Abstract 851
Background
The Royal Marsden Hospital (RMH) and Gustave Roussy Institute (GRIm) have prospectively validated prognostic scores to aide patient selection for phase I immunotherapy trials in many tumour sites, including NSCLC. These include number of metastatic sites, LDH, Albumin and Neutrophil-to-Lymphocyte Ratio (NLR). GRIm score stratified 155 patients to high-risk and low-risk categories, according to LDH, Albumin and NLR, with median OS of 4 months in high-risk cohort and 17 months in low-risk group. NSCLC was the predominant tumour site in this analysis including 30 stage IV patients. This score had similar design to RMH score, except for number of metastatic sites instead of NLR.
Methods
165 consecutive Nottinghamshire patients with stage IIIB/IV NSCLC on PD1/PDL1 immune-checkpoint inhibitors from December 2015 to December 2018 have been retrospectively analysed. At data cut-off in April 2019, 148 - 151 patients were censored for median TTF, PFS and OS, according to GRIm - RMH scores respectively: 17 patients were unclassified into GRIm (10.3%) and 14, into RMH (8.5%) for LDH unavailability; 70 patients remain alive (42.4%), 31 of whom still receiving immunotherapy (18.8%).
Results
Table:
1508P
mTTF (cycles) | mPFS (months) | mOS (months) | ||
---|---|---|---|---|
GRIm score | 0-1 80 patients (95% CI) Pembrolizumab-61 p Atezolizumab-13 p Nivolumab-3 p | 9 (9-13) 9 (7.5-11) 7 (4.6-10.5) 6 | 7 (6.9-10) 7 (7.5-11) 6 (3.6-7.3) 3 | 10 (10-13.5) 11 (11-15) 7.5 (5.2-9.1) 6 |
2-3 68 patients (95% CI) Pembrolizumab-59 p Atezolizumab-6 p Nivolumab-3 p | 3 (3.8-7) 3 (4-7.5) 3.5 (0.3-8.1) 1 | 2 (3-5.7) 2 (3-6.1) 3 (0.04 - 5.4) 1 | 4 (5.1-8.6) 5 (5-9.1) 6 (1.3-10) 1 | |
RMH score | 0-1 93 patients (95% CI) Pembrolizumab-78 p Atezolizumab-12 p Nivolumab-3 p | 9 (8.6-12.4) 8 (8.8-13.2) 11 (4.7-12.1) 6 | 7 (6.9-9.9) 6.5 (7.2-10.7) 7 (3.3-8) 3 | 10 (10-13.5) 11 (10.6-14.6) 8 (5.5-9.5) 6 |
2-3 58 patients (95% CI) Pembrolizumab-46 p Atezolizumab-9 p Nivolumab-3 p | 2.5 (3.4-7) 3 (3.7-8.1) 2 (1.35-4.2) 1 | 2 (2.6-5.4) 2.5 (2.8-6.2) 3 (0.9-3.4) 1 | 3 (4.5-7.9) 4 (4.8-9) 3 (1.7-7.3) 1 |
Conclusions
GRIm / RMH scores on our population have consistently shown predictive and prognostic relevance, with more favourable TTF, PFS and OS in low-risk groups across any immunotherapy. On treatment stratification, Atezolizumab outcomes show better correlation with RMH score and Nivolumab remains underrepresented at our centre. Our results are consistent with international multi-institutional studies at Gustave Roussy (France) on Lung Immune Prognostic Index (LIPI) and Princess Alexandra Hospital (Australia) on modified LIPI. Disease control has been observed when immune-related adverse events have occurred, suggesting baseline autoimmune antibodies may be predictive of response and immune-related toxicity, a currently open line of observational prospective research.
Clinical trial identification
Not applicable
Editorial acknowledgement
No editorial assistance in the writing of the abstract to be declared
Legal entity responsible for the study
Nottingham University Hospitals NHS Trust at UK.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
5823 - Pulmonary tumor-draining vein exosomal lincRNA-p21 levels impacts non-small cell lung cancer prognosis
Presenter: Joan Castellano
Session: Poster Display session 1
Resources:
Abstract
1842 - Immunological impact of surgery in NSCLC patients
Presenter: Akitoshi Yanagihara
Session: Poster Display session 1
Resources:
Abstract
4124 - The prognostic value of selected immunological panel in predicting the prognosis of early-stage resectable non-small cell lung cancer
Presenter: Sha Zhao
Session: Poster Display session 1
Resources:
Abstract
4468 - Genomic Heterogeneity and Clonality Analysis of Multiple synchronous lung cancers (MSLCs)
Presenter: Fachen Zhou
Session: Poster Display session 1
Resources:
Abstract
5547 - Analysis of immunosuppressive factors produced by tumorspheres in NSCLC. Prognostic value of Galectin-3 in adenocarcinoma
Presenter: Susana Torres Martinez
Session: Poster Display session 1
Resources:
Abstract
1658 - Frequency of epidermal growth factor receptor (EGFR) mutations in stage IB–IIIA EGFR mutation positive non-small-cell lung cancer (NSCLC) after complete tumour resection
Presenter: Masahiro Tsuboi
Session: Poster Display session 1
Resources:
Abstract
1535 - EGFR mutation is not a prognostic factor in completely resected lymph node–negative pulmonary adenocarcinoma (LNNPA)
Presenter: Nussara Leeladejkul
Session: Poster Display session 1
Resources:
Abstract
3262 - Prognostic significance of elements of the adaptive immunity in the microenvironment of early-stage non small cell lung cancer
Presenter: Aliki Liakea
Session: Poster Display session 1
Resources:
Abstract
4643 - Combined immunoscore for prognostic stratification of early stage NSCLC patients
Presenter: Giulia Pasello
Session: Poster Display session 1
Resources:
Abstract
4819 - Radiation-induced lung injury and misdiagnosis rate after SBRT
Presenter: Xiaolong Fu
Session: Poster Display session 1
Resources:
Abstract