View in EDS

Does Disease Burden on PET Predict Outcomes for Advanced NSCLC Patients Treated With First-Line Immunotherapy?

Saved in:
Bibliographic Details
Title: Does Disease Burden on PET Predict Outcomes for Advanced NSCLC Patients Treated With First-Line Immunotherapy?
Authors: Andraos, T.Y.1 (AUTHOR), Halmos, B.2 (AUTHOR), Cheng, H.2 (AUTHOR), Huntzinger, C.3 (AUTHOR), Shirvani, S.3 (AUTHOR), Ohri, N.1 (AUTHOR)
Source: International Journal of Radiation Oncology, Biology, Physics. 2021 Supplement, Vol. 111 Issue 3, pe428-e428. 1p.
Subjects: Non-small-cell lung carcinoma, Overall survival, Proportional hazards models, Prognosis, Disease progression
Abstract: Purpose/objective(s): First-line immunotherapy (IT), with or without chemotherapy (CTX), is now recommended for most patients with advanced non-small cell lung cancer (NSCLC) with no treatable driver mutations. Trials performed before first-line IT became standard suggested that patients with oligometastatic disease (OMD) may have a favorable prognosis and benefit from aggressive local therapy. We reviewed outcomes for NSCLC patients treated with first-line IT at our institution to test the hypothesis that measures of disease burden on staging FDG-PET would have prognostic value and examine if the presence of brain metastases (BM) affects prognosis.Materials/methods: Advanced NSCLC patients who were staged with FDG-PET and treated with first-line IT between 2015 and 2019 were included in this analysis. Patient, disease, and treatment details were collected. A gradient-based segmentation tool was used to delineate each PET-avid extracranial lesion. Number of extrathoracic lesions, composite metabolic tumor volume (MTV), and presence of BM were tabulated. OMD was defined as having 3 or fewer extrathoracic lesions, with any number of thoracic lesions. Progression-free survival (PFS) and overall survival (OS) rates following initiation of IT were evaluated using the Kaplan-Meier method, and predictors of PFS and OS were assessed using Cox proportional hazards models and log rank tests.Results: One hundred twenty-four patients met inclusion criteria, and 1,143 lesions were contoured. Seventy-four patients (60%) had OMD. Median MTV was 88 cc (interquartile range: 33 to 206 cc). Thirty-two patients (26%) had BM. Fifty-eight patients (47%) received IT with CTX. With a median follow-up duration of 17.3 months for surviving patients, the median PFS and OS durations were 8.5 and 36.5 months, respectively. The presence of OMD was associated with favorable PFS (median 13.1 vs. 6.9 months, P = 0.011) and OS (median not reached vs. 20.7 months, P = 0.003). In multivariable models adjusted for performance status, PD-L1 TPS, and receipt of CTX, OMD was associated with favorable PFS (HR = 0.62, P = 0.044) and OS (HR = 0.43, P = 0.018), and high MTV was associated with inferior OS (HR 1.12 per 100 cc, P = 0.048). Among patients who developed progressive disease, the brain was the first site of progression for 12 of 21 patients (57%) with BM at diagnosis and 2 of 55 patients (4%) without BM at diagnosis (P < 0.001). However, the presence of BM at diagnosis was not significantly associated with OS (HR = 0.84, P = 0.642) or PFS (HR = 1.13, P = 0.631) in multivariable models.Conclusion: For advanced NSCLC patients treated with first-line IT, having OMD is a favorable prognostic factor. Volume of disease on FDG-PET could provide additional prognostic information. The presence of brain metastases does not seem to affect outcomes, which may reflect the activity of IT in the central nervous system and should be considered when designing clinical trials. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Engineering Source
FullText Text:
  Availability: 0
Header DbId: egs
DbLabel: Engineering Source
An: 152497260
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Does Disease Burden on PET Predict Outcomes for Advanced NSCLC Patients Treated With First-Line Immunotherapy?
– Name: Author
  Label: Authors
  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Andraos%2C+T%2EY%2E%22&quot;&gt;Andraos, T.Y.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Halmos%2C+B%2E%22&quot;&gt;Halmos, B.&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Cheng%2C+H%2E%22&quot;&gt;Cheng, H.&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Huntzinger%2C+C%2E%22&quot;&gt;Huntzinger, C.&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Shirvani%2C+S%2E%22&quot;&gt;Shirvani, S.&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ohri%2C+N%2E%22&quot;&gt;Ohri, N.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics%22&quot;&gt;International Journal of Radiation Oncology, Biology, Physics&lt;/searchLink&gt;. 2021 Supplement, Vol. 111 Issue 3, pe428-e428. 1p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Non-small-cell+lung+carcinoma%22&quot;&gt;Non-small-cell lung carcinoma&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Overall+survival%22&quot;&gt;Overall survival&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Proportional+hazards+models%22&quot;&gt;Proportional hazards models&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Prognosis%22&quot;&gt;Prognosis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Disease+progression%22&quot;&gt;Disease progression&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: &lt;bold&gt;Purpose/objective(s): &lt;/bold&gt;First-line immunotherapy (IT), with or without chemotherapy (CTX), is now recommended for most patients with advanced non-small cell lung cancer (NSCLC) with no treatable driver mutations. Trials performed before first-line IT became standard suggested that patients with oligometastatic disease (OMD) may have a favorable prognosis and benefit from aggressive local therapy. We reviewed outcomes for NSCLC patients treated with first-line IT at our institution to test the hypothesis that measures of disease burden on staging FDG-PET would have prognostic value and examine if the presence of brain metastases (BM) affects prognosis.&lt;bold&gt;Materials/methods: &lt;/bold&gt;Advanced NSCLC patients who were staged with FDG-PET and treated with first-line IT between 2015 and 2019 were included in this analysis. Patient, disease, and treatment details were collected. A gradient-based segmentation tool was used to delineate each PET-avid extracranial lesion. Number of extrathoracic lesions, composite metabolic tumor volume (MTV), and presence of BM were tabulated. OMD was defined as having 3 or fewer extrathoracic lesions, with any number of thoracic lesions. Progression-free survival (PFS) and overall survival (OS) rates following initiation of IT were evaluated using the Kaplan-Meier method, and predictors of PFS and OS were assessed using Cox proportional hazards models and log rank tests.&lt;bold&gt;Results: &lt;/bold&gt;One hundred twenty-four patients met inclusion criteria, and 1,143 lesions were contoured. Seventy-four patients (60%) had OMD. Median MTV was 88 cc (interquartile range: 33 to 206 cc). Thirty-two patients (26%) had BM. Fifty-eight patients (47%) received IT with CTX. With a median follow-up duration of 17.3 months for surviving patients, the median PFS and OS durations were 8.5 and 36.5 months, respectively. The presence of OMD was associated with favorable PFS (median 13.1 vs. 6.9 months, P = 0.011) and OS (median not reached vs. 20.7 months, P = 0.003). In multivariable models adjusted for performance status, PD-L1 TPS, and receipt of CTX, OMD was associated with favorable PFS (HR = 0.62, P = 0.044) and OS (HR = 0.43, P = 0.018), and high MTV was associated with inferior OS (HR 1.12 per 100 cc, P = 0.048). Among patients who developed progressive disease, the brain was the first site of progression for 12 of 21 patients (57%) with BM at diagnosis and 2 of 55 patients (4%) without BM at diagnosis (P &lt; 0.001). However, the presence of BM at diagnosis was not significantly associated with OS (HR = 0.84, P = 0.642) or PFS (HR = 1.13, P = 0.631) in multivariable models.&lt;bold&gt;Conclusion: &lt;/bold&gt;For advanced NSCLC patients treated with first-line IT, having OMD is a favorable prognostic factor. Volume of disease on FDG-PET could provide additional prognostic information. The presence of brain metastases does not seem to affect outcomes, which may reflect the activity of IT in the central nervous system and should be considered when designing clinical trials. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: &lt;i&gt;Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=egs&AN=152497260
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1016/j.ijrobp.2021.07.1219
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 1
        StartPage: e428
    Subjects:
      – SubjectFull: Non-small-cell lung carcinoma
        Type: general
      – SubjectFull: Overall survival
        Type: general
      – SubjectFull: Proportional hazards models
        Type: general
      – SubjectFull: Prognosis
        Type: general
      – SubjectFull: Disease progression
        Type: general
    Titles:
      – TitleFull: Does Disease Burden on PET Predict Outcomes for Advanced NSCLC Patients Treated With First-Line Immunotherapy?
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Andraos, T.Y.
      – PersonEntity:
          Name:
            NameFull: Halmos, B.
      – PersonEntity:
          Name:
            NameFull: Cheng, H.
      – PersonEntity:
          Name:
            NameFull: Huntzinger, C.
      – PersonEntity:
          Name:
            NameFull: Shirvani, S.
      – PersonEntity:
          Name:
            NameFull: Ohri, N.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 02
              M: 11
              Text: 2021 Supplement
              Type: published
              Y: 2021
          Identifiers:
            – Type: issn-print
              Value: 03603016
          Numbering:
            – Type: volume
              Value: 111
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: International Journal of Radiation Oncology, Biology, Physics
              Type: main
ResultId 1