1204P - Concurrent Immuno-radiotherapy in lung and renal cancer- a new treatment paradigm

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Cancer in Adolescents
Renal Cell Cancer
Cancer Immunology and Immunotherapy
Genitourinary Cancers
Lung and other Thoracic Tumours
Surgery and/or Radiotherapy of Cancer
Presenter Jawaher Ansari
Citation Annals of Oncology (2017) 28 (suppl_5): v403-v427. 10.1093/annonc/mdx376
Authors J. Ansari1, M. Ali1, A. Alomair2, A. Mohammed Ali1, E. Murshid1, A. Shaukat1, E. Batubara3, F. Bashir1, A. Farrag1, K. Hussein1, A. Alhamad1
  • 1Department Of Oncology, Prince Sultan Military Medical City, 111159 - Riyadh/SA
  • 2Radiation Oncology, King Faisal specialist hospital and research centre, 111 - riyadh/SA
  • 3Department Of Pulmonology, Prince Sultan Military Medical City, 111159 - Riyadh/SA

Abstract

Background

Concurrent administration of checkpoint inhibitors and radiotherapy (Immuno-RT) remains investigational and is the subject of multiple clinical trials. Nivolumab is an anti-programmed death-1 receptor monoclonal antibody that exhibits checkpoint-mediated immune response against tumor cells. Nivolumab has received regulatory approval for the second-line management of metastatic non-small cell lung cancer (NSCLC) & renal cell carcinoma (RCC). Ionising radiation could increase the diversity & quantity of tumoral antigen presentation, thereby augmenting anti-tumour immune response achieved with checkpoint inhibitors. The aim of this study was to assess the efficacy & toxicity of concurrent administration of nivolumab and radiotherapy.

Methods

We identified 6 patients that received concurrent nivolumab and radiotherapy to 19 lesions; metastatic NSCLC (n = 4), metastatic RCC (n = 2). Treatment-related toxicities were identified by retrospective review of patient notes. Measurable lesions were assessed by RECIST 1.1 criteria. Pain score was used to assess symptomatic responses.

Results

Stereotactic and conformal radiotherapy were delivered to 9 and 10 lesions, respectively. Treatment sites (number of lesions): lung (n = 8), hip (n = 3), brain (n = 4), shoulder, scalp, ethmoid and adrenal. The gap between radiotherapy & nivolumab did not exceed 2 weeks for all patients. No grade 3-4 toxicities were observed. Two of the lung cancer patients developed grade 1 pneumonitis. Fractionation schedules included 48Gy/4 fractions (#), 40Gy/4#, 34Gy/4#, 22Gy/1#, 30Gy/10#, 25Gy/5#, 20Gy/4# and 20Gy/5#. Of the 14 measurable lesions, 86% had excellent response including complete response of 3 lesions. Symptomatic benefit was observed in 4 out of 6 treatment sites (66%).

Conclusions

The of role of concurrent nivolumab & radiotherapy in patients with metastatic NSCLC and RCC has never been reported previously. In our study, concurrent administration of nivolumab and radiotherapy appears to be well tolerated with excellent radiological and symptomatic responses. Ongoing clinical trials may help determine the future role of Immuno-RT in the rapidly evolving treatment paradigm of metastatic NSCLC and RCC management.

Clinical trial identification

Legal entity responsible for the study

Jawaher Ansari

Funding

None

Disclosure

J. Ansari: Paid honoraria for lectures and/or advisory boards for Amjen, AstraZeneca, Pfizer, Novartis, Boehringer Ingleheim, Bristol-Myers Squibb, Roche and Sanofi. A. Shaukat: lecture fees and advisory board for Bristol-Myers Squibb. A. Alhamad: Advisory board for Bristol-Myers Squibb. All other authors have declared no conflicts of interest.