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Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

4631 - Prognostic factors in non-small cell lung cancer (NSCLC) patients (pts) with brain metastases (BM) treated with immune checkpoint inhibitors (ICI)

Date

20 Oct 2018

Session

Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

Topics

Immunotherapy

Tumour Site

Presenters

Lizza Hendriks

Citation

Annals of Oncology (2018) 29 (suppl_8): viii493-viii547. 10.1093/annonc/mdy292

Authors

L. Hendriks1, C. Henon1, E. Auclin2, L. Mezquita Pérez1, R. Ferrara1, C. Audigier Valette3, J. Mazieres4, C. Lefebvre4, S. Le Moulec5, B. Duchemann6, C. Le Pechoux7, A. Botticella7, S. Ammari8, A. Gazzah9, C. Caramella8, J. Adam10, D. Planchard1, D. De Ruysscher11, A.C. Dingemans12, B. Besse1

Author affiliations

  • 1 Medical Oncology, Institut Gustave Roussy, 94800 - Villejuif/FR
  • 2 Oncology, Hopital European George Pompidou, 75015 - Paris/FR
  • 3 Pneumology, Hospital Sainte Musse, 83100 - Toulon/FR
  • 4 Thoracic Oncology, Hospital Larrey, 31400 - Toulouse/FR
  • 5 Medical Oncology, HIA Val de Grace, 75005 - Paris/FR
  • 6 Pulmonary Diseases, Hôpital Avicenne, 93009 - Bobigny/FR
  • 7 Radiation oncology, Institut Gustave Roussy, 94800 - Villejuif/FR
  • 8 Radiology, Institut Gustave Roussy, Villejuif/FR
  • 9 Drug Development Department (ditep), Gustave Roussy, 94800 - VILLEJUIF/FR
  • 10 Pathology, Institut Gustave Roussy, 94800 - Villejuif/FR
  • 11 Radiation oncology (maastro Clinic), Maastricht University Medical Centre (MUMC)-MAASTRO clinic, 6229 ET - Maastricht/NL
  • 12 Pulmonology, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
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Resources

Abstract 4631

Background

Brain metastases (BM) are frequent in NSCLC. Unfortunately, pts with (untreated) BM are often excluded from ICI trials and prognostic factors in ICI treated BM pts are largely unknown.

Methods

Retrospective data collection of all consecutive advanced ICI treated NSCLC pts in 6 centers (5 French, 1 Dutch) (nov 2012 – March 2018). All BM pts were selected; (intracranial) overall response rate (investigator assessed), progression free survival (PFS), overall survival (OS) data were collected. Active BM: non-irradiated new and/or growing lesions on brain imaging < 6 weeks before ICI start.

Results

241/945 (26%) pts had BM: 61% male, 76% WHO PS 0-1, median age 61 years, 75% nonsquamous, 4% driver mutation, 31% known PD-L1 (61% ≥1% expression). ICI treatment was median 2nd line (range 1-8), 95% had monotherapy ICI. Median time BM diagnosis till ICI start: 184 days. >5 BM: 30%, active BM: 40%, symptomatic: 14%, steroid use: 26%, known disease specific Graded Prognostic Assessment (ds-GPA) at start of ICI: 94% (36% 0-1, 58% 1.5-2.5, 6% 3), previous cranial irradiation (RT): 68% (56% stereotactic, 44% whole brain), median time RT to ICI start: 109 days. Median follow-up: 14 months. 78% had PD on ICI: 12% BM only, 28% extracranial, 50% both, 10% no imaging (clinical PD). At PD, 23% of BM only PD pts had extracranial response and 21% of extracranial only PD pts had cranial response. Median (95% CI) PFS and OS were 2 (1-2) and 9 (7-13) months, respectively. In multivariate analysis, > 2 metastatic organs and symptomatic BM at ICI start were associated with a worse PFS and OS; higher ds-GPA with superior PFS and OS (Table). In univariate analysis, active BM vs stable BM and brain RT vs no brain RT were not associated with outcome (HR PFS 0.98 (p = 0.66)/ HR OS 0.93 (p = 0.92) and HR PFS 0.82 (p = 0.19) / HR OS 0.82 (p = 0.27)).

Conclusions

Number of metastatic organs, symptomatic BM and ds-GPA are associated with outcome in BM pts treated with ICI.

Clinical trial identification

Legal entity responsible for the study

Gustave Roussy.

Funding

L. Hendriks: Grant: DUERTECC/euronco.

Editorial Acknowledgement

Disclosure

L. Hendriks: Outside the current abstract: Research funding: Roche; Advisory board: Boehringer Ingelheim, BMS; Travel reimbursement: Roche, BMS. C. Le Pechoux: Outside the current abstract: Advisory board: Astrazeneca. A-M.C. Dingemans: Outside the current abstract: Advisory board: BMS, MSD, Roche. B. Besse: Outside the current abstract: Institutional grants for clinical and translational research: AstraZeneca, BMS, Boehringer Ingelheim, Lilly, Pfizer, Roche-Genentech, Sanofi-Aventis, Servier, Onxeo, OncoMed, Inivata, Ose Pharma, Loxo. All other authors have declared no conflicts of interest.Table: 1408P

FactorPFS HR (95% CI)p-valueOS HR (95% CI)p-value
Smoking yes vs no0.75 (0.38-1.51)0.420.86 (0.38-1.94)0.71
Histology squamous vs adeno1.11 (0.71-1.73)0.801.42 (0.83-2.43)0.36
Nr of organs with metastases > 2 vs ≤ 21.66 (1.15-2.39)0.0071.58 (1.02-2.47)0.04
Immuno line > 2 vs ≤ 20.89 (0.63-1.26)0.521.06 (0.71-1.59)0.78
Use of corticosteroids at ICI start yes vs no2.16 (1.47-3.18)<0.0011.51 (0.95-2.38)0.08
BM symptomatic at start IO yes vs no1.38 (0.86-2.23)0.191.71 (1.01-2.90)0.046
Ds-GPA 1.5-2.5 vs 0-1 Ds-GPA 3 vs 0-10.61 (0.43-0.85) 0.77 (0.38-1.55)0.010.44 (0.29-0.66) 0.50 (0.21-1.21)0.0003

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