Abstract 1069P
Background
The first-line therapy for metastatic non-small cell lung cancer (mNSCLC), with the exception of oncogene-addicted NSCLC, is based on either immunotherapy (IT) or chemo-immunotherapy (CT-IT). These treatments revolutionized the therapeutic landscape, but responses are variable in clinical practice. For this reason, it would be fundamental to predict the clinical outcome from these therapies to get to more tailored therapeutic scenarios, such as the implementation of CT-IT or a therapy de-intensification.
Methods
We dosed several immune-based biomarkers in the serum of all pts starting a first-line treatment with IT at our centre from September 2020 to January 2022. We considered four biomarkers of sensitivity to IT: 1) high serum levels of interleukin-2; 2) high serum levels of interleukin-6; 3) low serum levels of tumour necrosis factor-alpha; 4) low CD4/CD8 ratio. The evaluation was performed before the start of IT, then at the time of the first evaluation and at the moment of disease progression. For the present analysis we focused on the baseline evaluations. We clustered patients into three classes: Group 1) pts with no biomarkers of sensitivity to IT at baseline; Group 2) pts with 1 or 2 biomarkers; Group 3) pts with 3 or 4 biomarkers. We compared the overall survival from the start of the first-line treatment in the three different classes with the Kaplan-Meier method.
Results
We performed analyses on 97 pts. The treatment was pembrolizumab in 95 pts, whereas only 2 pts received atezolizumab. 25 pts were in group 1, 32 in group 2, and 40 in group 3. We observed a median overall survival of 6.84 months (95%CI 4.71-8.97) in Group 1, 12.3 months (95%CI 11.37-13.18) in Group 2, and 20.3 months (95%CI 17.59-23) in Group 3; such differences were statistically significant (log-rank p < 0.001).
Conclusions
The clinical outcome of monotherapy with IT in mNSCLC is variable. Our immune-based score may give a good stratification of the clinical benefit of IT. It could be helpful in clinical practice to identify those pts who might benefit from more intensive therapeutic approaches, such as first-line CT-IT, or to de-intensify treatment in those pts who experience long and durable responses.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Sbrana: Financial Interests, Personal, Writing Engagements: Novartis; Financial Interests, Personal, Other, Travel fee: Pfizer. All other authors have declared no conflicts of interest.