Abstract 1278P
Background
A novel progression pattern defined HPD has been reported in ∼14-26% and ∼5% of pre-treated NSCLC pts receiving single-agent ICI or chemotherapy (CT) respectively. The rate of HPD upon first-line ICI as single-agent or in combination with CT is currently unknown.
Methods
Data were retrospectively collected from NSCLC pts treated with single-agent ICI alone (01/2016-01/2020) or in combination with CT (09/2016-04/2020) in two institutions [Istituto dei Tumori di Milano (INT) and Gustave Roussy (GR)]. HPD was defined according to dynamic indexes [(i.e. delta tumor growth rate (TGR) (Ferrara et al.), TGR ratio (Champiat et al.), tumor growth kinetics (Saada-Bouzid et al.)] or to clinical/radiological criteria (Lo Russo et al), as previously reported. At least one radiological evaluation upon ICI was required for all definitions. Correlations between HPD and categorical variables were performed by Fisher test. Median overall survival (mOS) curves were estimated by Kaplan Meier and compared by log-rank.
Results
94 NSCLC pts (63 from INT, 31 from GR) were included. 44 received single-agent ICI, 50 ICI-CT combinations. In the single-agent ICI cohort all pts had PD-L1 expression (TPS) ≥50%. Overall response rate (ORR) and mOS were 48% and 38.8 months (m) (95%CI NR-NR), respectively. HPD was reported in 7 (16%) pts, 5 (11.3%) were HPD according to only clinical/radiological criteria, 2 (4.5%) pts were HPD according to both clinical/radiological criteria and at least one dynamic index. Pts’ characteristics were uniformly distributed except for a higher rate of pts with ECOG performance >1 among HPD (57.1% vs 8.3%, p=0.008). At a median follow-up of 20.8 m (95%CI 15.9-25.8), HPD was associated with worse mOS compared to non-HPD [4.2 m (95%CI 1.3-7.1) vs 38.8 m (95%CI NR-NR), p<0.0001]. In the ICI-CT cohort, 22% of pts had PD-L1 TPS ≥50%. HPD was reported in 3 (6%) pts by clinical/radiological criteria and did not correlate with pts’ characteristics. No HPD was reported according to dynamic indexes.
Conclusions
In first-line setting, HPD occurs in up to 16% PD-L1 TPS≥50% NSCLC pts treated with single-agent ICI, whereas it is a rare phenomenon upon ICI-CT combinations.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
R. Ferrara: Advisory/Consultancy: MSD; Travel/Accommodation/Expenses: Pfizer. F. Facchinetti: Honoraria (self): BMS; Honoraria (self): Roche. D. Signorelli: Advisory/Consultancy: AstraZeneca; Travel/Accommodation/Expenses: BMS; Travel/Accommodation/Expenses: Roche; Travel/Accommodation/Expenses: Pfizer. A. Prelaj: Travel/Accommodation/Expenses: roche; Advisory/Consultancy: AstraZeneca; Honoraria (self): BMS. P. Lavaud: Travel/Accommodation/Expenses: AstraZeneca. F. Barlesi: Honoraria (self): AstraZeneca; Honoraria (self): BMS; Honoraria (self): Roche; Honoraria (self): MSD; Honoraria (self): Eli Lilly. D. Planchard: Honoraria (institution), Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Honoraria (institution), Advisory/Consultancy: BMS; Honoraria (self), Advisory/Consultancy: Eli Lilly; Honoraria (self), Advisory/Consultancy: Merck; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Roche. J-C. Soria: Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: MSD; Advisory/Consultancy: Eli Lilly; Advisory/Consultancy: Roche/Genentech; Shareholder/Stockholder/Stock options, Full/Part-time employment, Officer/Board of Directors: AstraZeneca; Shareholder/Stockholder/Stock options: Gritstone. M.C. Garassino: Advisory/Consultancy: Boehringer Ingelheim; Advisory/Consultancy: Novartis; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer ; Advisory/Consultancy: Inivata; Advisory/Consultancy: Sanofi Aventis; Advisory/Consultancy: Celgene; Advisory/Consultancy: Bayer; Advisory/Consultancy: MSD ; Advisory/Consultancy: AstraZeneca; Honoraria (self): Takeda; Advisory/Consultancy: Jansenn ; Advisory/Consultancy: GlaxoSmithKline; Speaker Bureau/Expert testimony: Otsuka Pharma; Advisory/Consultancy: Eli Lilly; Advisory/Consultancy: Roche ; Advisory/Consultancy: BMS; Advisory/Consultancy: Blueprint Medicine. B. Besse: Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): BMS; Research grant/Funding (institution): Eli Lilly; Research grant/Funding (institution): Roche; Research grant/Funding (institution): Merck. G. Lo Russo: Advisory/Consultancy: MSD; Advisory/Consultancy: AstraZeneca; Speaker Bureau/Expert testimony: BMS. All other authors have declared no conflicts of interest.