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Poster Display session

459 - Predictive score using clinical and blood biomarkers in advanced non-small cell lung cancer (aNSCLC) patients treated with immunotherapy

Date

14 Dec 2018

Session

Poster Display session

Presenters

Arsela Prelaj

Citation

Annals of Oncology (2018) 29 (suppl_10): x1-x10. 10.1093/annonc/mdy493

Authors

A. Prelaj1, S.E. Rebuzzi2, P. Pizzutilo3, M. Montrone3, F. Pesola3, V. Longo3, V. Lapadula3, F. Cassano3, P. Petrillo3, D. Bafunno3, N. Varesano3, V. Lamorgese3, A. Mastrandrea3, D. Ricci3, A. Catino3, G. Domenico3

Author affiliations

  • 1 Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 - Milan/IT
  • 2 Medical Oncology, Ospedale Policlinico San Martino of Genova, 16132 - Genova/IT
  • 3 Medical Thoracic Oncology Unit, Clinical Cancer Center "Giovanni Paolo II", Bari,, 70124 - Bari/IT
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Resources

Abstract 459

Background

Despite the overall survival (OS) benefit, only 18-20% of aNSCLC patients respond to immune-checkpoint inhibitors (ICI) as second-line therapy with a median progression-free survival (mPFS) of 2-4 months. The identification of predictive and prognostic biomarkers to select patients most likely to respond to ICI is greatly needed in guiding clinical practice.

Methods

We conducted a retrospective monocentric analysis of 154 aNSCLC patients receiving single-agent Nivolumab or Pembrolizumab as second-line (68%) and >3rd line (32%). We collected complete blood cell count at baseline and evaluated LDH, absolute neutrophil count (ANC), lymphocyte count (ALC), monocyte count (AMC) and eosinophil count (AEC) and their ratio such as neutrophil-lymphocyte ratio (NLR), derived-NLR (dNLR) and lymphocyte-monocyte ratio (LMR). Univariate and multivariate analyses were performed to identified indipendent predictors factors for immunotherapy (using Kaplan–Meier and Cox Progression analyses).

Results

The multivariate analysis on clinical factors showed the negative predictive role of ECOG PS 2 and liver metastasisand the positive predicitive role of smoking status. The multivariate analysis for PFS showed the negative predictive role of higher ANC (>6000/mL) and LDH (>400 mg/dl) and positive predictive role of higher ALC (>2200/mL). Also, according to stepwise regression analyses, NLR>4 playsa negative predictive and prognostic role at baseline. Finally, five predictive clinical and blood biomarkers at baseline (smoking status, ECOG PS, liver metastases, LDH and NLR), were used to create a predictive score for immunotherapy. Three predictive groups were defined as high, intermediate and low with a mPFS of 10.2 vs 4.9 vs 1.7 months respectively (HR 4.18 95% IC 2.64–6.62, p < 0.001).Table: 6P

Predictive FactorAssessmentPoint
ECOG PS0-1 20 1
Smoking (pack-years)> 43 < 430 1
Liver metastasesNo Yes0 1
LDH (mg/dl)< 400 > 4000 1
NLR< 4 > 40 1
Predictive groups (Points): 1 = 0 2 = 1-2 3 = 3-5PFS (months): 10.2 4.9 1.7HR 4.18 95% IC (2.64 – 6.62) p < 0.001

Conclusions

In advanced NSCLC patients treated with second-line immunotherapy, the identification of five and predictive clinical and blood biomarkers at baseline, combined in a predictive score, may help identify patients most likely to benefit from immunotherapy.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Clinical Cancer Center Giovanni Paolo II, Bari, Italy.

Funding

Has not received any funding.

Disclosure

G. Domenico: Advisory board: Bristol-Myers Squibb. All other authors have declared no conflicts of interest.

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