P2.07-005 Impact of Baseline Leptomeningeal and Brain Metastases on Immunotherapy Outcomes in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients

e21181 Background: This study aimed to explore cerebrospinal fluid (CSF) and peripheral blood-based liquid biopsy before and after radiotherapy of non-small cell lung cancer (NSCLC) brain metastases. Methods: Thirty NSCLC patients with brain metastases receiving brain radiotherapy were enrolled in this study. CSF and peripheral blood were collected at baseline, 24 hours (T0) and 28 days (T28) after treatment. Somatic mutations and T-cell receptor (TCR) sequences were identified by high-throughput sequencing in both compartments. Results: At baseline, identical mutations shared by paired blood and CSF emerged in nine patients (30%). Dimension reduction analysis identified distinct signatures of V and J gene recombination in blood and CSF TCR sequences. Throughout treatment, both compartments experienced a TCR diversity decrease, however, the degradation of low-abundance clones and the expansion of emerging clones might be two separate processes underwent in blood and CSF, respectively. Diversity changes and ctDNA in blood were possibly related to pulmonary responses, while the increase of maximal clone abundance in CSF might indicate a favorable intracranial response. Blood-ctDNA clearance at T28 was significantly associated with better overall survival (OS, HR = 4.027, p = 0.028) and progression-free survival (PFS, HR = 4.176, p = 0.024), and superior blood TCR diversity at T28 against baseline was associated with longer OS (HR = 5.700, p = 0.039). Combined blood factors achieved a better predictive power (OS, HR = 10.53, p < 0.001; PFS, HR = 4.843, p < 0.001). Patients with increase of maximal clone abundance ≥ 50 in CSF also had a better intracranial PFS (HR = 8.320, p = 0.011). The predictive effects of these markers were independent of other clinical factors in multivariate Cox analysis. Conclusions: CSF and peripheral blood were independent compartments showing disparate genomic and immune signatures. Longitudinal surveillance of both compartments could be a promising method to predict clinical outcomes for NSCLC patients with brain metastases.

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P14.97 High risk of venous thromboembolism in patients with brain metastases from non-small cell lung cancer

Neuro-Oncology ◽

10.1093/neuonc/noz126.332 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii91-iii91

Author(s):

P Mir Seyed Nazari ◽

C Ay ◽

A Steindl ◽

B Gatterbauer ◽

J M Frischer ◽

...

Keyword(s):

Lung Cancer ◽

Venous Thromboembolism ◽

High Risk ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Carcinoma ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Nsclc Patients

Abstract BACKGROUND Venous thromboembolism (VTE) is a common complication in patients with cancer. In general, patients with metastatic disease are at highest risk. Lung cancer belong to those tumor entities with a particularly high risk of VTE, ranging between 3–13.8%. However, little is known about the VTE rate in lung cancer patients with brain metastases. MATERIAL AND METHODS Our study was conducted in the framework of the Vienna Brain Metastasis Registry. Clinical data and VTE events during the course of the disease were recorded via retrospective chart review. In this analysis, non-small cell lung cancer (NSCLC) patients with a resection of brain metastases at the Medical University of Vienna between 2006 and 2010 were included. RESULTS In total, 69 NSCLC patients with brain metastases were analyzed. Overall, 69.6% (48/69) patients had an adenocarcinoma, 13% (9/69) a squamous cell carcinoma, 8.7% (6/69) a large cell carcinoma and 8.7% (6/69) other primary tumor histologies. After cancer diagnosis, 20.3% (14/69) patients developed VTE during the course of the disease. Of those, 85.7% (12/14) thromboembolic events occurred after the diagnosis of brain metastases. CONCLUSION Based on our data, patients with brain metastases from NSCLC have a very high VTE risk. Further investigations are needed in order to identify patients with distinct VTE risk profiles. Patients at high risk might potentially benefit from primary thromboprophylaxis over the high risk of intracerebral bleeding.

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9055 Outcome of non-small-cell lung cancer (NSCLC) patients treated for brain metastases (BM) in a single institution

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(09)71768-9 ◽

2009 ◽

Vol 7 (2) ◽

pp. 521-522

Author(s):

M. Chaubet ◽

N. Abedallaa ◽

C. Le Pechoux ◽

D. Planchard ◽

J.C. Soria ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Single Institution ◽

Nsclc Patients

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An examination of the recruitment of non-small cell lung cancer (NSCLC) patients with brain metastases to QUARTZ and TACTIC clinical trials in a UK cancer centre

Lung Cancer ◽

10.1016/s0169-5002(10)70096-9 ◽

2010 ◽

Vol 67 ◽

pp. S31

Author(s):

N. Bayman ◽

O. Ferguson ◽

C. Faivre-Finn

Keyword(s):

Lung Cancer ◽

Clinical Trials ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Cancer Centre ◽

Nsclc Patients

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Alectinib Treatment of ALK Positive Non Small Cell Lung Cancer Patients with Brain Metastases: Our Clinical Experience

PRILOZI ◽

10.2478/prilozi-2020-0030 ◽

2020 ◽

Vol 41 (2) ◽

pp. 29-36

Author(s):

Simonida Crvenkova

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Performance Status ◽

Small Cell ◽

Poor Performance Status ◽

Small Cell Lung ◽

Anaplastic Lymphoma ◽

Nsclc Patients

AbstractSummary: Anaplastic lymphoma kinase (ALK) rearrangement is identified in approximately 3-7% of all metastatic non-small cell lung cancer (NSCLC) patients, and ALK tyrosine kinase inhibitors (TKIs) have revolutionized the management of this subset of lung cancer cases.Purpose: This study aims to show alectinib (TKI) effectiveness and safety with focus on alectinib intracranial efficacy for ALK+ NSCLC patients.Case presentation: Patient 1 was a 46-year-old woman diagnosed with non-small cell lung cancer with an echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene (ALK+). She presented with intracranial and liver metastases and poor performance status of ECOG 3. Alectinib was initiated as a second line therapy, after whole brain irradiation and discontinuation of first line chemotherapy after two cycles, due to the central nervous system progression and liver metastases. Good response was consequently achieved, characterized with improved overall performance and without significant adverse events.Patient 2 was a 53-year old man with left sided lung adenocarcinoma surgically treated in 2017. Post-operative pTNM stage was IIB with a positive resection margin- R1. He received adjuvant chemotherapy and radiotherapy. In 2019, after two and half years of being disease free, he presented with severe cerebral symptoms leading to poor performance status. CT scan of the brain showed multiple brain metastases. He was treated with first line alectinib after completion of whole brain radiotherapy. In 5 months period he got significantly better and able for work again.Conclusions: We recommend alectinib as a first and second line treatment approach for ALK+ NSCLC patients, in particular the ones with brain metastases at the time of diagnosis and poor PS.

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Case-control study of prophylactic cranial irradiation in nonmetastatic non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.7050 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 7050-7050

Author(s):

Simon Cheng ◽

Michael Nino Corradetti ◽

David Paul Horowitz ◽

Eric Xanthopoulos ◽

Amanda Lusa ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Cranial Irradiation ◽

Prophylactic Cranial Irradiation ◽

Small Cell ◽

Primary Therapy ◽

Small Cell Lung ◽

Nsclc Patients

7050 Background: Prophylactic cranial irradiation (PCI) reduces the incidence of brain metastases in NSCLC patients after primary therapy, but its impact on survival is uncertain. We report on the largest study of survival in patients treated with and without PCI for non-small cell lung cancer (NSCLC). Methods: We reviewed 17 Surveillance, Epidemiology and End Results (SEER) registries for a retrospective study on patients who had PCI as part of their primary treatment for NSCLC from 1988 - 97. Cases were limited to those with non-metastatic (Stage I-III) NSCLC. To balance the cohorts, we matched each PCI patient with four non-PCI patients on stage, histology, race and sex. Associations between treatment type, clinical factors, and demographics were assessed using the Chi-squared test. Survival time was calculated as the number of months from diagnosis to the date of death. Survival was censored as of the last month when patients were known to be alive. Overall (OS) and cancer cause-specific survival (CSS) were investigated using the Kaplan-Meier, competing risks, Cox proportional hazards, and log-rank tests. Results: We found 472 PCI matched to 1,888 non-PCI patients. Characteristics were balanced across groups: race (p = 1.00), sex (p = 0.95), histology (p = 1.00), stage (p = 1.00), and surgery (p = 0.81). PCI group was younger, median age 64 vs 68 (p < 0.01). PCI vs no PCI median OS was 8 vs 10 months (p < 0.01). OS was 14% vs 28% at 2 years and 5% vs 12% at 5 years, PCI vs no PCI respectively (p < 0.01). Stage III OS was also different; 10% vs 21% at 2 years, PCI vs no PCI respectively (p < 0.01). Median CSS was the same at 9 months in both groups. Median follow-up was 14 years. Conclusions: PCI was not associated with improved OS or CSS in these NSCLC patients, and PCI may have a detrimental effect on OS. In limited-stage small cell lung cancer, a retrospective SEER analysis during the 1988 – 97 period showed a survival benefit in treated patients with PCI, which has been confirmed with prospective studies. To date, 4 prospective trials examining PCI for NSCLC have shown a reduced incidence of brain metastases, but the effect on survival is unclear. Further investigation is needed to determine whether PCI for NSCLC increases the risk of other causes of death.

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