Abstract 3302
Background
Preclinical and retrospective clinical studies suggest that combining radiotherapy (RT) with programmed cell death protein 1 (PD-1) blockade may elicit a synergistic anti-tumour response. We aimed to assess whether prior or concurrent RT was associated with improved disease control in patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab.
Methods
We conducted a retrospective study of patients receiving nivolumab as second or subsequent line therapy for metastatic NSCLC across four tertiary oncology centers. All patients received nivolumab at a dose of 3mg/kg every 2 weeks intravenously. Survival and toxicity data were collected prospectively. Patients were categorized into those who received any RT for NSCLC (with curative or palliative intent, thoracic or otherwise) prior to or during nivolumab therapy, and those with no history of RT for NSCLC. Kaplan-Meier survival analysis was performed for progression-free survival (PFS) and overall survival (OS) following commencement of nivolumab.
Results
85 patients (32 female, 53 male) received nivolumab between July 2015 and December 2016. Patients had a median age of 67 years (range 42-84) at commencement of nivolumab and were followed up for a median of 15 months. 65 patients (76.4%) received RT prior to or during nivolumab and 20 patients (23.6%) received nivolumab alone. Baseline characteristics of age, performance status, histology, smoking status, sites of metastatic disease and previous therapy were similar between the two groups. Prior or concurrent RT was associated with prolongation of PFS, median 2.8 months with RT versus 1.3 months without RT (P = 0.02, HR = 0.494, 95% CI 0.279-0.873). The median OS of the group receiving RT was 6.4 months vs 4.2 months for the no RT group but the difference did not reach statistical significance (p = 0.20). RT was not associated with an increase in toxicity and Grade 2 or greater pneumonitis rates were low in both groups (RT 4.6% vs no RT 5%).
Conclusions
RT prior to or concurrent with nivolumab for metastatic NSCLC was associated with superior PFS over nivolumab alone with no evidence of increase in adverse effects. RT may potentiate the effect of anti-PD-1 immunotherapy in NSCLC.
Clinical trial identification
Legal entity responsible for the study
Royal Brisbane and Womens’ Hospital, Herston, Queensland.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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