Impact of chemoradiotherapy (CRT) on immune-related tumor microenvironment and the efficacy of anti-PD-1 therapy after the recurrence of CRT in unresectable locally advanced NSCLC patients.

Authors

null

Masayuki Shirasawa

National Cancer Center Hospital, Tokyo, Japan

Masayuki Shirasawa , Tatsuya Yoshida , Noriko Motoi , Yuji Matsumoto , Yuki Shinno , Yusuke Okuma , Yasushi Goto , Hidehito Horinouchi , Noboru Yamamoto , Shun-ichi Watanabe , Yuichiro Ohe

Organizations

National Cancer Center Hospital, Tokyo, Japan, Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan, Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan, Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan, Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

Research Funding

No funding received
None

Background: Chemoradiotherapy (CRT) followed by durvalumab as maintenance therapy prolonged progression-free survival (PFS) and overall survival (OS) in unresectable locally advanced NSCLC (LA-NSCLC). Additionally, the history of radiotherapy and CRT has been reported to increase the efficacy of PD-1 blockade in advanced NSCLC patients. We evaluated the efficacy of anti-PD-(L)1 antibody therapy after CRT failure, and how CRT changes the status of PD-L1 expression on tumors and tumor infiltrated lymphocytes (TILs) in tumor microenvironment (TME) in unresectable LA-NSCLC patients. Methods: We retrospectively reviewed unresectable LA-NSCLC patients treated with CRT between December 2007 and December 2018, and evaluated the efficacy of PD-1 blockade after CRT failure. We also analyzed PD-L1 (clone: 22C3) expression on tumor cells, and CD8 positive TILs using the paired specimens that had been obtained pre-CRT and post-CRT failure. Results: We identified 422 patients who received CRT. Median follow-up was 36.1 months (range 2.7–138.1 months). Among these patients, sixty-five patients who had progressed post-CRT received anti-PD- (L)1 therapy (PD-1 therapy: 61 patients, PD-L1 therapy: 4 patients). Response rate (RR) and PFS of anti-PD-(L)1 therapy were 48% (95% CI, 35–60) and 8.7 (95% CI, 4.5–13.0) months. The RR and PFS did not differ according to PD-L1 expression levels (Table). Of the 18 patients, 9, 7, and 2 showed upregulation in PD-L1 expression or down- or no change, respectively, post-CRT. In contrast, the density of CD8 positive TILs in TME increased by CRT treatment ([pre-CRT]: median, 110 ± 239 /mm2 vs. [post-CRT]: median, 470 ± 533 /mm2, p = 0.025). Conclusions: The clinical outcome of anti-PD-(L)1 therapy after CRT failure in LA-NSCLC patients could be better than advanced NSCLC patients, but did not differ according to PD-L1 expression levels. The efficacy of PD-(L)1 therapy enhanced by CRT treatment could be due to the infiltration of CD8 T-cells into TME.

TotalNORR (confirmed)
Survival, median (95% CI), mo
n (%)95% CIPFSOS
PD-L16531(48)35-608.7 (4.5–13.0)25.1 (12.0–38.2)
TPS ≥50%167 (44)14-735.1 (2.4-7.8)26.3 (7.8-44.9)
TPS ≥1%-49%2414 (58)36-8111.3 (2.7-11.9)25.1 (5.1-45.1)
TPS < 1%146 (42)10-769.2 (3.6-14.8)12.3 (0.0-38.2)
Unknown114 (36)0-769.0 (2.8-15.2)NR (NR)

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Publication Only

Session Title

Publication Only: Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Citation

J Clin Oncol 38: 2020 (suppl; abstr e21719)

DOI

10.1200/JCO.2020.38.15_suppl.e21719

Abstract #

e21719

Abstract Disclosures