Purpose
Lung cancer is the leading cause of cancer-related mortality in the United States1and among the most common cancers worldwide.
Non–small cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases2and among patients with NSCLC approximately 40% present with stage IV disease3.
Although targeted therapy has been associated with a significant benefit in patients presenting gene abnormalities,
those abnormalities are rare and thus chemotherapy remains the mainstay of treatment for most patients4.
The ability to avoid the immune system is one of the hallmarks...
Methods and Materials
A retrospective analysis of all consecutive patients receiving anti-PD-1 antibodies (nivolumab) for advanced NSCLC after failure of at least one line of chemotherapy,
was conducted at the San Martino Policlinic,
University of Genoa,
Italy,
between January 2015 and April 2017 (n=74).
Informed consent was obtained from all patients.
Patients with a concomitant second cancer,
who had received radiation therapy,
without baseline or follow up CT scan or with inadequate CT evaluation (mainly non contrast enhanced CT scans due to renal function impairment) were excluded,
thus...
Results
Δ-Features were calculated as absolute variation between baseline and follow up examination.
Correlation of Δ-Features and clinical endpoints as Progression Free Survival (PFS) and Overall Survival (OS) were assessed by using the Pearson coefficient; a p-value of 0.05 or lower has been considered statistically significant.
Our analysis showed that variations in CTTA parameters,
specially those features derived from co-occurence matrices,
correlated with PFS and OS in our cohort of patients.
Interestingly,
many features correlated with PFS when the progression was established through the irRECIST criteria...
Conclusion
As the use of immune checkpoint blockade agents increases,
so does the challenge of assessing their efficacy.
CT scans might demonstrate unconventional or delayed patterns of response,
so morphologic imaging evaluation of tumor response is challenging; although repeated tumor biopsies during treatment might provide useful information about the viability of tumor cells and the activity of the immune response within a lesion,
biopsy is not always achievable because tumors may be inaccessible or multiple.
Additionally,
biopsy of a single lesion may not accurately capture patients...
References
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Miller KD,
Jemal A.
Cancer statistics,
2016.
CA Cancer J Clin 2016; 66: 7–30.
2-Govindan R,
Page N,
Morgensztern D,
et al.
Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance,
epidemiologic,
and end results database.
J Clin Oncol 2006; 24:4539–44.
3-Morgensztern D,
Ng SH,
Gao F,
et al.
Trends in stage distribution for patients with non-small cell lung cancer: a National Cancer Database survey.
J Thorac Oncol 2010;5:29–33.
4-Masters GA,
Temin S,...