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
4294 - The Patient Voice: An Irish Survey of Nutrition Attitudes & Access to Dietetic Care Throughout the Cancer Journey
Presenter: Erin Stella Sullivan
Session: Poster Display session 1
Resources:
Abstract
1925 - Homcology: home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients
Presenter: Claudio Chini
Session: Poster Display session 1
Resources:
Abstract
4701 - Treatment-related adverse events and tolerability in patients with advanced non-squamous non-small cell lung cancer treated with first-line checkpoint inhibitors in combination with chemotherapy
Presenter: Ruth D'cunha
Session: Poster Display session 1
Resources:
Abstract
2985 - Clinical utility of a systematic toxicity assessment form (STAF) in patients with breast cancer receiving adjuvant or neoadjuvant therapy.
Presenter: Jwa Hoon Kim
Session: Poster Display session 1
Resources:
Abstract
2358 - Physicians’ satisfaction with Health-related quality of life (HRQoL) assessment in daily clinical practice using electronic patient-reported outcome (ePRO) for cancer patients.
Presenter: Guillaume Mouillet
Session: Poster Display session 1
Resources:
Abstract
5172 - Predictors of Survival in Patients with Incurable Cancer
Presenter: Erin Stella Sullivan
Session: Poster Display session 1
Resources:
Abstract
2281 - Patients and Physicians' Satisfaction with Telemedicine (TM) in Cancer Care and Factors that Correlate with a Positive Patient’s Experience
Presenter: Hurria Gondal
Session: Poster Display session 1
Resources:
Abstract
2193 - Adherence to ESMO 2014 guidelines on bone-targeting agent (BTA) initiation for breast and prostate cancer patients: real-world insights from practicing European physicians
Presenter: Alex Rider
Session: Poster Display session 1
Resources:
Abstract
2200 - Use of skeletal-related events preventive agents in patients with solid tumours and bone metastases in central Denmark
Presenter: Anders Boysen
Session: Poster Display session 1
Resources:
Abstract
2504 - Inadequacy of current definition and staging system of Medication-Related Osteonecrosis of Jaw (MRONJ) released by AAOMS : a Computed Tomography study in 151 cancer and myeloma patients
Presenter: Vittorio Fusco
Session: Poster Display session 1
Resources:
Abstract