant correlations were observed between CEA and CYFRA21-1 decrease with RECIST or irRC: with RECIST, a decrease of 20% of CEA was achieved in 43% of responders and in 8% of non-responders (p=0.013), while a decrease of 20% of CYFRA21-1 occurred in 67% of responders and in 8% of non-responders (p<0.007). With irRC, a decrease of 20% of CEA was achieved in 42% of responders and in 9% of non-responders (p=0.018), while a decrease of 20% of CYFRA21-1 occurred in 58% of responders and in 14% of non-responders (p=0.002). Multivariate analysis confirmed the positive association between CYFRA 21-1 (≤20%) and ORR (RECIST: p=0.004; irRC: p=0.016).

      Conclusion:
      The reduction in serum level of CEA and CYFRA21-1 might be a reliable biomarker to predict immunotherapy efficacy in NSCLC patients.

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    P3.02c - Poster Session with Presenters Present (ID 472)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.02c-077 - Cardiac Troponin-I Elevation in Patients with Non-Small Cell Lung Cancer during PD1/PDL1 Inhibition with Nivolumab (ID 6258)

      14:30 - 14:30  |  Author(s): M. Mussap

      • Abstract

      Background:
      Immune check-point inhibitors are effective for the treatment of advanced non-small cell lung cancer (NSCLC); however, their mechanism of action is associated with peculiar immune-related adverse events (irAEs). While cardiac irAEs are seldom reported, animal data suggest that the myocardium might be sensitive to PD1/PD-L1 impairment. Minimal alterations of Cardiac Troponin-I (CTnI) can identify subclinical cardio-toxicity induced by antineoplastic agents like anthracyclines. The aim of this study is to determine whether CTnI might be used as a biomarker of cardiologic irAEs during treatment with nivolumab in advanced NSCLC.

      Methods:
      Serum samples were collected and stored from 61 patients receiving nivolumab (3 mg/Kg every 14 days) for advanced NSCLC within a single-institutional translational research study conducted in the San Martino Hospital – National Institute for Cancer Research, Genova, Italy (approved by the local ethical committee); samples were collected at baseline and at each cycle up to 5 cycles, and then every 2 cycles. Cardiac Troponin-I was retrospectively quantified with the luminescent oxygen channeling immunoassay (LOCI™) optimized on the Dimension Vista[®] analytical platform (Siemens Healthcare, Milan, Italy); and defined as undetectable (<0.015 μg/L) or detectable (>0.015 μg/L); a value of 0.045 μg/L was considered significant. Cardiologic anamnesis of the patients with detectable CTnI was collected from clinical documentation; additionally, patients alive at the time of the analysis underwent cardiologic evaluation.

      Results:
      Fifty-nine patients were evaluable: median age= 69 years (44-81); male/female: 69%/31%; current or former smokers= 86.4%; non-squamous/squamous histology= 80%/20%; median number of cycles= 6 (1-29). Twenty-six out of 351 collected samples had detectable CTnI levels. Thirteen patients (22%) had detectable CTnI levels in at least one sample; among these, 6 (10%) patients had significant alterations in at least one sample, and in 3 cases (5%) this alteration was reported in multiple samples. No specific time-related pattern was identifiable for CTnI alterations. Five patients with detectable CTnI, of which 2 with significant alterations (0.292 μg/L and 0.285 μg/L), had neither evident cardiovascular disease, nor cancer-related para-cardiac infiltration. Two patients had pericardial effusion, while two other had concurrent irAEs (hyperthyroidism and hepatitis).

      Conclusion:
      Troponin-I was altered in a considerable number of patients receiving nivolumab, in some cases with no evident concurrent cardiovascular disease or manifest indirect noxae. Although a rationale for immunotherapy-related myocardial inflammation is acknowledged, further investigations on the cardiovascular effects of PD1/PDL1 inhibitors are required to draw meaningful conclusions, such as studies involving prospective cardiovascular assessments of patients receiving these agents.