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ELCC 2017: Some Patients With Lung Cancer Benefit From Immunotherapy Even After Disease Progression

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Key Points

  • Investigators found that the tumors in 82% of the patients who had continued on atezolizumab treatment subsequently stabilized or shrank.
  • Median overall survival was 11.8 months, and objective response rate increased when immune-related RECIST was used.

Some patients with advanced lung cancer benefit from immunotherapy, even after the disease has progressed as evaluated by standard criteria, according to research presented by Artal-Cortes et al at the 2017 European Lung Cancer Conference (ELCC, Abstract 96PD). The findings pave the way for certain patients to continue treatment if the disease is not progressing according to new and more specific criteria.

The Response Evaluation Criteria in Solid Tumors (RECIST) system is used to evaluate changes in tumor size and identifies whether patients are responding to treatment or showing disease progression. An enlarging tumor on a computed tomography (CT) scan signals that disease is progressing, and treatment is changed to best supportive care or a different drug. Immune-related RECIST was developed to account for the fact that tumors enlarge temporarily in patients taking immunotherapy.

“Immunotherapy causes lymphocytes … to infiltrate the tumor, leading to a transient increase in size,” said lead author Angel Artal-Cortes, MD, Medical Oncologist, University Hospital Miguel Servet, Zaragoza, Spain. “With chemotherapy, tumor enlargement indicates that the tumor is growing and the disease is progressing.”

POPLAR Trial

The study presented today is a post hoc analysis of the phase II POPLAR trial, which randomized patients with non–small cell lung cancer (NSCLC) who had progression on platinum-based chemotherapy to second-line treatment with the anti–programmed death ligand 1 (PD-L1) antibody atezolizumab (Tecentriq) or chemotherapy with docetaxel. Response to treatment was assessed with RECIST and immune-related RECIST criteria. As previously reported by Fehrenbacher et al in The Lancet, atezolizumab significantly improved survival compared with docetaxel.

The study protocol allowed patients to continue atezolizumab treatment if they had not shown progression according to immune-related RECIST and had no major toxicities, even if conventional RECIST indicated progression. The post hoc analysis evaluated overall survival and performance status in the 61 patients who continued atezolizumab after standard progression.

Study Findings

The investigators found that the tumors in 82% of these patients subsequently stabilized or shrank. Median overall survival was 11.8 months, and objective response rate increased when immune-related RECIST was used.

Dr. Artal-Cortes said: “We found that there was a benefit for some patients continuing with the drug even after a CT scan suggested progressive disease. Atezolizumab can control lung cancer for a longer period of time than was initially thought. Patients who were maintained on atezolizumab had no major increase in toxic side effects, since most of these occur in the first few months.”

He concluded, “Our results suggest that immune-related RECIST should be kept in mind to decide whether or not to continue atezolizumab treatment in patients who are responding to the drug, have a good performance status, no serious toxicities from the drug, and no major symptoms from the tumor.”

Commentary

Commenting on the research, Marina Garassino, MD, Head of Thoracic Medical Oncology, National Cancer Institute of Milan (Fondazione IRCCS Istituto Nazionale dei Tumori), Italy, said, “This study shows that conventional RECIST may not be the best criteria to evaluate response to immunotherapy. It found that immune-related RECIST better predicted outcome with immunotherapy than RECIST.”

“The research suggests that immunotherapy can be prolonged when the new criteria are used,” she added. “Patients continuing atezolizumab based on immune-related RECIST benefited from the drug, even though it was a progressive disease by the RECIST criteria. This was a post hoc analysis of a phase II trial … so the results need to be confirmed in other studies.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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