Abstract 113P
Background
Lung cancer is the most common type of cancer. EGFR and ALK mutation can be seen between 12 – 17% and 5 – 7% of the lung adenocarcinoma, respectively. Prognostic nutritional index (PNI) which can be calculated easily by using peripheral blood parameters is used for reflection of the nutritional and immunological condition. We aimed that investigate the prognostic effect of pre-treatment PNI in advanced lung adenocarcinoma patients with targetable mutation.
Methods
Inclusion criteria; age ≥18 years, Stage 3C-4 patients, presence of EGFR /ALK mutation, receipt of erlotinib/gefitinib in EGFR mutation patients and crizotinib in ALK rearrangement patients as first or second-line treatment. PNI was calculated with the following formula to identified by Onodera and colleagues: 10 × serum albumin (g/dl) + 0.005 × peripheral lymphocyte count (per mm3).
Results
In the EGFR+ group, 47% were PNI ≥ 50, 53% were PNI < 50. In ALK+ group, 42% were PNI ≥ 50 and 58% were PNI<50. In EGFR+ subgroup, PFS was significantly longer in PNI ≥ 50 than PNI < 50. In the patients with PNI ≥ 50 and < 50, the median PFS was 17.47 months and 12.45 months, respectively. In PNI ≥ 50 group, the risk for disease progression or death was lower approximately 50% compared with PNI < 50 group. In EGFR exon 19-deletion positive subgroup, median PFS was nearly significant longer in PNI ≥ 50 than < 50. The median PFS was also significantly longer in PNI ≥ 50 group in the patients with EGFR exon 21 L858R mutation. In ALK-positive patients, PFS was significantly longer in patients with PNI ≥ 50 than PNI < 50. The median PFS was 24.9 months in PNI ≥ 50, 8.8 months in PNI<50. As a result, PNI was found as an independent prognostic factor in both group.
Conclusions
We found that high PNI level was related with significant longer PFS in the whole group. This investigation has elucidated the prognostic significance of the PNI as indicators reflective of both inflammatory status and nutritional well-being in advanced lung cancer cases harboring targetable mutations. Table: 113P
Patients' demographic and clinical characteristics, and PFS rates in relation to PNI levels
| EGFR mutant patients | PNI | ALK mutant Patients | PNI | ||||
| < 50 | ≥ 50 | P | < 50 | ≥ 50 | P | ||
| Age (med) | 64 | 62 | 0.34 | Age (med) | 52 | 49 | 0.387 |
| Sex (M/F)(%) | 43.9/56.1 | 43.1/56.9 | 0.92 | Sex (M/F)(%) | 65.5/35.5 | 49 (26 –70) | 0.387 |
| Brain met (Y/N- %) | 10.6/89.4 | 18.6/81.4 | 0.201 | Brain met (Y/N- %) | 32/68 | 40/60 | 0.57 |
| Liver met (Y/N- %) | 15.2/84.8 | 15.3/84.7 | 0.98 | Liver met (Y/N- %) | 17.9/82.1 | 9.5/90.5 | 0.409 |
| Bone met (Y/N- %) | 54.5/45.5 | 40.7/59.3 | 0.121 | Bone met (Y/N- %) | 37.9/62.1 | 33.3/66.7 | 0.73 |
| mPFS (months) | 12.45 | 17.4 | 0.004 (HR:0.51) | mPFS (months) | 8.8 | 24.9 | 0.01 (HR:0.42) |
| mPFS -EGFR exon 19del (months) | 12.09 | 16.9 | 0.098 | ||||
| mPFS -EGFR exon 21 L858R (months) | 13.4 | 18.1 | 0.007 |
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors
Funding
Has not received any funding
Disclosure
All authors have declared no conflicts of interest.