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A. Sato
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-054 - PD-L1 Expression in Patients with Non-Small Cell Lung Cancer According to Underlying Pulmonary Disease: A Retrospective Study (ID 8705)
09:30 - 09:30 | Author(s): A. Sato
- Abstract
Background:
Immune checkpoint inhibitors (ICIs) have good treatment outcomes for non-small cell lung cancer (NSCLC) especially with smoking history. The drug-induced interstitial lung diseases (ILDs) are frequently seen in patients treated with ICIs. The risk assessment for ILDs before ICIs treatment is important, however the pulmonary toxicities of ICIs in patients with smoking related pulmonary diseases such as emphysema and fibrosis are not known. In this study, we retrospectively analyzed PD-L1 expression of NSCLC according to underlying pulmonary disease.
Method:
We tested PD-L1 expressions in NSCLC using 22C3 antibody as tumor proportion score (TPS). We then compared PD-L1 expression TPS according to underlying pulmonary diseases assessed by chest CT (normal, fibrosis, emphysema).
Result:
We reviewed 44 NSCLC patients at NTT Medical Center Tokyo. The median age of all the patients was 71 years (range 46-90). Thirty-eight patients were male (86%). Adenocarcinoma was the most frequent with 26 patients (59%), followed by squamous cell carcinoma with 16 patients (36%). As to PD-L1 expression, 7 patients (16%) were TPS more than 50%, 12 patients (27%) were TPS 1-49% and 22 patients (50%) were TPS less than 1%. Three patients (7%) did not have evaluable material. All the patients with TPS >50% and 1-49% had smoking history. For patients with TPS <1%, there were three patients (14%) without smoking history. As to histology, there were 4 patients (57%) with squamous cell carcinoma for patients with TPS >50%, 4 patients (33%) for TPS 1-49% and 8 patients (36%) for TPS <1%. Among patients with TPS >50%, 2 patients (29%) had emphysema, 5 patients (23%) fibrosis, and no normal lung. Among patients with TPS 1-49%, there were 4 patients (33%) with normal lung, 6 patients (50%) with emphysema and 2 patients (17%) with fibrosis. For patients with TPS <1, there were 9 patients (41%) with normal lung, 10 patients (45%) with emphysema and 2 patients (9%) with fibrosis.
Conclusion:
No patients with normal lungs showed TPS >50%, whereas more than half of patients with TPS <1% had normal lung. Our results show that patients with higher PD-L1 expression has higher rate of underlying pulmonary disease which might be a higher risk for drug-related ILDs. Further treatment strategy is needed for use of ICIs with higher PD-L1 expression with underlying pulmonary diseases.
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-017 - Clinical Features and Treatment with Afatinib in Patients with Squamous Cell Lung Cancer with Sensitive EGFR Mutations (ID 8527)
09:30 - 09:30 | Author(s): A. Sato
- Abstract
Background:
As LUX-Lung8 has shown significant improvements in the progression-free survival and the overall survival with afatinib when compared with erlotinib, afatinib could be an additional option for the second-line treatment of patients with squamous cell lung cancer. The selection process of patients on the basis of EGFR mutations would likely result in a population with a greater sensitivity to afatinib. However squamous cell lung cancer is not routinely examined for EGFR mutation status because of the low frequency of positive results and the poor clinical response of squamous cell lung cancer with EGFR sensitive mutations to gefitinib, compared to that of adenocarcinoma. We reviewed clinical features of squamous cell lung cancer with EGFR mutations at our hospital and their responses to EGFR-tyrosine kinase inhibitors.
Method:
The medical records of this retrospective review were taken from patients with histological or cytological proven squamous cell lung cancer from April 2008 to May 2017 at NTT Medical Center Tokyo. The patients were tested for EGFR mutation status with PNA-LNA clamp method. The electronic medical records were reviewed to obtain clinical and demographic data, including gender, age, smoking history, clinical stage of lung cancer, treatment, and survival.　Based on the chest CT findings, the patients were categorized into three groups according to the underlying pulmonary disease; normal lungs, emphysematous lungs and fibrotic lungs. The differences among the categorized groups were then compared.
Result:
Of 441 patients with squamous cell lung cancer, 23 patients (5.2%) were tested EGFR mutation status. Of 23 patients, we identified 5 (21.7%) patients with an EGFR mutation (Exon 19 deletion 3, L858R 2). All patients with EGFR mutation were female and never-smokers. EGFR mutations were identified in 4 (44.4%) of 9 patients with normal lungs, 1(8.3%) of 12 with emphysema, and 0 (0%) of 2 with pulmonary fibrosis. Of the 5 patients with EGFR mutation, 2 patients received gefitinib and 2 patients received afatinib. Although the two patients treated with gefitinib did not respond to treatment (SD 1, PD 1), the two patients treated with afatinib responded well (PR 2).
Conclusion:
Squamous cell carcinoma patients with sensitive EGFR mutations had a prognosis comparable to patients with adenocarcinoma. Selecting an afatinib treatment for patients on the basis of the underlying pulmonary diseases(normal lungs) and the smoking status (never smoker) for the EGFR mutation test would likely result in a population with a greater sensitivity to afatinib.
