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D.S. Heo



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    P3.02a - Poster Session with Presenters Present (ID 470)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.02a-018 - Efficacy of Pemetrexed Based Chemotherapy Compared with Non-Pemetrexed Based Chemotherapy in Advanced, ALK-Positive NSCLC (ID 5555)

      14:30 - 14:30  |  Author(s): D.S. Heo

      • Abstract

      Background:
      Previous retrospective studies suggested that lung cancer patients with anaplastic lymphoma kinase (ALK) gene rearrangements are associated with sensitivity to pemetrexed chemotherapy. To determine the efficacy of pemetrexed based chemotherapy compared with non-pemetrexed based chemotherapy, we retrospectively evaluated clinical outcome in ALK positive non-small cell lung cancer (NSCLC) patients.

      Methods:
      We identified 126 patients with advanced, ALK-positive NSCLC who received 1st line cytotoxic chemotherapy from Seoul National University Hospital and Seoul National University Bundang Hospital. We compared response rate, progression-free survival, and overall survival according to chemotherapy regimens. We also analyzed the intra-cranial time to progression and proportion of ALK-positive cells as a predictive factor of pemetrexed efficacy.

      Results:
      Forty eight patients received pemetrexed based chemotherapy and Seventy eight patients received non-pemetrexed based chemotherapy as first line systemic treatment. One hundred eighteen patients received platinum double combination chemotherapy. The pemetrexed based chemotherapy group shows superior overall response rate (44.7% versus 14.3%, p<0.001) and disease control rate (85.1% versus 62.3%, p=0.008). Pemetrexed based chemotherapy group had longer progression free survival (6.6 months versus 3.8 months, p<0.001). Exposure to pemetrexed and exposure to second generation ALK inhibitor were independent prognostic factors of overall survival (p=0.016 and p=0.011, respectively). Intra-cranial time to progression (TTP) was similar among treatment group (32.7 months versus 35.7 months, p= 0.733). Proportion of ALK positive cells was not statistically significant predictive factor of survival in pemetrexed based chemotherapy.

      Conclusion:
      Pemetrexed based regimen may prolong progression free survival compared with other regimens in ALK positive NSCLC in the first line setting. Exposure to pemetrexed is associated with improved survival compared with that of premetrexed-naive controls in ALK positive NSCLC.

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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-061 - Neutrophil/Lymphocyte Ratio Predicts the Efficacy of Anti-PD-1 Antibody in Patients with Advanced Lung Cancer (ID 4974)

      14:30 - 14:30  |  Author(s): D.S. Heo

      • Abstract

      Background:
      Therapeutic antibodies to programmed death receptor 1 (PD-1) have shown clinical activity in lung cancer. The aim of this study is to investigate the clinical factors, including inflammatory markers such as neutrophil/lymphocyte ratio (NLR), to predict response to anti-PD-1 antibody in advanced lung cancer patients.

      Methods:
      We retrospectively analyzed 51 patients who had advanced lung cancer and had been treated with anti-PD-1 antibodies between 2013 and 2015. The values of NLR were assessed at two time points: at baseline (pre-treatment) and at 6 week after the start of treatment (post-treatment). NLR of 5 was used as the cutoff value.

      Results:
      The median age of the patients was 68 years; 76.5% were male, and 27.5% were never smokers. Most patients had adenocarcinoma (n = 28); 17 had squamous cell carcinoma, and 6 had others. Eighteen of 51 patients (35.3%) had clinical objective response to anti-PD-1 antibody. Non-adenocarcinoma histology and low post-treatment NLR was significantly associated with clinical response, while gender, smoking history, line of treatment and pre-treatment NLR were not predictive of response. Liver metastasis, brain metastasis, and high post-treatment NLR were significantly associated with worse tumor response. Patients with a high post-treatment NLR had significantly shorter PFS (median 1.3 months vs. 6.1 months, p < 0.001). Multivariable analysis demonstrated that high post-treatment NLR (hazard ratio [HR] 20.1, 95% confidence interval [CI] 5.5 - 73.9, p < 0.001), presence of liver metastasis (HR 5.5, 95% CI 2.1 - 14.6, p = 0.001), and CNS metastasis (HR 2.9, 95% CI 1.1 - 7.4, p = 0.027) were independent predictive factors for short PFS. Figure 1



      Conclusion:
      Clinical factors including post-treatment NLR at 6 week might be predictive of clinical benefits from anti-PD-1 antibody therapy in lung cancer.