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H. Yoshioka
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OA 05 - Next Generation TKI (ID 657)
- Event: WCLC 2017
- Type: Oral
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:James Chih-Hsin Yang, Fiona Blackhall
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 301 + 302
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OA 05.08 - Final Result of Phase I/II Study (AF-001JP) of Alectinib, a Selective CNS-Active ALK Inhibitor, in ALK+ NSCLC Patients (Pts) (ID 9732)
17:00 - 17:10 | Author(s): H. Yoshioka
- Abstract
- Presentation
Background:
Alectinib (ALC) is a selective, CNS-active ALK tyrosine kinase inhibitor. In two Phase 3 studies (J-ALEX and ALEX), ALC proved superior efficacy and tolerability compared to crizotinib (CRZ). Here we report the final efficacy and safety results of the 46 pts enrolled in the phase II part of study AF-001JP with a longer follow-up period than that observed in J-ALEX and ALEX studies.
Method:
ALC 300 mg b.i.d was given to ALK+ NSCLC pts who were ALK inhibitor-naive and had disease progression after at least one line of chemotherapy to investigate the efficacy and safety until the investigator confirmed no further clinical benefits.
Result:
This study was completed in December 2016. The median treatment duration was 46.1 months (range: 1-62). 20 of 46 pts were on treatment with alectinib at the study termination. Progressive disease (PD) was confirmed in 20 pts (43%). Median PFS was not reached and 4-year PFS rate was 52% (95% CI: 36-66). 14 of 46 pts had CNS metastasis at baseline. Median PFS was 38 months (95% CI: 9-NE) in pts with CNS metastases and was not reached in pts without CNS metastases. Four pts had CNS progression and the 4-year cumulative incidence rate of CNS progression was 9.5%. Median OS was not reached and the 4-year OS rate was 70% (95% CI: 54-81). Safety profile was similar to that reported previously and there were no treatment-related Grade 4 or 5 adverse events for this long administration period.
Conclusion:
Regardless of CNS metastases at baseline, ALC have demonstrated excellent efficacy in ALK+ NSCLC pts without prior ALK inhibitor treatment. ALC was well tolerated over a prolonged administration period.
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P1.07 - Immunology and Immunotherapy (ID 693)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.07-004 - Predictive Biomarkers of Response to Nivolumab in Non–Small Cell Lung Cancer: A Multicenter Retrospective Cohort Study (ID 7441)
09:30 - 09:30 | Author(s): H. Yoshioka
- Abstract
Background:
It is important to seek predictive factors for the efficient use of immune check point inhibitors in non-small-cell lung cancer (NSCLC), because of the lack of a definitive predictive biomarker.
Method:
Study design for the analysis: A multicenter retrospective cohort study. Patient eligibility criteria: Consecutive patients treated with nivolumab between January 2016 and October 2016 after the second line systemic chemotherapy outside of a clinical trial. Definition of exposures: Variables were retrieved from the medical records before the administration of nivolumab. All variables were dichotomized based on previous study or median. Definition of study endpoint: Progression free survival (PFS) defined by response evaluation criteria in solid tumours (RECIST) 1.1. Two researchers evaluated the endpoint independently. Any disagreements were resolved by discussion. Statistical methods: Cox proportional hazards models were used to assess the impact of pretreatment markers on PFS. Missing values were imputed by multiple imputation.
Result:
A total of 189 patients were included in the study. Median follow-up time was 5.5 months. Fourty six (24%) patients were censored. Median age was 69 (range, 38–88); 26% were female. 64% had received ≧2 prior systemic therapies. In multivariate analyses, worse performance status, higher lactate dehydrogenase, and higher carcinoembryonic antigen,were independently associated with inferior PFS (Table 1). Figure 1
Conclusion:
Our study indicated that patients with NSCLC treated with nivolumab in routine practice, pretreatment performance status ≧2, carcinoembryonic antigen ≦13.8, and Lactate Dehydrogenase ≧217 were associated with inferior PFS. Another study is warranted to determine the precise utility of each marker take account of the programmed death-ligand 1.
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-001 - Serum Albumin Level Predicts the Survival Benefit of Chemotherapy in Elderly Advanced NSCLC Patients with Poor Performance Status (ID 7326)
09:00 - 09:00 | Author(s): H. Yoshioka
- Abstract
Background:
There have been few data on the chemotherapy in elderly advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS), and usefulness of chemotherapy for such patients remains unclear.
Method:
All consecutive patients with advanced NSCLC, elerly (≥75 years old), ECOG PS ≥2, EGFR mutation negative/unknown, and newly diagnosed from January 2009 to December 2012 at Kurashiki Central Hospital, were retrospectively reviewed to clarify the factors which predicts the survival benefit of chemotherapy.
Result:
59 patients were enrolled. 31 patients received at least one chemotherapy regimen (chemotherapy group), whereas 28 patients received best supportive care (BSC) alone (BSC group). The proportion of PS 2 and serum albumin level were significantly higher in the chemotherapy group than in the BSC group. The overall survival (OS) was longer in the chemotherapy group than in the BSC group (median OS of 4.7 months and 3.1 months, p = 0.0119). In the chemotherapy group, log-rank testing did not show statistically significant differences in OS between single-agent therapy group and carboplatin-based doublet therapy group, whereas the OS of the patients who received chemotherapy for only 1 cycle was significantly better than those of the patients who received chemotherapy for ≥ 2 cycles. Hypoalbuminemia was not only the risk factor for the early termination of chemotherapy, but also the independent prognostic factor in the chemotherapy group. A receiver operating characteristic curve analysis showed that the best cut-off value was 3.40 g/dl. In the patients with serum albumin ≥ 3.40 g/dl, OS was significantly longer in chemotherapy group than that in BSC group (p=0.0156), whereas, the patients with serum albumin < 3.40 g/dl exhibited poor prognosis regardless of presence/absence of chemotherapy. Figure 1
Conclusion:
In the elderly advanced NSCLC patients with poor PS, serum albumin level may help identify the patients who are more likely to benefit from chemotherapy.
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P2.01-034 - Phase I/II Trial of Weekly Nab-Paclitaxel as 2nd or 3rd Line Treatment in NSCLC Without Driver Mutations. (OLCSG1303) (ID 9275)
09:00 - 09:00 | Author(s): H. Yoshioka
- Abstract
Background:
Although nab-paclitaxel (PTX) plus carboplatin is one of the standard treatment for chemo-naive advanced non-small cell lung cancer (NSCLC), the efficacy, safety and optimal schedule of nab-PTX monotherapy as 2nd or 3rd line for NSCLC patients without any driver mutations remains unknown.
Method:
This was a single arm phase I/II study. Eligible patients are advanced NSCLC without EGFR mutation and ALK rearrangement that progressed after platinum-doublet chemotherapy. The patients were received 100mg/m[2] of nab-PTX on day 1, 8, 15 and 22 (level 0) or on day 1, 8, and 15 (level -1) every 4-week in the phase I portion. Dose limiting toxicities (DLT) was assessed and the recommended schedule was determined. The primary endpoint was objective response rate (ORR), assuming that estimated ORR was 15% and threshold ORR was 5% with α error of 0.05 and β error of 0.2 in the phase II part. Total of 55 patients were planned to be enrolled.
Result:
The recommended schedule of nab-PTX was determined as the level -1, because the DLTs were found in 4 of 5 patients. The characteristics of the 55 patients enrolled in the phase II were as followings; median age, 66 years (range, 41–90 years), male/female=40/15, PS 0/1/2=12/39/4, 2nd/3rd line=34/21, adeno/squamous/large/others=34/17/2/2. The median number of treatment cycles was three (range, 1–10). The ORR was 7.3% (95% confidence interval [CI], 2.0–17.6%; 4 PR, 26 SD, 24 PD, 1 NE). At the median follow-up time of 5.3 months (range, 1.9–26.0 months) for all patients, the median PFS was 3.4 months (95% CI, 1.9–4.0 months). Treatment related grade 3 or 4 toxicities were neutropenia (36%), febrile neutropenia (5.5%) and pulmonary infection (3.6%). Three patients (5.5%) had grade 2 pneumonitis and one patient was died due to ARDS.
Conclusion:
This study failed to meet predefined primary endpoint although PFS was comparable and toxicity was acceptable for patients with advanced NSCLC without EGFR or ALK mutation as 2nd or 3rd line treatment. (UMIN registration number: 000012404).
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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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P2.03-008 - Phase I/II Study of Intermitted Erlotinib in Combination with Docetaxel in Patients with Recurrent NSCLC with Wild-Type EGFR: WJOG 4708L (ID 7556)
09:30 - 09:30 | Author(s): H. Yoshioka
- Abstract
Background:
Erlotinib (ERL) is modestly active to non-small cell lung cancer (NSCLC) with wild type epidermal growth factor receptor (EGFR). We hypothesized that an intermittent delivery of erlotinib and docetaxel (DOC) would increase efficacy.
Method:
This was a multi-center, single-arm phase I/II study in patients with wild type EGFR NSCLC who failed one prior chemotherapy. The phase I was designed a standard 3+3 dose escalation design to determine feasibility, the maximum tolerated dose (MTD) and phase II recommend dose (RD) of ERL on days 2 to 16, in combination with a fixed dose of 60mg/m[2] DOC on day 1. The phase II primary endpoint was objective response rate (ORR) by independent review committee. This study required 41 patients with expected ORR of 30% and threshold ORR of 10% (one-sided α= 0.025; β=0.1). The target number was 45 patients assuming the loss of follow-up cases. All eligible patients had ECOG performance status of 0/1 and adequate organ functions.
Result:
Between Mar 2009 and Dec 2010, 12 patients were enrolled in the phase I, and between May 2011 and Feb 2015, 46 patients in the phase II. Five patients were excluded from per protocol set, because of deviation of entry criteria. Planned dose escalation was completed without reaching a MTD. The RD was determined as 150 mg/dose of ERL. In the phase II, the ORR was 17.1% (95%CI, 7.2-32.1). The median progression free survival and median overall survival were 3.48 months (95%CI, 3.06-4.50) and 11.27 months (95%CI, 8.61-16.56), respectively. Gender, smoking status, or concomitant drugs which influence the ERL metabolism had no significant differences in ORR, or disease control rate. All 46 patients were evaluable for toxicity. The grade 3 non-hematological toxicities included 9 (19.6%) febrile neutropenia, 7 (15.2%) appetite loss, 3 (6.5%) oral mucositis and 3 (6.5%) infections. The grade 4 hematological toxicities were 31 (67.4%) neutropenia. Two treatment related deaths were observed; interstitial lung disease, and pleural infection.
Conclusion:
Intermittent dosing of ERL plus DOC is clinically feasible, but has no statistically significant improvement of ORR, in patients with recurrent NSCLC with wild type EGFR.
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P2.07 - Immunology and Immunotherapy (ID 708)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.07-024 - Real-World Data of Nivolumab for Previously Treated Non-Small Cell Lung Cancer Patients in Japan: A Multicenter Retrospective Cohort Study (ID 8699)
09:30 - 09:30 | Author(s): H. Yoshioka
- Abstract
Background:
Real-world data in non-small cell lung cancer (NSCLC) patients treated with nivolumab are currently lacking. This study aimed to obtain a detailed understanding of the characteristics and outcomes of these patients.
Method:
We retrospectively analyzed data for stage IIIB-IV (7th edition) NSCLC patients treated with nivolumab between January 2016 and January 2017.
Result:
A total of 394 patients were included in the study. Most patients had a PS of 0 or 1 (76%) and non-squamous histology (80%). Epidermal growth factor receptor (EGFR) gene mutations were detected in 16% of all patients. Two hundred and seventy-two patients (69%) had received ≥ 2 prior systemic therapies. Response rate was 20.8 %, and median progression-free survival (PFS) was 2.2 months. Estimated PFS and overall survival (OS) at 1-year were 17 % and 55 %, respectively. Multivariate analysis using Cox proportional hazards models identified poor performance status (PS 2-4) and EGFR mutation as independent predictors of PFS (hazard ratio [HR] 2.17; 95% confidence interval [CI], 1.68 to 2.80, P<0.001; HR 1.44; 95% CI, 1.02 to 2.02, P=0.04, respectively). In 255 patients without these negative predictive factors for PFS, response rate was 27.3 %. In these patients, estimated PFS and OS at 1 year were 23 % and 64 %. Severe immune related adverse events (≥Grade 3) were identified in 11.2 % of all patients, and 8.3 % of the patients developed pneumonitis (any grade). Overall incidence of pseudoprogression was approximately 2 %.
Conclusion:
Nivolumab has demonstrated a favorable efficacy and safety profile in real-world patients. Poor PS and EGFR mutation positivity were independent negative predictive factors for PFS. Importantly, pseudoprogression was rare in real-world patients.
