Outcomes with immune checkpoint inhibitor use in lung cancer patients with hepatic metastases

Background:   Immune checkpoint inhibitors have shown promising responses in advanced lung cancer as well as a number of other malignancies. However, efficacy appears to be variable based on the site of disease. We reviewed the outcomes of patients with lung cancer and hepatic metastases from a single institution.  Methods: We performed a retrospective analysis of the lung cancer patients treated at East Carolina University with the PD1 inhibitor Nivolumab. Patients were enrolled in an IRB approved study designed to evaluate predictive markers of response to immune checkpoint blockade. Clinical characteristics, laboratory data, and imaging studies were analyzed and recorded.  Results:   Data for 75 patients with lung cancer who received anti-PD1 therapy was analyzed. Of the 75 patients included, 13% (n = 9) had liver metastases. Average age of the patients was 61.8 years, 66% patients were male, 22% had squamous cell, 33% had adenocarcinoma and 44 % small cell neuroendocrine histology. Average number of prior therapies was 1.7 (range 1-4). Thirty three percent of patients had modified Glasgow prognostic score of 2 and a mean CRP of 63.61mg/L (range 0.1-172.7mg/ L) at the initiation of anti-PD1 therapy. They received an average of 4 cycles of anti-PD1 therapy.  Forty four percent of patients received adjunctive therapy such as ablative radiation (33%) or immune modulating chemotherapy with the aim of augmenting the effect of the anti-PD1 therapy. None of the analyzed patients with liver metastases had an objective decrease in liver metastases and the average survival in these patients after starting anti-PD1 therapy was 132 days. Conclusions:   To our knowledge, this study is the largest reported series examining patients with hepatic metastases from lung cancer treated with PD-1 inhibitors. Our observations are consistent with prior reports indicating poor outcomes with anti-PD1 therapy in patients with liver metastases. The mechanisms underlying such resistance must be elucidated so that more effective treatment combinations can be developed.

Duke Scholars

Author Srikala Addepalli Medicine, Hematology