Abstract 1929
Background
The impact of previous cumulative exposure to CS before treatment start is unknown, while its use for the treatment of immune-related adverse events during PD-(L)1 therapy does not seem to reduce efficacy. We used real-world data to evaluate the effect of CS immunosuppressive dose (cumulative dose of > 700 mg of prednisone equivalent) or CS delivery modality (prolonged, daily dose >10 mg of prednisone equivalent lasting >5 days, or pulsed, duration ≤5 days) over 3 months before treatment start.
Methods
Patients with advanced NSCLC treated at our Institution with single agent PD-(L)1 blockade after failure of platinum-based chemotherapy and on CS treatment in the previous 3 months were included. Clinical and pharmacy records were reviewed to identify CS dose and duration. According to the label, patients must not have received CS > 10 mg prednisone or equivalent over 10 days before start of anti-PD-(L)1 therapy and had PS ≤ 1. Patients must also have received >2 cycles of PD-(L)1 blockade to be eligible for efficacy analysis.
Results
We identified 62 patients fulfilling our inclusion criteria, 28 (45%) and 36 (58%) of them received a CS immunosuppressive dose and pulsed CS, respectively, 8 (13%) had brain metastases, and 20 (32%) had squamous histology. As of the general population, 36 (58%) patients achieved a durable clinical benefit (DCB, partial response or stable disease >6 months). The median PFS was 4.3 months, and the 1-year survival rate was 39%. CS immunosuppressive dose was not associated with decreased DCB (44% vs 55%; p-value 0.9), nor with shorter median PFS (3.7 vs 4.4 months; HR 1.2; p-value 0.2), nor with lower 1-year survival rate (31% vs 43%; p-value 0.6). CS prolonged exposure was significantly associated with either decreased DCB (30% vs 69%; p-value 0.01) and shorter median PFS (2.7 vs 4.5 months; HR 1.8; p-value 0.05), but not with lower 1-year survival rate (29% vs 41%; p-value 0.06).
Conclusions
Prolonged exposure to > 10 mg of prednisone equivalent through pretreatment 3 months was associated with poorer outcome in patients with advanced NSCLC treated with second-line PD-(L)1 blockade.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
5822 - Greek nursing students experience facing death in clinical practice
Presenter: Maria Dimoula
Session: Poster Display session 3
Resources:
Abstract
2866 - HOPEVOL: Hospice care appropriate to the wishes and needs of patients in the palliative terminal phase.
Presenter: Merel van Klinken
Session: Poster Display session 3
Resources:
Abstract
829 - Mindfulness-based stress reduction in early palliative care for advanced cancer patients : an italian single-centre study. MINDEEP
Presenter: Emilia Gianotti
Session: Poster Display session 3
Resources:
Abstract
2702 - Optimising Inpatient Oncology Care
Presenter: Lisa Judge
Session: Poster Display session 3
Resources:
Abstract
1527 - Analysis on the Implementation Results of Family Sickbed for Oncology Patients in Dongshi Township Health Centers from 2015 to 2017
Presenter: Yayu Huang
Session: Poster Display session 3
Resources:
Abstract
2054 - Exploring needs for palliative care and quality of life for oncology patients with advanced disease who undergo radiotherapy
Presenter: Foteini Antonopoulou
Session: Poster Display session 3
Resources:
Abstract
5605 - Cytotoxic contamination in cancer care settings – Risks and safety awareness among cancer nurses
Presenter: Sandra Lundman Vikberg
Session: Poster Display session 3
Resources:
Abstract
5769 - Understanding Chemotherapy - group education sessions prior to commencing chemotherapy
Presenter: Aileen McHale
Session: Poster Display session 3
Resources:
Abstract
2620 - Estimation of HPQ-based absenteeism and presenteeism in cancer patients via ResearchKit
Presenter: Shunsuke Kondo
Session: Poster Display session 3
Resources:
Abstract
4705 - Identifying falls-related variables and risk factors in hospitalised cancer patients
Presenter: Maria Montserrat Martí Dillet
Session: Poster Display session 3
Resources:
Abstract