ELCC 2017 Unveils New Research Regarding Screening, Immunotherapy, Treatment Planning, and More

By Keightley Amen, BA, ELS

In early May, at the seventh annual European Lung Cancer Conference (ELCC) in Geneva, Switzerland, multidisciplinary lung cancer professionals gathered to learn about the latest research advances in the field.

Men Require More Frequent Screening for Lung Cancer
A study presented at ELCC retrospectively reviewed patients who underwent chest computed tomography (CT) screening to investigate gender differences in screening intervals, stage, and pathology in newly developed lung cancer.1

It found that the average time between a previous lung cancer scan and a scan that diagnosed lung cancer was significantly longer in women (5.6 years) than in men (3.6 years). However, lung cancer stage at diagnosis was higher in men: 82% of lung cancers diagnosed in women were stage I compared to 49% in men. In addition, pathological analyses showed that solid nodule (72%) was the most common finding in men and ground glass opacity nodule (45%) was the most common in women.

The study suggests that follow-up scans for women might be necessary only every two to three years.

White Blood Cell Counts May Predict Response to Immunotherapy
Another study presented at ELCC found that white blood cell counts can predict whether patients with lung cancer will benefit from immunotherapy.2

The researchers assessed 54 patients with non-small cell lung cancer (NSCLC) who received nivolumab 3 mg/kg every 14 days. They measured white blood cell counts at baseline, after two nivolumab cycles, and after four nivolumab cycles, then compared counts between nivolumab responders and non-responders.

White blood cell counts at baseline and during therapy predicted whether patients would respond. Furthermore, greater number and concentration of natural killer cells at baseline were associated with response, as were an increase in natural killer cells during treatment and a greater number and concentration of CD8-positive T cells that expressed PD-1.

Osimertinib Reduces Symptom Burden and Improves Functioning
A recent analysis of patient-reported outcomes from the AURA3 phase III clinical trial found that osimertinib treatment improves cancer-related symptoms in patients with advanced epidermal growth factor receptor (EGFR) mutation NSCLC who progressed after first-line EGFR tyrosine kinase inhibitor therapy.3

According to previously released results, patients taking osimertinib had significantly longer progression-free survival than those on chemotherapy (10.1 months versus 4.4 months). The latest analysis found that osimertinib also reduced the symptoms of lung cancer, primarily appetite loss, fatigue, breathlessness, and chest pain. Osimertinib also significantly improved global health status, physical functioning, role functioning, and social functioning.

Pretreatment with PD-1/PD-L1 Checkpoint Inhibitor Boosts Salvage Chemotherapy in Patients with Advanced NSCLC
Another study in NSCLC reported that patients with advanced disease who require salvage chemotherapy are 30% more likely to achieve a partial response if they have been pretreated with a PD-1/ PD-L1 checkpoint inhibitor compared to those who have not.4

The retrospective analysis assessed patients with stage IV NSCLC and controls: 67 had been previously treated with a PD-1/PD-L1 inhibitor, and the remaining 15 served as controls. All had been pretreated with chemotherapy. CT scans within the first month and then every six weeks showed a significantly higher partial response rate in those who had received a PD-1/PD-L1 inhibitor compared to controls (27% versus 7%). Stable disease was seen in 51% of cases and 53% of controls, and progressive disease was seen in 22% of cases versus 40% of controls.

More Specific Criteria May Help Prolong Immunotherapy After Disease Progression
Additional research regarding immunotherapy has found that some patients with advanced lung cancer may benefit from prolonged immunotherapy even after the disease has progressed as evaluated by standard criteria. The ELCC presentation provided provide new, more specific criteria that may allow certain patients to continue treatment.5

The current Response Evaluation Criteria in Solid Tumours (RECIST) evaluates changes in tumor size and identifies whether patients are responding to treatment or progressing. According to RECIST, when a CT scan finds that a tumor is growing and a patient is progressing, treatment is changed to best supportive care or a different drug.

In a post hoc analysis of the phase 2 POPLAR trial, researchers assessed response to treatment with RECIST versus immune-related RECIST criteria. The study allowed patients to continue atezolizumab treatment if they had not progressed according to immune-related RECIST and had no major toxicities, even if RECIST indicated progression.

The newly reported research evaluated overall survival and performance status in the 61 patients who continued atezolizumab after standard progression. Tumors stabilized or shrunk in 82%; median overall survival was 11.8 months and objective response rate increased when immune-related RECIST was used.

Flu Vaccine May Be Contraindicated with PD-1/PD-L1 Checkpoint Inhibitors
Patients with cancer receiving PD-1/ PD-L1 checkpoint inhibitors may be at increased risk of adverse events after receiving the seasonal influenza vaccination.6

Twenty-three patients with cancer who were receiving nivolumab or pembrolizumab were vaccinated with a trivalent influenza vaccination and followed for safety, efficacy, and frequency of immune-related adverse events (irAEs). Ten controls received the same vaccine.

All patients showed adequate immune response to the vaccine, none experienced severe adverse events attributable to the vaccine, and none developed influenza infection. However, there was an unusual high frequency of irAEs (52.2%), and six patients (26.1%) experienced severe grade 3 or 4 irAEs.

The most common were skin rashes and arthritis (13% each), followed by colitis and encephalitis (8.7% each), hypothyroidism, pneumonitis, and neuropathy (4.3% each).

References
1. Koo HJ. Optimal screening interval for detection of newly developed lung cancer: Comparison of sexual difference. Abstract 18PD presented at poster discussion session: ELCC; May 6, 2017; Geneva, Switzerland.

2. Tiseo M. Circulating immune-profile as predictor of outcome in NSCLC patients treated with nivolumab. Abstract 30PD presented at poster discussion session: ELCC; May 6, 2017; Geneva, Switzerland.

3. Lee C. Patient-reported symptoms and impact of treatment with osimertinib versus chemotherapy for advanced non-small-cell lung cancer. Abstract 85O presented at proffered paper session: ELCC; May 6, 2017; Geneva, Switzerland.

4. Rothschild S. Response to salvage chemotherapy following exposure to PD-1/PD-L1 inhibitors in patients with NSCLC. Abstract 91PD presented at poster discussion session: ELCC; May 7, 2017; Geneva, Switzerland.

5. Artal-Cortes A. Evaluation of non-classical response by immune-modified RECIST and efficacy of atezolizumab beyond disease progression in advanced NSCLC: Results from the randomized phase II study POPLAR. Abstract 96PD presented at poster discussion session: ELCC; May 6, 2017; Geneva, Switzerland.

6. Rothschild S. Immune response and adverse events to influenza vaccine in cancer patients undergoing PD-1 blockade. Abstract 112P_PR on poster display: ELCC; May 6, 2017; Geneva, Switzerland.