1334P - PET/CT-guided immune checkpoint blocker treatment discontinuation vs treatment continuation in lung cancer long-term responders: A National Network Genomic Medicine Lung Cancer Germany (nNGM) analysis

Background

Optimal duration of immune checkpoint blocker (ICB)-treatment in lung cancer has not been determined yet. One in five patients treated with first-line ICB achieves durable responses for ≥2 years. Treatment continuation beyond 2 years impacts on economic burden and might cause avoidable toxicities. Thus, safe discontinuation strategies represent an urgent medical need.

Methods

For this retrospective cohort analysis, 430 nNGM-patients from 20 centers and stable on first-line ICB-based treatment for ≥2 years were enrolled into 2 cohorts, either with a PET/CT after ≥2 years and offer to discontinue treatment (A, n=101) or with continued ICB administration without PET/CT (B, n=329). Treatment outcome was assessed with PET/CT as a time-depending covariate.

Results

Frequencies of (non-) squamous NSCLC and SCLC were 72%, 21% and 7%. In cohort A, median time to PET/CT was 26 months [25-27] with a complete metabolic response (CMR) observed in 59 (58%) cases. In non-CMR patients (n=42, 42%), 28 rebiopsies were performed (67%), confirming residual vital cancer in 13 patients (46%). Of these, 10 patients (77%) underwent subsequent local ablative treatments. Median duration of ICB-treatment was 28 (A) vs. 44 months (B) (p<0.001), with the main reasons for treatment discontinuation being the PET/CT (A: 89%) and subsequent irAE (B: 31%). After a median FU of 46 months [44-49], HR for PFS and OS (A vs. B) were 0.55 [0.31-0.96; p=0.03] and 0.45 [0.20-1.05; p= 0.06], respectively.

Conclusions

Shorter treatment duration in group A was not associated with inferior PFS or OS, and patients benefitted from a lower incidence of treatment-limiting irAE. PET/CT-guided treatment seems reasonable, might identify high-risk patients and should be evaluated prospectively. Table: 1334P

Selected baseline characteristics (if not otherwise specified: n, %)

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

German Cancer Aid (Deutsche Krebshilfe).

Disclosure

N. Frost: Financial Interests, Personal, Advisory Board: AbbVie, Amgen, AstraZeneca, BeiGene, BMS, Boehringer Ingelheim, Daiichi Sankyo, Janssen Oncology, Merck Serono, MSD, Novartis, Pfizer, Roche, Takeda; Financial Interests, Personal, Invited Speaker: Berlinchemie, Boehringer Ingelheim, Eli Lilly, MSD, Roche, Sanofi, Regeneron; Financial Interests, Personal and Institutional, Research Grant, ANTELOPE trial (NCT05689671): Roche; Non-Financial Interests, Leadership Role, Member of the steering board, section thoracic oncology: Working Group Medical Oncology within German Cancer Society (AIO). M. Wiesweg: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Takeda, GSK, AstraZeneca, Daiichi Sankyo; Financial Interests, Personal, Advisory Board: GSK, Novartis, Pfizer, Roche, Janssen, Daiichi Sankyo, Bristol Myers Squibb; Financial Interests, Institutional, Local PI: Takeda; Financial Interests, Institutional, Funding: Bristol Myers Squibb. J. Kollmeier: Financial Interests, Institutional, Advisory Board: Boehringer Ingelheim, MSD, Roche Pharma AG, Bristol Myers Squibb, Janssen-Cilag GmbH; Financial Interests, Institutional, Local PI: MSD Sharp & Dohme GmbH, Takeda, Roche Pharma AG, Novartis; Non-Financial Interests, Member: Deutsche Gesellschaft für Hämatologie und Onkologie, Deutsche Krebsgesellschaft. N. Reinmuth: Financial Interests, Personal, Invited Speaker, including Ad-Boards: AstraZeneca; Financial Interests, Personal, Invited Speaker: Amgen, Daiichi Sankyo, F. Hoffmann-La Roche, Lilly, Pfizer, Takeda, Merck, GSK; Financial Interests, Personal, Invited Speaker, including Advisory Boards: Bristol Myers Squibb, Boehringer-Ingelheim, MSD; Financial Interests, Institutional, Invited Speaker: Sanofi. J. Roeper: Financial Interests, Personal, Invited Speaker: AstraZeneca. A. Rittmeyer: Financial Interests, Personal, Advisory Board: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Daichi Sankyo, Gilead, GSK, MSD, Eli Lilly, Novartis, Pfizer, Roche. S. Heinzen: Financial Interests, Personal, Advisory Board: BeiGene; Financial Interests, Personal, Invited Speaker: AstraZeneca GmbH; Financial Interests, Institutional, Other, Congress and Travelling Support: BeiGene; Financial Interests, Institutional, Research Grant, Research Award: Novartis. F.C. Saalfeld: Financial Interests, Personal, Advisory Board: Janssen, Takeda, AstraZeneca, Janssen, BMS; Financial Interests, Personal, Invited Speaker: Pfizer, GWT TUD GmBH, AstraZeneca, Novartis, German Society for Thoracic Surgery; Financial Interests, Personal, Writing Engagement: Thieme; Financial Interests, Institutional, Research Grant: Roche; Non-Financial Interests, Personal, Training: Lilly; Non-Financial Interests, Member: German Cancer Society - AIO. C. Wesseler: Financial Interests, Personal, Advisory Board: MSD, Boehringer Ingelheim, BMS, Novocure; Financial Interests, Personal, Invited Speaker: Roche, Boehringer Ingelheim, MSD, BMS, AstraZeneca, Lilly, Takeda, Novartis, Pfizer, GSK, Chugai, Amgen, Novocure, Janssen; Financial Interests, Institutional, Local PI: Gilead, Roche, MSD, Novartis, BMS, Takeda, AstraZeneca, Novocure, Lilly, Janssen, Merus, Helsinn Healthcare. D. Kauffmann-Guerrero: Financial Interests, Personal, Advisory Board: MSD, Boehringer Ingelheim, Janssen, Pfizer, BMS; Financial Interests, Personal, Invited Speaker: Roche. P. Christopoulos: Financial Interests, Personal, Advisory Board: AstraZeneca, Boehringer Ingelheim, Chugai, Pfizer, Novartis, MSD, Takeda, Roche, Daiichi Sankyo; Financial Interests, Personal, Writing Engagement: Gilead; Financial Interests, Personal, Invited Speaker: Thermo Fisher; Financial Interests, Institutional, Funding: AstraZeneca, Boehringer Ingelheim, Amgen, Novartis, Roche; Financial Interests, Personal, Funding: Takeda. M. Kemper: Financial Interests, Personal and Institutional, Research Grant, InCa (Inflammation and Lung Cancer) Award 2021: Novartis; Financial Interests, Personal, Other, AIO Travel Grant ESMO 2023: Amgen, AstraZeneca, Daiichi Sankyo, Janssen-Cilag, Roche Pharma, Takeda Pharma. M. Collienne: Financial Interests, Personal, Invited Speaker: RG Gesellschaft für Information und Organisation mbH; Financial Interests, Institutional, Other, local subinvestigator: AbbVie, MSD Sharp & Dohme GmbH, Pharma Mar, Roche, IOVANCE biotherapeutics; Financial Interests, Institutional, Local PI: Servier, Roche. T.R. Overbeck: Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, Boehringer Ingelheim, Eli Lilly, Merck, MSD, Novartis, Roche, Takeda; Financial Interests, Personal, Other, travel support: AstraZeneca, Boehringer-Ingelheim, Janssen-Cilag, Amgen, Daiichi Sankyo. C. Kropf: Financial Interests, Personal, Advisory Board: Amgen, AstraZeneca, AstraZeneca, Boehringer Ingelheim, BMS, Daiichi Sankyo, Lilly, Novartis, MSD, Pfizer, Roche, Sanofi, Takeda; Financial Interests, Personal, Invited Speaker: Amgen, Art Tempi, Boehringer Ingelheim, BMS, Daiichi Sankyo, Lilly, Novartis, MSD, Pfizer, Regeneron, Roche, Sanofi, Streamed up, Takeda; Financial Interests, Personal, Other, Reporting from conferences as an expert: Onkowissen; Financial Interests, Institutional, Local PI: AstraZeneca, Novartis. M. Reck: Financial Interests, Personal, Invited Speaker: Amgen, AstraZeneca, BMS, Boehringer-Ingelheim, Lilly, MSD, Merck, Novartis, Regeneron, Roche, Sanofi, GSK, Pfizer; Financial Interests, Personal, Advisory Board: Amgen, AstraZeneca, BMS, BioNTech, Boehringer-Ingelheim, Daiichi Sankyo, Gilead, MSD, Mirati, Pfizer, Regeneron, Roche, Sanofi, GSK, Lilly; Financial Interests, Personal, Other, Member of DMSB: Daiichi Sankyo; Financial Interests, Personal, Coordinating PI: AstraZeneca; Financial Interests, Institutional, Steering Committee Member: Amgen, Boehringer-Ingelheim, BeiGene, Daiichi Sankyo, GSK, BMS, Lilly, MSD, Regeneron, Roche; Financial Interests, Institutional, Local PI: Pfizer Seagen. All other authors have declared no conflicts of interest.