Abstract 1296P
Background
Bone metastases (BM) are a negative prognostic factor in patients with non-small cell lung cancer (NSCLC). Although immune checkpoint inhibitors (ICIs) have dramatically and positively impacted the therapeutic landscape of patients with NSCLC, little information is available on bone metastatic disease treated with ICIs alone or in association with bone-targeted therapy (BTT) such as zoledronate or denosumab.
Methods
From 2014 to 2020, 111 of the 142 patients with BM from NSCLC enrolled in the prospective multicenter Italian Bone Metastasis Database trial were eligible for the present analysis. Information on blood count, co-morbidities and toxicity were retrospectively collected. The neutrophil-to-lymphocyte ratio (NLR) pre- and post-treatment was calculated. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method, and the log-rank test was used to assess differences in survival among patient subgroups.
Results
Median age was 66 (range 42-84) years. ECOG PS was 0-1 in 79/111 patients. The majority of patients (89.2%) had adenocarcinoma histology. At a median follow-up of 47.4 months, median progression-free survival (mPFS) and overall survival (mOS) were 4.9 (95%CI 2.8-10.0) and 11.9 (95%CI: 8.2-14.4) months, respectively. Forty-six (43.4%) patients underwent first- or further-line treatment with ICIs, 28 (60.8%) with nivolumab, 9 (19.6%) with pembrolizumab and 9 (19.6%) with atezolizumab. 30/46 (65.2%) patients received BTT, 24 (80.0%) zoledronate and 6 (20.0%) denosumab. The ICI-alone group had a mOS of 15.8 months (95%CI: 8.2-NE) vs. 21.8 months (95%CI: 14.5-not evaluable) for ICI plus BTT patients vs. 7.5 months (95%CI: 6.1-10.9) for the group undergoing other treatments (p= <0.001). NLR ≤ 5 had a positive impact on OS.
Conclusions
BTT appears to have a synergistic effect with ICIs, improving survival.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.