340P - Advanced lung cancer inflammation index (ALI) association with increased risk of immune related adverse events (irAE) among non-small cell lung cancer (NSCLC) patients treated with single agent immunotherapy

Background

The advanced lung cancer inflammation index (ALI) indicates the host systemic inflammation status in metastatic non-small cell lung cancer (NSCLC). It has been found to be a strong predictor of clinical outcome; response rate (RR), progression free survival (PFS) and overall survival (OS). Its correlation with immune related adverse events (irAEs) has not been investigated yet. Thus, here we aimed to confirm association with clinical outcomes and investigate its association with irAEs.

Methods

We conducted a retrospective study among 214 NSCLC patients treated with programmed death ligand 1 (PD-L1) inhibitor monotherapy across two cancer centres in Western Australia. ALI was calculated as [(body mass index x serum albumin)/neutrophil-to-lymphocyte ratio]. Patients were divided into two groups: low systemic inflammation (ALI values ≥18) and high systemic inflammation (ALI values <18). The association of ALI with PFS and OS was calculated using log rank analysis. The ALI of patients relative to their treatment response and the development of irAE were compared using Mann-Whitney U-tests. All analyses were conducted using GraphPad Prism version 9.3.1.

Results

We analysed results from 121 patients treated with PD-L1 inhibitor monotherapy (93 patients were excluded due to incomplete BMI data). In our cohort, 58% of them were male and 42% were female. 34 of the patients had an ALI <18 and 87 of them had an ALI ≥18. High ALI was associated with improved OS (HR=2.56, 95%CI 1.25-5.28, P<0.001) and PFS (HR=0.07, 95%CI 1.17-3.68, P=0.002). Patients that responded to treatment and those that developed irAE had significantly higher ALI than those that did not (P=0.011 and P=0.025, respectively).

Conclusions

As previously suggested, ALI is a strong predictor of outcomes, as illustrated by its association with OS and PFS in patients with NSCLC treated with immune checkpoint inhibitors. In NSCLC patients treated with PD-L1 monotherapy, the development of toxicity is associated with higher ALI values.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Dr Afaf Abed.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.