scholarly journals Tumor burden as possible biomarker of outcome in advanced NSCLC patients treated with immunotherapy: a single center, retrospective, real-world analysis

2021 ◽  
Author(s):  
Edoardo Lenci ◽  
Giulia Marcantognini ◽  
Valeria Cognigni ◽  
Alessio Lupi ◽  
Silvia Rinaldi ◽  
...  
Keyword(s):  
Real World ◽  
Advanced Nsclc ◽  
Eastern Cooperative Oncology Group ◽  
Tumor Burden ◽  
Prognostic Impact ◽  
Second Line ◽  
Significant Difference ◽  
Metastatic Sites ◽  
Nsclc Patients ◽  
Sites Of Metastases

Aim: The role of tumor burden (TB) for patients with non-small cell lung cancer (NSCLC) receiving immunotherapy is still unknown. The aim of this analysis was to analyze the prognostic value of TB in a real-world sample of advanced NSCLC patients. Methods: Sixty-five consecutive patients with advanced NSCLC treated with immunotherapy as first or second line therapy were retrospectively analyzed between August 2015 and February 2018. TB was recorded at baseline considering sites and number of metastases, thoracic vs. extrathoracic disease, measurable disease (MD) vs. not-MD (NMD) and evaluating dimensional aspects as maximum lesion diameter (cut-off = 6.3 cm), sum of the 5 major lesions diameters (cut-off = 14.3 cm), and number of sites of metastases (cut-off > 4). All cut-offs were calculated by receiver operating characteristic curves. Median overall survival (OS) was estimated using Kaplan-Meier method. A Cox regression model was carried out for univariate and multivariate analyses. Results: Median age was 70 years and most patients (86.2%) had a good performance status (PS-Eastern Cooperative Oncology Group < 2). No significant difference in OS was noted between subgroups of patients according to TB. Bone metastases (BM) had a negative prognostic impact [median OS (mOS), 13.8 vs. 70.0 months, P = 0.0009; median progression free survival in the second line (mPFS2) 2.97 vs. 8.63 months; P = 0.0037]. Patients with NMD had a poorer prognosis (mOS, 15.9 months vs. not reached, P < 0.0001; mPFS2 3.8 vs. 12.2 months; P = 0.0199). Patients with disease limited to the thorax had a better prognosis compared to patients with involvement of extrathoracic sites (mOS, 70 vs. 17.3 months; P = 0.0136). Having more than 4 metastatic sites resulted as a negative prognostic factor (mOS, 15.9 vs. 25.2 months; P = 0.0106). At multivariate analysis, BM, NMD, extrathoracic disease and number of sites of metastases > 4 were negative prognostic factors (P < 0.0001). Conclusions: This study underlines the negative prognostic impact of specific metastatic sites, presence of NMD and extrathoracic disease in advanced NSCLC patients treated with immunotherapy. However, TB does not appear to affect the outcome of these patients.

scholarly journals Distant Metastases in Patients with Intrahepatic Cholangiocarcinoma: Does Location Matter? A Retrospective Analysis of 370 Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Felix Hahn ◽  
Lukas Müller ◽  
Aline Mähringer-Kunz ◽  
Yasemin Tanyildizi ◽  
Daniel Pinto dos Santos ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Tertiary Care ◽  
Distant Metastases ◽  
Tumor Burden ◽  
Hepatic Tumor ◽  
Prognostic Impact ◽  
Volumetric Assessment ◽  
Significant Difference ◽  
Metastatic Sites ◽  
Intrahepatic Tumor

Background. Intrahepatic cholangiocarcinoma (ICC) is an aggressive tumor entity, and distant metastases are common. However, studies investigating patterns and clinical relevance of distant metastases are rare. Therefore, we aimed to analyze occurrence, location, and prognostic impact of distant metastases on overall survival (OS). Methods. Between 1997 and 2018, 417 patients with ICC were treated at our tertiary care center. Distant metastases and intrahepatic tumor burden were retrospectively evaluated in a longitudinal approach using volumetric assessment of cross-sectional imaging studies and all available medical/histopathological reports. Results. Finally, 370 patients with histopathologically confirmed ICC were included. Of these, 186 showed distant metastases, either initially (n = 59) or during follow-up (n = 127). The most common metastatic sites were the lung (n = 105), peritoneum (n = 81), and bone (n = 50). After detection of lung metastases, the residual median OS was 5.3 months; followed by peritoneal metastases, 4.5 months, and bone metastases, 4.4 months (P=0.17). At the time of first metastatic occurrence, residual OS according to intrahepatic tumor burden of <25%, 25–50%, and >50% was 6.5 months, 4.9 months, and 1.2 months, respectively (P<0.001). In multivariate hazard regression, hepatic tumor burden, liver function, and subsequent treatment were significant predictors of survival. Conclusions. During the disease course, every second patient developed extrahepatic metastases. While the presence of distant metastases was associated with poor patient outcomes, there was no significant difference between metastatic sites. However, hepatic tumor burden was the life-limiting risk factor in a majority of patients at the time of distant metastatic disease.

scholarly journals A clinical variable‐based nomogram could predict the survival for advanced NSCLC patients receiving second‐line atezolizumab

2021 ◽  
Author(s):  
Xiaoling Shang ◽  
Jianxiang Shi ◽  
Xiaohui Wang ◽  
Chenglong Zhao ◽  
Haining Yu ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Clinical Variable ◽  
Second Line ◽  
Nsclc Patients

Real-world-outcomes for ALK positive advanced NSCLC patients treated in South Yorkshire

Lung Cancer ◽  
2021 ◽  
Vol 156 ◽  
pp. S39
Author(s):  
Roseleen Sheehan ◽  
Dina Barakat ◽  
Jamie Bhakta ◽  
Danielle Meehan ◽  
Farah Shah ◽  
...  
Keyword(s):  
Real World ◽  
Advanced Nsclc ◽  
Alk Positive ◽  
Nsclc Patients

scholarly journals P1.01-04 Treatment Patterns and Overall Survival Following Biomarker Testing in Real-World Advanced NSCLC Patients

2018 ◽  
Vol 13 (10) ◽  
pp. S459-S460 ◽  
Author(s):  
F. Barlesi ◽  
L. Paz-Ares ◽  
D. Page ◽  
A. Shewade ◽  
P. Lambert ◽  
...  
Keyword(s):  
Overall Survival ◽  
Real World ◽  
Advanced Nsclc ◽  
Treatment Patterns ◽  
Biomarker Testing ◽  
Nsclc Patients

scholarly journals P1.13-11 PRO-CTCAE Toxicities in Advanced NSCLC Patients with EGFR Mutations: A Real World Assessment

2018 ◽  
Vol 13 (10) ◽  
pp. S586
Author(s):  
K. Hueniken ◽  
M. Hurry ◽  
S. Jiang ◽  
C. Labbe ◽  
M.C. Brown ◽  
...  
Keyword(s):  
Real World ◽  
Advanced Nsclc ◽  
Egfr Mutations ◽  
Nsclc Patients

Circulating Endothelial Cells for Evaluation of Tumor Response in Non-Small Cell lung cancer patients receiving first-line chemotherapy

2015 ◽  
Vol 30 (4) ◽  
pp. 374-381
Author(s):  
Fadi Najjar ◽  
Ghassan Al-Massarani ◽  
Israa Banat ◽  
Moosheer Alammar
Keyword(s):  
Advanced Nsclc ◽  
Tumor Response ◽  
Small Cell ◽  
Percentage Change ◽  
Circulating Endothelial Cells ◽  
Small Cell Lung ◽  
First Line ◽  
Significant Difference ◽  
Nsclc Patients ◽  
Line Chemotherapy

Background Circulating endothelial cells (CECs) reflect the neovascularization in the tumor mass. We therefore investigated the potential role of CEC kinetics after first-line chemotherapy in advanced non-small cell lung cancer (NSCLC) patients. Methods Peripheral blood samples were obtained from 45 healthy subjects and 51 naïve patients with advanced NSCLC. Quantification of CD146+ CECs was performed using immunomagnetic separation (IMS). Results Pretreatment and posttreatment CEC levels in NSCLC patients were significantly higher than in healthy subjects (p<0.0001). An objective response was achieved after chemotherapy with partial response (PR) or stable disease (SD) in 26 patients, whereas the remaining 25 patients had progressive disease (PD). Baseline CEC levels were significantly higher in PR/SD patients than in PD patients (p = 0.039). After chemotherapy, CEC count significantly decreased in PR/SD patients (p = 0.014) and increased in patients with PD (p = 0.019). Moreover, there was a significant difference in the percentage change of CEC counts between the 2 groups (p = 0.0016). No significant difference in the median progression-free survival and overall survival (OS) was observed between patients with high baseline CEC counts and those with low baseline CEC levels. However, patients with high percentage change in CEC count had longer OS than those with low percentage change after chemotherapy (p = 0.05). Conclusions Changes in CEC counts after chemotherapy reflect tumor response in advanced NSCLC patients. Moreover, high percentage changes in CEC counts after chemotherapy may predict longer OS in advanced NSCLC. High baseline CEC levels might be an indicator of tumor response in advanced NSCLC patients after first-line chemotherapy.

scholarly journals The Agnostic Role of Site of Metastasis in Predicting Outcomes in Cancer Patients Treated with Immunotherapy

Vaccines ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 203 ◽  
Author(s):  
Andrea Botticelli ◽  
Alessio Cirillo ◽  
Simone Scagnoli ◽  
Bruna Cerbelli ◽  
Lidia Strigari ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Predictive Factor ◽  
Univariate Analysis ◽  
Eastern Cooperative Oncology Group ◽  
Tumor Burden ◽  
Clinicopathological Parameters ◽  
Anatomical Site ◽  
Metastatic Sites ◽  
Ecog Ps

Immune checkpoint inhibitors have revolutionized treatment and outcome of melanoma and many other solid malignancies including non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC). Unfortunately, only a minority of patients have a long-term benefit, while the remaining demonstrate primary or acquired resistance. Recently, it has been demonstrated that the prevalence of programmed death-ligand 1 (PD-L1) and tumor-infiltrating lymphocytes (TILs) varies based on the anatomical site of metastases. In particular, liver seems to have more immunosuppressive microenvironment while both the presence of lymph nodal disease and lung metastases seem to have the highest prevalence of PD-L1 and TILs. The aim of the present study is to investigate the possible role of site of metastases as a predictive factor for response or resistance to immunotherapy in several types of cancer. In this multicenter retrospective study, we enrolled patients with metastatic NSCLC, melanoma, RCC, urothelial, merkel carcinoma, and colon cancer who received immunotherapy from April 2015 to August 2019. Major clinicopathological parameters were retrieved and correlated with patients’ survival outcomes in order to assess their prognostic value and build a useful tool to assist in the decision-making process. A total of 291 patients were included in this study. One hundred eighty-seven (64%) patients were male and 104 (36%) female. The tumor histology was squamous NSCLC in 56 (19%) patients, non-squamous NSCLC in 99 (34%) patients, melanoma in 101 (35%) patients, RCC in 28 (10%) patients, and other tumors in the remaining 7 (2%) patients. The number of metastatic sites was 1 in 103 patients (35%), 2 in 104 patients (36%) and 3 in 84 patients (29%). Out of 183 valuable patients, the entity of response was complete response (CR), partial response (PR), stable disease (SD), and progression disease (PD) in 15, 53, 31, and 79 patients, respectively. Using an univariate analysis (UVA), tumor burden (p = 0.0004), the presence of liver (p = 0.0009), bone (p = 0.0016), brain metastases (p < 0.0001), the other metastatic sites (p = 0.0375), the number of metastatic sites (p = 0.0039), the histology (p = 0.0034), the upfront use of immunotherapy (p = 0.0032), and Eastern Cooperative Oncology Group (ECOG) Perfomance status (PS) ≥ 1 (p < 0.0001) were significantly associated with poor overall survival (OS). Using a multivariate analysis (MVA) the presence of liver (p = 0.0105) and brain (p = 0.0026) metastases, the NSCLC diagnosis (p < 0.0001) and the ECOG PS (p < 0.0001) resulted as significant prognostic factors of survival. Regarding the progression free survival (PFS), using a UVA of the tumor burden (p = 0.0004), bone (p = 0.0098) and brain (p = 0.0038) metastases, the presence of other metastatic sites (p = 0.0063), the number of metastatic sites (p = 0.0007), the histology (p = 0.0007), the use of immunotherapy as first line (p = 0.0031), and the ECOG PS ≥ 1 (p ≤ 0.0001) were associated with a lower PFS rate. Using an MVA, the presence of brain (p = 0.0088) and liver metastases (p = 0.024) and the ECOG PS (p < 0.0001) resulted as predictors of poor PFS. Our study suggests that the site of metastases could have a role as prognostic and predictive factor in patients treated with immunotherapy. Indeed, regardless of the histology, the presence of liver and brain metastases was associated with a shorter PFS and OS, but these results must be confirmed in further studies. In this context, a deep characterization of microenvironment could be crucial to prepare patients through novel strategies with combination or sequential immunotherapy in order to improve treatment response.

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