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Omar Macedo-Pérez
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-049 - Long Progression Free Survival and Overall Survival in Advanced NSCLC Patients with EGFR Mutation and Complete Response with TKI Treatment (ID 10265)
09:00 - 09:00 | Presenting Author(s): Omar Macedo-Pérez
- Abstract
Background:
Lung cancer is the first cause of death by cancer worldwide. Around 70% of patients are diagnosed in advances stages. The EGFR mutations (EGFRmut) are present in 15-20% of cases of lung adenocarcinoma. Most frequent mutations are exon 19 deletions and L858R (90%); in those patients, the TKI treatment have higher response rates (RR) and longer progression free survival (PFS) compared versus chemotherapy. However, the long time OS is low and the complete responses (CR) are achieved in 1-3% only. Nevertheless, contributing factors to long term survival are still unclear. Our objective was to describe long PFS and OS associated factors in patients with TKI treatment.
Method:
We analyzed patients with EGFRmut NSCLC, who received TKI between 2011 and 2017 in the Thoracic Tumors Clinic at Instituto Nacional de Cancerologia, Mexico. EGFR mutational test was performed by RT-PCR (SCORPION/ARMS therascreen). We search factors associated with CR and Major responses (MR; defined as tumor size reduction > 80%) and correlated with PFS and OS.
Result:
One-hundred sixty patients were analyzed. Median age was 62y (SD ±12.8), female 66%, never smoking 82%, adenocarcinoma 98%, exon 19 deletions 60.6% and L858R 34.4%, uncommon mutations 5%. The RR were 56.3%; 12/160 (7.5%) patients had CR (Group1), 16/160 (10%) patients had MR and received local control with Radiotherapy (Group2) and 132/160 (82.5%) had non-CR without radiotherapy (Group3). In the total population PFS and OS was 15months (CI95% 8.2-21.9mo) and 27.9mo (21.8-32.2mo) respectively; in group3 PFS/OS was 8.77 (CI95% 7.66-9.88mo)/24.7mo (CI95% 20.8-28.8mo); in Group1 PFS/OS was 38.7mo (CI 95% 35.7-41.6)/47.8mo (CI95% 40.1-55.5mo) and Group2 PFS/OS 28.1mo (0.43-56.4mo)/OS 36.1mo (CI95% 11.6-60.7mo). We found significant differences in PFS and OS compared group1 vs Group3 (p=0.003 and p=0.0001, respectively) and Group2 vs group3 (p=0.009 and 0.007, respectively). Was not significant differences in PFS/OS between Group1 vs Group2 (p=0.09/0.9, respectively). All patients with CR are alive, except one patient who died due to pneumoniae. In the multivariate analysis were not found association with CR and TKI or mutation subtype (Exon 19 vs L858R).
Conclusion:
Patients treated with TKI who reach CR or MR followed by local control with radiotherapy have longer PFS and OS. These findings support the importance to optimize TKI treatment, in order to achieve CR as well as the importance of local control in residual lesions to improve survival outcomes.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-012 - Risk of Developing Pneumonitis Increases in Patients Receiving Immunotherapy with a History of Lung Irradiation (ID 10344)
09:30 - 09:30 | Author(s): Omar Macedo-Pérez
- Abstract
Background:
A large proportion of patients with locally advanced/metastatic Non-Small Cell Lung Cancer (NSCLC) present disease progression despite aggressive treatments and will further receive immunotherapy. Pneumonitis is an uncommon but potentially fatal toxicity related to immunotherapy treatment. The association with the history of radiotherapy and the risk of developing pneumonitis have not been well described. We associated the history of radiotherapy with the development of pneumonitis in patients receiving immunotherapy.
Method:
Clinical information was retrospectively obtained from histologically confirmed advanced NSCLC patients treated from February 2013 to February 2017. Clinical and radiologic features of pneumonitis were collected from patients receiving immunotherapy. We sought associations between pneumonitis incidence and clinical characteristics.
Result:
Of 59 patients who received immunotherapy 61.7% were treated with nivolumab, 29.9% with pembrolizumab and 6.7% with the combination durvalumab plus tremelimumab. Immunotherapy treatment was administered in first line in 26.6% of patients, 28.3% received in second line and 36.7% in third or more line of treatment. Twenty-five of the 59 patients (41.7%) received previous radiotherapy, 16 of them (26.7%) to the lung and 9 (15%) to the thoracic spine. Fifteen (15/59) patients (25%) developed pneumonitis; this occurred irrespective of line of therapy in which immunotherapy was received (first line: 38.5%; second line: 33.5%; third line or more: 26.7%). No association was found between line of treatment and pneumonitis development. Median time from therapy initiation to pneumonitis was 4.5 months (range 18 days - 13.1 months). For any grade of pneumonitis, the percentage was of 25% (15 patients) of which 48% (12/25) had received radiotherapy, Grade >2 pneumonitis was seen in 10 patients (17%) and 32% (8/25) had history of radiation therapy. All Grade 3 pneumonitis events (n=4) presented in patients with previous lung radiotherapy. The incidence and severity of pneumonitis was higher in patients who had received radiotherapy (OR, 95% CI: 6.8 (1.6 – 28.5); p=0.009).
Conclusion:
The incidence of pneumonitis related to immunotherapy treatment could be underestimated. We observed an increase in the risk and severity of pneumonitis in patients with previous radiation therapy and subsequent treatment with immunotherapy, regardless of used drug or line of therapy. In these patients, we recommend close clinical and radiologic follow-up.
