Virtual Library
Start Your Search
P. Pastina
Author of
-
+
P2.03a - Poster Session with Presenters Present (ID 464)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
-
+
P2.03a-053 - Immuno-Inflammatory Markers in Advanced NSCLC Patients Undergone Fractioned Cisplatin, Oral Etoposide and Bevacizumab (ID 6172)
14:30 - 14:30 | Author(s): P. Pastina
- Abstract
Background:
The BEVA2007 study is a multistep phase I-II trial aimed to investigate in advanced NSCLC patients the safety, the immunobiological and the antitumor activity of the mPEBev, an original metronomic chemo-biological regimen whose results showed significant antiangiogenic and immune-modulating and antitumor activity.
Methods:
Eighty-six advanced NSCLC patients (76 males and 10 females; 53, adenocarcinoma; 13 squamous carcinoma; and 20 with different subtypes) were enrolled between September 2007 and September 2015. All of them received cisplatin (30mg/sqm, days 1-3q21), oral etoposide (50mg, days 1-15q21) and bevacizumab 5mg/kg on the day 3q21 (mPEBev regimen).
Results:
There were two cases of fatal bleeding after 3 and 4 treatment courses, and five cases of severe infections fully recovered with medical treatment. Hematological toxicity [grade 1-3 leukopenia (25%), anemia (25%)], g 1-2 gastroenteric toxicity (10%) and alopecia (50%) were the most common adverse events. There was a partial response in 54 cases ( 62,8%) and a stable disease in 9 cases (10,5%) with a mean progression free survival (PFS) and overall survival (OS) of 13.46 (8.39-18.54) and 20.57 (14.5-26.6) months, respectively. Log-rank tests, revealed a longer survival in patients with baseline levels of Neutrofil to lymphocyte ratio (NLR) [L vs. H= 24.9 vs. 8.9 months, P=0.033], IL17 [L vs. H= 32.9 vs 11 months, P=0.033], leptine [L vs. H= 30,5 vs 8,5 months, P=0,025] and T~reg~s [L vs. H= 35.37 vs 9.9 months, P=0.049] lower than median value of each specific parameter. A longer survival was also found in patients with a treatment related fold increase to baseline > 1 in CD4+/CD8+ t cell ratio and DCs expressing CD83 [L vs H 8.4 vs 20.85 months, P=0.05 ] and CD80 [L vs H = 8 vs 23 months, P=0.046].
Conclusion:
These results suggest that both systemic Inflammatory status and treatment-related immunomodulation may affect the outcome of these patients a finding that highlight a possible involvement of immunesystem in ultimate antitumor effect of this regimen, and offer a solid rationale to test our metronomic regimen in a module of sequential combination with anti-PD-1/PDL-1 inhibitors.
-
+
P2.05 - Poster Session with Presenters Present (ID 463)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
-
+
P2.05-057 - Baseline Inflammatory and Immunological Profile Predict the Survival of NSCLC Patients Undergone Palliative Radiotherapy (ID 6135)
14:30 - 14:30 | Author(s): P. Pastina
- Abstract
Background:
Dose-fractioned cisplatin and oral etoposide (mPE) +/- bevacizumab (mPEBev) is a metronomic treatment showed anti-tumor anti-angiogenic and immunological activity in non-small-cell-lung-cancer (mNSCLC) patients enrolled in BEV2007 trial. These effects could altogether contribute to final antitumor activity. Recent findings suggested that radiotherapy may induce immunological effects on this bases we investigated whether palliative radiotherapy could affect the survival of patients enrolled in BEVA trial. We therefore, carried out a retrospective analysis in the subset of 47 who received palliative radiation therapy after four courses of mPE +/- bevacizumab.
Methods:
All of the patients had received chemotherapy with cisplatin (30mg/sqm, days 1-3q21) and oral etoposide (50mg, days 1-15q21) (mPE) while thirty-five also received bevacizumab at the dosage of 5mg/kg on the day 3q21 (mPEBev regimen). Radiation therapy was delivered with a palliative intent to different target sites including bones (19 patients), brain (Whole brain) (18 patients), lung parenchymal lesions and nodes (7 patients), stereo-tactic ablative radiation therapy (3 patients).
Results:
Our statistical analysis found that the use of RT was associated to a much longer survival (RT vs no RT: 23.26 vs 16.05 months, P=0.003) months, with no difference in term of PFS 1.65 vs 13.12 P= 0.135). We found no differences with treatment (+/- bevacizumab), sex, grading, stage (IIIB versus IV). Log-rank tests revealed a much longer OS in those patients presenting serum levels of IL17 (p:0.046), c-reactive-protein (p:0.056) and ESR nome per esteso (p:0.014) lower than median value, after Mpe +/- bevacizumab and prior irradiation. We finally observed a longer survival in patients showing a CD4+/CD8+ T cell ratio higher than median value (p:0.050).
Conclusion:
These results suggest that palliative radiation therapy delivered after our metronomic regimen in mNSCLC is associated to a longer survival with a mechanism presumably driven by immunological effectors. These results represent a solid rationale to test our metronomic regimen and RT in sequential combination with immune-checkpoint inhibitors in mNSCLC patients.
