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Abstract: The standard treatment for inoperable locally advanced non-small cell lung cancer (LA NSCLC) includes concurrent or sequential chemotherapy (ChT) and radiation therapy (RT). Long term survival rates with these approaches remains only in the order of 15%, therefore new treatment strategies, including immunotherapy, are under investigation, with programmed death ligand-1 (PD-L1) as one of the major players. We evaluated the clinical significance of PD-L1 expression in tumor samples from patients with inoperable LA NSCLC who underwent concurrent chemoradiotherapy (CRT) in our institution between 2005 and 2010 and correlated their expression with clinicopathological parameters and outcome of treatment. Among 107 patients treated with concurrent CRT, a total of 43 (36 males and 7 females) had sufficient tissue for immunohistochemical (IHC) staining. The expression of PD-L1 was demonstrated in 7 tumors, in 6 males and 1 female. No statistical significant differences in patient characteristics, including age, smoking status and gender, were found according to the PD-L1 expression. After a median follow up of 103.6 months, median progression free survival (PFS) was 19.9 months in patients without and 10.1 months in patients with PD-L1 expression (p=0.008). Median overall survival (OS) was 28.4 and 12.1 months for PD-L1 negative and PD-L1 positive patients, respectively (p=0.012). In conclusions, patients with PD-L1 expression had shorter PFS and OS after concurrent CRT in LA NSCLC. Unfortunately, only small number of patients had tissue available for the IHC testing, therefore no firm conclusions could be made and further investigation is warranted.
Keywords: non-small cell lung cancer, lung cancer, chemoradiotherapy, survival
Published in DiRROS: 17.12.2020; Views: 1324; Downloads: 417
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Abstract: Background: Expression of PD-L1 is the most investigated predictor of benefit from immune checkpoint blockade in advanced NSCLC but little is known about the association of PD-L1 expression and clinicopathological parameters of patients with unresectable stage III NSCLC. Methods: National registry data was searched for medical records of consecutive inoperable stage III NSCLC patients treated with ChT and RT from January 2012 to December 2017. Totally 249 patients were identified that met inclusion criteria and of those 117 patients had sufficient tissue for PD-L1 immunohistochemical staining. Results: Eighty patients (68.4%) expressed PD-L1 of >- 1% and 29.9% of more than 50%. Median PFS was 15.9 months in PD-L1 negative patients and 16.1 months in patients with PD-L1 expression >- 1% (p = 0.696). Median OS in PD-L1 negative patients was 29.9 months compared to 28.5 months in patients with PD-L1 expression >- (p = 0.888). There was no difference in median OS in patients with high PD-L1 expression (>- 50%) with 29.8 months compared to 29.9 months in those with low (1-49%) or no PD-L1 expression (p = 0.694). We found that patients who received a total dose of 60 Gy or more had significantly better median OS (32 months vs. 17.5 months, p < 0.001) as well as patients with PS 0 (33.2 vs. 20.3 months, p = 0.005). Conclusions: In our patients PD-L1 expression had no prognostic value regarding PFS and OS. Patients with good performance status and those who received a total radiation dose of more than 60 Gy had significantly better mOS.
Keywords: non small cell lung cancer, chemoradiotherapy, stage III
Published in DiRROS: 09.11.2020; Views: 1406; Downloads: 1006
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Keywords: rak pljuč, nedrobnocelični pljučni rak, imunoterapija, zdravljenje, kemoradioterapija
Published in DiRROS: 28.05.2020; Views: 1680; Downloads: 550
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Keywords: diagnostika, urgentna stanja, kirurško zdravljenje, komplikacije, radioterapija, kemoterapija, tarčno zdravljenje, imunoterapija, napredovali rak, paliativna oskrba, podporno zdravljenje, alternativno zdravljenje, nedrobnocelični pljučni rak, rehabilitacija
Published in DiRROS: 15.05.2020; Views: 1912; Downloads: 595
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Keywords: pljučni rak, urgentna stanja, simptomatsko zdravljenje
Published in DiRROS: 08.05.2020; Views: 1679; Downloads: 519
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