Clinical outcomes of immunotherapy continued beyond radiographic disease progression in older adult patients with advanced non‑small cell lung cancer

Immunotherapy is an effective and generally well-tolerated treatment strategy for older adult patients (aged ≥70 years) with advanced non-small cell lung cancer (NSCLC). Unfortunately, most patients who receive immunotherapy eventually exhibit disease progression during treatment. The present study reports on a subset of older adult patients with advanced NSCLC who could effectively continue immunotherapy beyond radiographic disease progression due to perceived clinical benefit. Local consolidative radiotherapy may be used in select older adult patients to prolong the duration of immunotherapy they receive, with a particular consideration of their preexisting co-morbidities, performance status and tolerance of potential toxicities associated with combined modality therapy. However, prospective research is needed to determine which patients benefit most from the addition of local consolidative radiotherapy, including whether type of disease progression (i.e., sites of progression, pattern of progression) and/or extent of consolidation offered (i.e., complete or incomplete) impact clinical outcomes. Further research is also warranted to determine which patients would most benefit from the continuation of immunotherapy beyond documented radiographic disease progression.

635 Online CME improves the interprofessional team's ability to manage patients with malignant pleural mesothelioma

Background

Malignant pleural mesothelioma (MPM) is a rare and aggressive inflammatory cancer commonly associated with prior exposure to asbestos. Until recently, approved systemic treatments for MPM have been limited to chemotherapy regimens that have had limited survival benefit with overall poor outcomes. Both immune checkpoint inhibitors (ICIs) and tumor treating fields (TTF) have been associated with improved survival in this population. As a result of these advancements and changing of the treatment landscape, many members of the interprofessional team are challenged to stay current with emerging data and knowing how best to integrate these regimens into MPM treatment paradigms. The objective of this study was to determine if an online continuing medical education (CME) intervention could improve oncologists' and pharmacists' ability in managing patients with MPM.

Methods

The activity consisted of a 30-minute video discussion between two expert faculty.1 Educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. Pre- and post-assessment scores were compared to determine relative changes in the proportion of correct responses to knowledge/competence questions. A paired samples t-test assessed overall number correct and confidence change statistical significance . The activity launched 5 January 2021; data were collected until 3 May 2021.

Results

Overall, statistically significant improvements in knowledge/competence were seen after education consumption for oncologists (N = 44, P < .001) and pharmacists (N = 223, P < .001). Relative improvement in correct answers was 79% for oncologists and 123% for pharmacists (total correct responses pre-/post-assessment were 33%/59% and 22%/49%, respectively). Following the activity, 41% of oncologists and 57% of pharmacists had a measurable increase in confidence regarding their ability to collaborate as part of the interprofessional team in the management of patients with MPM.

Conclusions

Participation in an online, video discussion-based CME-certified activity resulted in statistically significant improvements in knowledge/competence, and measurable increases in confidence of oncologists and pharmacists regarding the management of patients MPM. These results have the ability to translate to improvements in clinical care. The need for additional educational activities was also identified to address residual gaps and further increase clinicians' ability in this clinical setting.

Acknowledgements

Sources of support: Developed through an independent educational grant from Bristol Myers Squibb Company and Novocure.

Reference

Tsao A, Borghaei H. Moving the Needle in Mesothelioma: advances in treatment. Medscape 2021. https://www.medscape.org/viewarticle/943353.

280 Clinical outcomes of immunotherapy continued beyond radiographic progression in older adults with advanced non-small cell lung cancer

Background

While the clinical outcomes of immune checkpoint inhibitor (ICI) use in older adults with advanced-stage non-small cell lung cancer (NSCLC) have been described, the role of ICI use continued beyond disease progression (BDP) remains to be well defined for this population. This retrospective single-center study explored the clinical outcomes of continuing ICIs BDP among older adult patients with advanced NSCLC.

Methods

Using MD Anderson’s Gemini Lung Cancer database, we retrospectively reviewed the clinical outcomes of older adults (≥70 years) diagnosed with advanced-stage NSCLC treated with anti-PD-(L)1 monotherapy from March 2015 through April 2019 to correlate clinicopathologic features with clinical outcomes. Clinical therapy responses were evaluated by Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1). Toxicities were assessed using Common Terminology Criteria for Adverse Events (CTCAE), version 5. Patients treated BDP were defined as individuals receiving ICIs for ≥8 weeks prior to documentation of progression who subsequently remained on ICIs for ≥6 weeks.

Results

Of the 159 older adults meeting the inclusion criteria, 33 (21%) received ICIs BDP (64% male, median age 74.9 years (70.1–82.0) at the start of ICI treatment, 3 received first-line ICI therapy). Most patients were former (85%) or current (6%) smokers. 79% had adenocarcinoma histology. The median duration of immunotherapy continued BDP was 7.1 months (95% CI: 3.0–8.2). After a follow-up of 30.1 months, the median overall survival (mOS) was 31.5 months (95% CI: 16.5-not reached). Eight (24%) received local consolidative radiotherapy with a median duration of ICI BDP of 8.2 months (95% CI: 1.9–13.3). Twenty-five (76%) did not receive local consolidative therapy and achieved a median duration of ICI BDP of 4.1 months (95% CI: 2.3–7.8). Six (18%) exhibited pseudo-progression (i.e. delayed response to immunotherapy with decreased tumor burden on subsequent radiologic studies), with 4 achieving ”stable disease” as best response and 2 achieving a partial response. The median duration of immunotherapy continued beyond pseudo-progression was 11.7 months (95% CI: 7.1–35.7), and the mOS was 26.2 months (95% CI: 16.5–40.0). Patients treated with ICI BDP most commonly experienced fatigue (18%), pneumonitis (12%), rash (9%), and hypothyroidism (9%). Three patients (9%) experienced grade 3 or higher toxicities (one grade 3 arthralgias and two grade 3 pneumonitis).

Conclusions

ICI-use BDP in older adults with advanced NSCLC may benefit a subset of patients. Additionally, local consolidative therapy with radiation may offer prolonged duration of ICI treatment.

Acknowledgements

Supported by the generous philanthropic contributions to The University of Texas MD Anderson Lung Moon Shot Program and the MD Anderson Cancer Center Support Grant P30 CA01667. Special acknowledgment to the GEMINI team.

Ethics Approval

This study was approved and conducted in accordance with the institutional review board at the University of Texas MD Anderson Cancer Center; approval number (PA13-0589).

NCOG-13. THE IMPACT OF CME ON THE KNOWLEDGE OF NEUROFIBROMATOSIS TYPE 1-RELATED TUMORS

BACKGROUND

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic condition characterized by a wide spectrum of clinical findings. Patients with NF1 develop benign and malignant tumors along the nerves of the skin, brain, and other body parts. Due to the unique presentation of each patient, clinicians are challenged to stay current with emerging data and how best to integrate new agents into multidisciplinary treatment paradigms. The objective of this study was to assess changes in neurologists’ and pediatricians’ knowledge and confidence through participation in education regarding NF1 treatment.

METHODS

The educational activity consisted of a 30-minute online enduring, 1 faculty, chapterized summary of a live symposium. Educational effect was assessed with a repeated pairs pre-/post-assessment study with a 3-item, multiple choice, knowledge questionnaire and one confidence assessment question. For all questions, each participant served as his/her own control. Pre- and post-assessment scores were compared to determine relative changes in the proportion of correct responses. A chi-square test assessed statistical significance at the P &lt; 0.05 level. The activity launched 23rd December 2019; data were collected until 2nd April 2020.

RESULTS

Overall, statistically significant improvements were seen after education for neurologists (N=171, P &lt; 0.05) and pediatricians (N=260, P &lt; 0.01). The relative improvement in correct answers was 26% for neurologists and 48% for pediatricians (percent of total correct responses pre-/post-assessment were 27%/34% and 23%/34%, respectively). Following the activity, 16% of neurologists and 22% of pediatricians had a measurable increase in confidence regarding their understanding of multidisciplinary management of NF1.

CONCLUSIONS

Participation in an online, 30-minute enduring CME intervention resulted in statistically significant improvements in knowledge and confidence of neurologists and pediatricians, that result in improvements in clinical care. Continued educational activities are paramount to address residual gaps and further increase clinicians’ confidence in this clinical setting.