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. 2018 Dec;67(12):1825-1832.
doi: 10.1007/s00262-018-2239-4. Epub 2018 Aug 31.

Organ-specific response to nivolumab in patients with non-small cell lung cancer (NSCLC)

Sabine Schmid  1   2 , Stefan Diem  3   4   5 , Qiyu Li  6 , Mirjam Krapf  7 , Lukas Flatz  4 , Sebastian Leschka  8 , Lotus Desbiolles  8 , Dirk Klingbiel  6 , Wolfram Jochum  9 , Martin Früh  3   7
Affiliations

Organ-specific response to nivolumab in patients with non-small cell lung cancer (NSCLC)

Sabine Schmid et al. Cancer Immunol Immunother. 2018 Dec.

Abstract

Background: Response to immune checkpoint inhibitors depends on tumor intrinsic properties and also on host factors in the tumour microenvironment including the presence of immune cells (IC). We hypothesized that nivolumab efficacy varies across different metastatic sites.

Methods: We retrospectively analyzed computed tomography scans of patients with metastatic non-small cell lung carcinoma (NSCLC) receiving nivolumab. RECIST 1.1 criteria were applied to assess the overall response rate (ORR) and organ-specific response rate (OSRR).

Results: We analyzed 52 patients including 44% females, 58% adenocarcinoma and 8% never smokers. Involved organs had target-lesions in the lung (42%), liver (25%), lymph nodes (56%) and soft tissue (13%) and non-target lesions in the bones (23%). ORR and disease control rate (DCR) were 20% and 45%, respectively. Median overall survival, progression-free survival and duration of response were 11.9, 2.3 and 10.3 months. OSRR and organ-specific DCR (OSDCR) were 28% and 90% in lymph nodes, 8% and 54 in the liver, and 9% and 55% in lung metastases. Nine out of 12 patients with bone metastases had progressive lesions. The cumulative incidence probability of organ-specific progression at 6 months was 14% in lymph nodes, 42% in the liver, 36% in lung metastases and 26% in the primary tumor, 29% in soft tissue and 33% in adrenal metastases.

Conclusion: In conclusion, the efficacy of immunotherapy is dependent on the metastatic location. Treatment appears more active in lymph nodes compared to other organ sites such as liver, adrenals and bone. Future strategies may include additional local treatment in case of oligoprogression in these organs in patients with otherwise sustained treatment benefit.

Keywords: Checkpoint inhibitors; NSCLC; Organ-specific response; Patterns of response.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Overall and organ-specific response in the adrenal, liver, lung, lymph node and soft tissue metastases and primary tumor
Fig. 2
Fig. 2
Cumulative incidence probability of organ-specific progression using competing risk approach
See this image and copyright information in PMC

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