Abstract 1315P
Background
Hyperglycemia is associated with poor outcome in patients (pts) with curable non-small cell lung cancer (NSCLC), but its role in pts with advanced NSCLC is unknown. About a third of patients with PD-L1 ≥ 50% will experience early progression to pembrolizumab and markers predicting unfavorable outcome are urgently needed.
Methods
We conducted this retrospective study to assess the prognostic value of high fasting plasma glucose (HFG, >7 mmol/L) in a cohort of stage IV EGFR/ALK negative NSCLC pts with PDL1 ≥ 50% who received frontline pembrolizumab. We collected demographic and laboratory data, ECOG performance status (PS) and clinical outcome. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier method and a multivariate Cox regression model and log-rank test were performed.
Results
From August 2017 to June 2020 66 pts were included. Median age was 65.1 years old (40.4-90.3); 50 pts (75.8%) were males and 10 (15.2%) presented liver metastases (mets) at diagnosis. HFG was found in 20 pts (30.3%) at diagnosis, being only 45.0% of them previously diagnosed with type 2 diabetes mellitus. No differences were found according to gender, smoking history, comorbidities, PS, tumor histology or PDL-1 expression between HFG and non-HFG groups. HFG was associated with liver mets (p=0.001) and early progression at 3 months (p=0.003). With a median follow up of 18 months (m), median PFS was significantly shorter in pts with HFG (2.2 m; 95% CI 1.9-2.5 m) vs non-HFG (27.0 m; 95% CI 11.2-42.8 m; p<0.001). Median OS was significantly shorter in pts with HFG (6.0 m; IC95% 0.0-13.5 m) vs non-HFG (40.7 m; 95% CI 22.6-58.9 m; p=0.002). In the univariate analysis, HFG, ECOG PS and liver mets at diagnosis were significantly associated with worse PFS. In the multivariate analysis for PFS, HFG remained as independent prognostic factor (HR 2.73; 95% CI 1.34-5.56, p=0.006) after adjusting by ECOG PS and presence of liver mets.
Conclusions
Baseline HFG is independently associated with worse PFS and early tumor progression at 3 months in this cohort of pts treated with frontline pembrolizumab. Prospective studies in larger cohorts of NSCLC pts treated with immunotherapy are warranted to confirm this association.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
R. Palmero: Financial Interests, Personal, Advisory Board: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Guardant Health; Financial Interests, Personal, Invited Speaker: Roche. J. Brenes: Financial Interests, Personal, Invited Speaker: Takeda. N. Vilariño: Financial Interests, Personal, Advisory Role: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Roche Farm; Financial Interests, Personal, Invited Speaker: Lilly; Financial Interests, Personal, Invited Speaker: Pfizer. J.C.C. Ruffinelli: Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Pierre Fabre. J. Saldaña Cañada: Financial Interests, Personal, Invited Speaker: Astellas. M. Jove Casulleras: Financial Interests, Personal, Advisory Board: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: Roche. E. Nadal: Financial Interests, Institutional, Research Grant: Roche; Financial Interests, Institutional, Research Grant: Pfizer; Financial Interests, Institutional, Research Grant: Merck Serono; Financial Interests, Institutional, Research Grant: BMS; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Merck Serono; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Lilly; Financial Interests, Personal, Advisory Board: Amgen; Financial Interests, Personal, Advisory Board: Boehringer Ingelheim; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Takeda. All other authors have declared no conflicts of interest.