Abstract 520P
Background
While immune checkpoint inhibitors (ICIs) have been shown to be effective for non-small cell lung cancer (NSCLC), their monotherapeutic response rate (RR) is roughly 20%. It has been noted that local radiation therapy (RT) might potentially activate off-target antitumor effect, which is so called “abscopal effect” induced by immune-mediated mechanism. We evaluated whether palliative-RT induced abscopal effect, resulting in improvement of Nivolumab (Nivo) effectiveness.
Methods
Pretreated advanced NSCLC patients (pts) who were indicated for Nivo and scheduled for palliative-RT were started on RT within 10 days of administration of Nivo 3 mg/kg q2 weeks until attached document was revised to 240 mg/body q2 weeks. The primary endpoint was RR of non-irradiated tumor lesions.
Results
Twenty-eight pts were enrolled from May 2016 to January 2019. The study was terminated before completion of targeted initial sample size (n = 35), because of poor accrual. The median age was 67 years (range: 53-89). 15 pts were male. 21 pts had adenocarcinoma histology, 2 pts squamous histology, and 6 pts driver oncogene alterations. 25 pts were PS0/1, and 3 pts PS2. 14 pts were treated as 2nd-line, 2 pts as 3rd-line, and 12 pts as 4th-line or later. The median number of treatment cycles was 4 (range: 1-6). Median radiation dose was 30 Gy (range: 25-40), and 16 pts were irradiated on the bone, 5 pts on the adrenal grand, and 2 pts on the primary lesion. The objective RR of non-irradiated tumor lesions was 14.3% (95% CI: 1.3–27.2). Partial response (PR) was observed in 3 pts treated as 2nd-line (3/14, 21.4%), and 1 pt as 3rd-line (1/2, 50%). No PR was observed in pts treated as 4th-line or later (0/12, 0%). The median PFS was 2.7 months (95% CI: 1.0–3.5). No severe and specific adverse events (AEs) of Nivo in combination with RT were observed compared to historical data of Nivo monotherapy.
Conclusions
Although the sample size was small, cleared abscopal effect by palliative-RT was not observed in Nivo treatment. However, some pts well responded to Nivo with palliative-RT during early-lines of treatment (2nd/3rd-line). Further investigations in the early-lines are warranted to evaluate a substantial synergistic effect of RT with ICIs.
Clinical trial identification
UMIN000023646.
Editorial acknowledgement
Legal entity responsible for the study
HANSHIN Oncology Group.
Funding
ONO Pharmaceutical Company.
Disclosure
A. Hata: Speaker Bureau / Expert testimony, Research grant / Funding (institution): Boehringer Ingelheim; Speaker Bureau / Expert testimony, Research grant / Funding (institution): Eli Lilly; Speaker Bureau / Expert testimony, Research grant / Funding (institution): AstraZeneca; Speaker Bureau / Expert testimony: Chugai; Research grant / Funding (institution): MSD. M. Satouchi: Speaker Bureau / Expert testimony, Research grant / Funding (institution): AstraZeneca; Speaker Bureau / Expert testimony, Research grant / Funding (institution): Boehringer Ingelheim; Speaker Bureau / Expert testimony, Research grant / Funding (institution): BMS; Speaker Bureau / Expert testimony, Research grant / Funding (institution): Chugai; Speaker Bureau / Expert testimony, Research grant / Funding (institution): Eli Lilly; Speaker Bureau / Expert testimony, Research grant / Funding (institution): MSD; Speaker Bureau / Expert testimony, Research grant / Funding (institution): Novartis; Speaker Bureau / Expert testimony, Research grant / Funding (institution): ONO; Speaker Bureau / Expert testimony, Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Takeda; Speaker Bureau / Expert testimony: Taiho. D. Harada: Honoraria (self): ONO; Honoraria (self): BMS. All other authors have declared no conflicts of interest.
Resources from the same session
205P - Treatment pattern and outcomes of radium-223 (Ra223) in metastatic castration resistant prostate cancer (mCRPC): Retrospective cohort analysis from Hong Kong
Presenter: Darren Poon
Session: Poster display session
Resources:
Abstract
206P - Population-based validation of the risk stratification among prostate cancer patients
Presenter: Mu Xie
Session: Poster display session
Resources:
Abstract
211P - Adjuvant axitinib in Asian vs non-Asian patients with metastatic renal cell carcinoma (mRCC): ATLAS trial subgroup analysis
Presenter: Chi Fai Ng
Session: Poster display session
Resources:
Abstract
212P - Immunotherapy with nivolumab in metastatic renal cell carcinoma patients in India: Bringing a change in clinical practice
Presenter: Amit Rauthan
Session: Poster display session
Resources:
Abstract
213P - An observational retrospective real-world study of sarcomatoid renal cell carcinoma (sRCC) patients in an Asian cancer centre
Presenter: Ravindran Kanesvaran
Session: Poster display session
Resources:
Abstract
214P - Targeting epithelial-mesenchymal transition (EMT), novel strategy to delay resistance or re-sensitize renal cancer to Sunitinib
Presenter: Revati Sharma
Session: Poster display session
Resources:
Abstract
215P - Radiologic and pathologic tumour size variation in localized renal cell carcinoma and its implications
Presenter: Shanky Singh
Session: Poster display session
Resources:
Abstract
216P - Partial versus radical nephrectomy: 10- year long-term survival among patients with Wilms tumour
Presenter: Mira Mostafa
Session: Poster display session
Resources:
Abstract
217P - Neutrophil-to-lymphocyte ratio is a useful biomarker for predicting worse clinical outcome in chemo-resistant urothelial carcinoma patients treated with pembrolizumab
Presenter: Koichiro Ogihara
Session: Poster display session
Resources:
Abstract
219P - Long-term outcomes of bladder preservation in muscle-invasive bladder cancer patients
Presenter: Amanda Dania Satiti
Session: Poster display session
Resources:
Abstract