Abstract 1480P
Background
The clinical standard for response evaluation and treatment monitoring in advanced non-small cell lung cancer (NSCLC) is repeated, imaging-based staging. However, on immune checkpoint inhibition (ICI), many patients achieve stable disease (SD) as the best overall response. Clinical outcomes in this group vary widely, and whether measuring tumor size adequately captures the complex, dynamic processes following immune checkpoint inhibition is controversial. Hence, complementary biomarkers that improve outcome prediction are needed. A promising candidate is the modified Glasgow prognostic score (mGPS), a well-established prognostic score based on the serum markers C-reactive protein (CRP) and albumin that has demonstrated to predict clinical outcomes in a variety of oncological settings.
Methods
We re-evaluated the mGPS at the time of first staging (6 weeks after the start of therapy) in patients with NSCLC treated with atezolizumab (anti-PD-L1 antibody) in the phase 3 OAK trial.
Results
In patients treated with anti PD-L1 (n = 412), the on-treatment mGPS yields prognostic information similar to radiological staging (c-index 0.65 (95 % confidence interval 0.61 – 0.68) vs 0.61 (0.57 - 0.64). Notably, the mGPS low-risk subgroup is larger (54.4 %) compared to the partial response (PR) subgroup (7,5%). In the clinically heterogenous SD subgroup, on-treatment mGPS strongly correlated with survival (intermediate risk HR 2.4, p < 0.001, high-risk HR 3.5, p < 0.001, compared to low risk). On-treatment mGPS was also prognostic in patients with progressive disease (PD, intermediate risk HR 1.7, p = 0.033, high-risk HR 2.9, p < 0.001, compared to low risk). Remarkably, patients with PD and low-risk mGPS at first staging had a higher 12-month survival probability compared to patients with SD with intermediate or high-risk mGPS (67.0% vs 64.0%/47.7%).
Conclusions
Integrating on-treatment biomarkers into imaging-based staging can improve outcome prediction. A multi-modal approach to response assessment more akin to current practice in many hematologic malignancies should be further investigated in solid oncology, particularly in the context of immunotherapy.
Clinical trial identification
NCT02008227.
Editorial acknowledgement
This publication is based on research using data from data contributors Roche that has been made available through Vivli, Inc. Vivli has not contributed to or approved, and is not in any way responsible for, the contents of this publication.
Legal entity responsible for the study
The authors.
Funding
BONFOR (Medical Faculty, University of Bonn), German Research Foundation (DFG).
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
1523P - Phase II dose optimization results from MOUNTAINEER-02: A study of tucatinib, trastuzumab, ramucirumab, and paclitaxel for HER2+ gastroesophageal cancer (GEC)
Presenter: Mustapha Tehfe
Session: Poster session 21
1524P - First-line TST001 plus capecitabine and oxaliplatin (CAPOX) for advanced G/GEJ cancer with CLDN18.2 positive overall survival data from study transtar102-Cohort C
Presenter: Lin Shen
Session: Poster session 21
1526P - Phase Ib results of bemarituzumab (BEMA)+mfolfox6+nivolumab (NIVO) for advanced gastric/gastroesophageal junction cancer (G/GEJC): Fortitude-102 part 1
Presenter: Zev Wainberg
Session: Poster session 21
1527P - Efficacy and safety of infigratinib in locally advanced or metastatic gastric cancer or gastroesophageal junction adenocarcinoma patients with FGFR2 gene amplification
Presenter: Jiajia Yuan
Session: Poster session 21
1528P - A phase I/II trial investigating safety and efficacy of autologous TAC01-HER2 in relapsed or refractory solid tumors
Presenter: Daniel Olson
Session: Poster session 21
1529P - Tislelizumab plus chemotherapy sequential neo-chemoradiotherapy therapy as total neoadjuvant therapy in locally advanced esophageal squamous cell carcinoma (ETNT)
Presenter: Wenwu He
Session: Poster session 21
1530P - Health-related quality of life (hrqol) in patients with claudin-18 isoform 2-positive (CLDN18.2+) locally advanced (LA) unresectable or metastatic gastric or gastroesophageal junction (mg/GEJ) adenocarcinoma: Results from SPOTLIGHT and GLOW
Presenter: Florian Lordick
Session: Poster session 21
1532P - Phase Ib study of futibatinib plus pembrolizumab in patients with esophageal carcinoma: Updated results of antitumor activity and tolerability results in combination with chemotherapy
Presenter: Shun Yamamoto
Session: Poster session 21