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AbstractAbstract
[en] Introduction: Randomized prospective studies on patients with metastatic non-small-cell lung cancers (NSCLCs) showed that anti-programmed death-1 (PD-1) agents notably improved 2-year overall survival (OS) rates, compared to docetaxel. NSCLC patients now receive nivolumab and irradiation, concurrently or not. However, little is known about the safety of this combination, even though the preclinical model suggested a possible synergic effect. We analyzed NSCLC patients treated with radiotherapy and nivolumab according to the former timing. Methods: We retrospectively reviewed records of a large series of metastatic NSCLC patients from three French centers, irradiated during the 6 months preceding, concomitantly or 3 months after nivolumab administration to assess nivolumab tolerance and outcomes. Results: Among 104 patients included (37 women; 67 men; median age 60.3 years; 67% with performance status <2; 93.2% were current or past smokers) and their 144 intra- or extracranial irradiation courses, any-grade adverse events (AEs) were observed in 62 (59.6%), with 10 (9.6%) experiencing at least one grade-3/4 toxicity and 9 (8.7%) at least one grade-3/4 immune-related AE. Respective 1- and 2-year OS rates were 48.8% and 29.1%, while 1- and 2-year progression-free survival (PFS) rates were 20.9% and 10.1%. Delivering radiation before or during/after nivolumab administration was not associated with better OS or PFS. Conclusion: Radiotherapy delivered before or during/after nivolumab for NSCLCs was not associated with an increased risk of severe or unexpected toxicities. (author)
[fr]
Introduction: Depuis 2014, plusieurs essais randomises ont montre la superiorite des inhibiteurs de checkpoint immunitaires, des anti PD-1, dans le traitement des cancers bronchiques non a petites cellules (CNBPC) metastatiques, par rapport a la chimiotherapie. Actuellement, il est frequent que des patients recoivent de maniere sequentielle ou concomitante un inhibiteur de PD-1, et une radiotherapie, souvent palliative, a visee symptomatique. Neanmoins la tolerance de cette association reste meconnue. Methodes: Nous avons analyse de maniere retrospective et multicentrique une large serie de patients presentant un CBNPC metastatique, et ayant recu une radiotherapie dans les 6 mois precedents une injection de nivolumab (anti PD-1), les 3 mois suivant ou de maniere concomitante. Resultats: Parmi les 104 patients et les 144 cibles irradiees inclus, des effets secondaires etaient observes chez 62 patients (59.6%) dont 10 presentant au moins une toxicite de grade III-IV. Pour 9 de ces 10 patients cette toxicite severe etait immuno- induite en rapport avec les injections de nivolumab. Les taux de survie globale a 1 et 2 ans etaient respectivement de 48.8% et 29.1% et ceux de survie sans progression de 20.9% et 10.1%. Le timing d'administration de la radiotherapie avant, ou pendant/apres nivolumab, n'influencait pas les taux de survie ou la frequence d'effets indesirables. La survie sans progression etait significativement superieure pour les patients presentant des effets secondaires induits par le nivolumab (p=0.038). Conclusion: La combinaison therapeutique radiotherapie plus nivolumab est bien toleree et ne semble pas etre associee a un surcroit d'effets indesirables. (auteur)Original Title
Tolerance et efficacite de la combinaison anti-PD-1 et radiotherapie chez les patients porteurs de cancers bronchiques non a petites cellules metastatiques: etude retrospective multicentrique
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12 Sep 2018; 76 p; 32 refs.; Available from the INIS Liaison Officer for France, see the INIS website for current contact and E-mail addresses; These pour l'obtention du grade de docteur en medecine
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