313P - Immunotherapy application for advanced cancers: One institution experiences since 2016 to 2019

Abstract

BackgroundImmunotherapy has brought clinical benefits in several kinds of advanced cancers, including melanoma, renal cell carcinoma, non-small cell lung cancer, gastric cancer, HNSCC, esophageal cancer, hepatocellular carcinoma, and urinary tract cancers. Reliable biomarkers, best sequencing, and novel combinations for cancer immunotherapy warrant further investigation. Our group will present immunotherapy experiences for advanced cancers since 2016 to 2019 to show possible clinical impacts, choices of several combinations, toxicity profiles, favorable cancer types, and potential biomarkers exploratio. MethodsSince Jan 2016 to Feb 2019, we reviewed the details of immunotherapy(anti-PD1or anti-PDL1 or anti-CTLA4 monoclonal antibody) application from cancer patients in Yin-lin Branch of National Taiwan University Hospital. ResultsTotal 153 refractory cancer patients were collected due to previous or current use of immunotherapy. 69 patients received pembrolizumab(33 with triweekly 2 mg/kg & 36 with triweekly 200 mg); 74 received nivolumab(from 20 mg totally to 3 mg/kg biweekly); 2 ever received pembrolizumab and then nivolumab with ipilimumab; 1 ever received pembrolizumab and then pembrolizumab with ipilimumab; 5 received atezolizumab(2 NSCLC, 1 SCLC, 2 urinary tract cancers); 2 durvalumab (NSCLC). The cancer types were listed as following: 32 NSCLC(11 SCC, 19 adenocarcinoma, 1 adenosquamous, 1 pleomorphic); 2 SCLCs; 30 HNSCC(1 HPV, 29 non-HPV); 5 NPC; 15 esophageal cancers; 6 gastric cancers(1 with MSI-H); 2 high grade serous ovary cancer; 1 skin basal cell carcinoma; 1 thymic cancer; 36 HCC; 3 intra-hepatic cholangiocarcinoma; 2 malignant peripheral nerve sheath tumors; 8 urinary tract cancers; 1 RCC; 2 liver neuroendocrine tumors; 1 adrenal carcinoma; 1 breast cancer; 1 mesothelioma; 2 melanoma; 1 primary CNS lymphoma; 1 Papilla of Vater cancer(HER2 amplification and high TMB). The overall clinical benefits were 85%(130/153) and objective response rates were 43%(66/153).Table313PTableCancer typesORRCommentsUrinary tract cancers7/8(87.5%)With Avastin and chemotherapyEsophageal cancer9/15(60%)Afatinib with anti-PD1NSCLC19/32(59%)KN189/IMpower150 in Adeno; CM227 in SCCHNSCC14/30(47%)Afatinib with anti-PD1(easy autoimmune cholestasis and interstitial pneumonitis with pembrolizumab)HCC9/36(25%)With metronomic therapy, Avastin, or chemotherapySCLC1/2(50%)+/-AvastinNPC2/5(40%)Biomarkers neededGC1/6(17%)Responder in MSI-HPapilla of Vater cancer1 stable diseaseHER2 amplification and high TMBSkin cancer1/1High TMBCholangiocarcinoma0/3Combinations searchingRCC1/1With anti-angiogenesis TxPCNSL1/1Rituximab with nivolumab ConclusionsIn one institutional experiences, immunotherapy combinations for refractory advanced cancers have brought encouraging responses and clinical benefits, esp. in urinary tract cancer, esophageal cancers, NSCLC, HNSCC, HCC(the top 5 cancer types endemic in Yun-lin), NPC, skin cancers, primary CNS lymphoma, and cancers with MSI-H or high TMB. Individual combinations, biomarkers, sequencing, and toxicities may be explored in different kinds of advanced cancers to reach favorable outcomes. Legal entity responsible for the studyIRB in National Taiwan University Hospital. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.