Abstract 1324P
Background
Recent evidence suggests that patients (pts) characteristics, serum biomarkers, and immune-related adverse events (irAE) may influence immune checkpoint inhibitors (ICI) treatment response in non-small cell lung cancer (NSCLC). We aim to Assess the impact of clinical and laboratory variables on the outcome of NSCLC pts treated with ICI.
Methods
Retrospective study of NSCLC pts treated with ICI from September 2015 to December 2019 on an oncology dedicated hospital. Pts and tumoral baseline characterization, laboratory results before and 3 weeks after ICI initiation, and treatment follow-up were recorded. Outcomes included overall survival (OS) and progression-free survival (PFS).
Results
164 pts were included: 68% males; mean age 62 ± 10.5 years; 14% obese (body-mass index ≥30). NSCLC were characterized as adenocarcinoma in 73% cases and squamous cell carcinoma in 21%. In 36% pts, PD-L1 was ≥50% and in 31% ICI was used as first-line treatment in monotherapy. At 3rd week after ICI initiation, a median neutrophile/lymphocyte (N/L) ratio of 3.68 (IQR 2.3 – 5.9) and a median lactate dehydrogenase (LDH) of 199 UI/L (IQR 166 – 275) were present. During follow-up, 13 months (IQR 5.0-24.5), 35% of pts had at least one irAE, 28% achieved tumor response, 80% had disease progression and 69% died. Tumor response (adjHR: 0.2; 95%CI, 0.11-0.38, p<0.001) and irAE (adjHR: 0.4; 95%CI, 0.32-0.84, p=0.008) were predictors of longer PFS; and higher LDH at 3rd week of shorter PFS (adjHR: 1.0; 95%CI, 1.00-1.01, p=0.003). Obesity (adjHR: 0.4; 95%CI, 0.20-0.87, p=0.02), tumor response (adjHR: 0.2; 95%CI, 0.08-0.353, p<0.001) and irAE (adjHR: 0.4; 95%CI, 0.26-0.77, p=0.004) were predictors of longer OS. Higher N/L ratio at 3rd week was predictive of shorter OS (adjHR, 1.04; 95% CI, 1.01-1.10, p=0.014) with an acceptable test discrimination (AUC 0.7, p=0.001).
Conclusions
In our cohort, obesity and irAE were predictors of better outcomes of ICI treatment in NSCLC. They both reflect a state of greater immune system activation, which may have led to a more effective tumor fight. Both higher LDH and N/L ratio were predictors of poor outcomes. They are inflammatory markers and may reflect an inflammatory activation related to other factors rather than ICI, such as infection.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Ricardo Estêvão Gomes.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.