Lung Cancer

PD 18 - Lung 5 - Poster Discussion - SBRT

1158 - Real World Immunotherapy Response and Pulmonary Toxicity in Patients Treated with Chest Radiation Therapy

Wednesday, October 24
2:00 PM - 2:06 PM
Location: Room 217 C/D

Real World Immunotherapy Response and Pulmonary Toxicity in Patients Treated with Chest Radiation Therapy
D. Glick, E. S. Wai, E. Brooks, D. Fenton, L. Fiorino, G. Geller, Z. Poonja, and D. Ksienski; BC Cancer, Victoria, BC, Canada

Purpose/Objective(s): Pivotal clinical trials (KEYNOTE-001) have demonstrated improved response and increased pulmonary toxicity in non-small cell lung cancer (NSCLC) patients treated with both radiation therapy (RT) and immunotherapy (IO). The purpose of this study was to document pulmonary toxicity and response rates in patients receiving both RT and IO in routine clinical practice.

Materials/Methods: All metastatic NSCLC patients treated with nivolumab or pembrolizumab between 11/2015 and 10/2017 in one Canadian province were identified. Demographic, tumor, treatment, toxicity, and response data were collected. Fisher’s Exact Test and Chi Squared Test were used to assess the relationship between treatment characteristics and outcome.

Results: 271 patients treated with IO were identified. Median follow up was 10 months. 170 patients (63%) received thoracic RT; 65 received curative intent RT, including 4 who received stereotactic RT. In total, 207 courses of thoracic RT were delivered; 25 patients received 2 courses, 6 received >2 courses. Median RT dose was 30 Gy (range: 4-70 Gy). There was no difference in physician assessed response rates in patients treated with chest RT compared to those not treated with RT (55% vs 45%, χ2 test p=0.12). Ten patients (3%) developed pneumonitis while on IO; 2 grade 1, 4 grade 2, 1 grade 3, 1 grade 4 and 2 grade 5. Both cases of grade 5 pneumonitis were in patients treated with previous chest RT, including one treated curatively. There was no difference in pneumonitis rates in patients treated with thoracic RT compared to those not treated with RT (4.1% vs 3.0%, p=0.74). Radical intent RT (3.1% vs 3.9%, p=1.0), conformal RT (5.0% vs 2.9%, p=0.50) and VMAT (4.8% vs 3.4%, p=0.70) were not associated with increased toxicity.

Conclusion: In keeping with previous clinical trials, pneumonitis was a rare complication in this real world cohort. There was no difference in response rates or pneumonitis rates with IO between those treated with or without thoracic RT.

Author Disclosure: D. Glick: None. E. Brooks: None. L. Fiorino: None. D. Ksienski: None.

Daniel Glick, MD, FRCPC

Disclosure:
No relationships to disclose.

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