Abstract 1396P
Background
Immunotherapy with ICI is active in a minority of NSCLC patients. The identification of new biomarkers of efficacy is needed. We studied the relationship between the metabolism of the patient and the effectiveness of ICI.
Methods
Consecutive outpatients with mNSCLC had a nutritional assessment prior to initiate immunotherapy with either nivolumab or pembrolizumab. Rest energy expenditure (REE) was measured using indirect calorimetry and compared with the theoretical value provided by the Harris and Benedict formula. The hypothesis was that patients with normometabolism, thus able to induce active ATP-dependent lymphocyte activation would have a 2-fold improvement in 6-month progression free survival in comparison with patients with altered basal energy expenditure. A training set was used to find a cuttof for normometabolism definition and a validation set was prospectively recruited in two centers. Logistic regression model was applied to identify factors associated with 6-month PFS and a Cox model was used for survival.
Results
In the training cohort (39 patients, one center), normometabolism defined as measured REE of 90-110% of theoretical REE, had better 6-month PFS (54% versus 12%; odds ratio : 8.32; IC95 [1,40-65,99]; p=0.01) and presented a trend for improved overall survival (HR 2.15 ; IC95 0.994-4.661 ; p=0.05). In the validation cohort (100 patients, 2 centers), normometabolic patients had better 6-month PFS (56% versus 29%; odds ratio: 3.09 IC95 [1,21 - 8,11]; p=0.01) and improved survival (HR 2.37; IC95 1.25-4.49; p=0.008). The positive predictive value was 71% and the negative predictive value was 56%, Sensitivity 76% Specificity 50%.
Conclusions
The measurement of REE prior to ICI initiation improves the identification of mNSCLC patients who will experience favorable 6-month PFS and survival.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
François Goldwasser.
Funding
Baxter.
Disclosure
P. Boudou Rouquette: Advisory/Consultancy: Takeda; Advisory/Consultancy: BMS; Travel/Accommodation/Expenses: PharmaMar. J. Arrondeau: Travel/Accommodation/Expenses: Takeda; Advisory/Consultancy: Roche, BMS. E. Fabre: Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self): BMS; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: MSD. D. Damotte: Research grant/Funding (institution), Non-remunerated activity/ies: Inserm; Research grant/Funding (institution): CARPEM; Research grant/Funding (self): LabEx; Research grant/Funding (institution): InCA; Research grant/Funding (self): MedImmune. K. Leroy: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: BMS; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Travel/Accommodation/Expenses, Non-remunerated activity/ies: Roche; Honoraria (self), Advisory/Consultancy: Lilly; Non-remunerated activity/ies: Nanostring technologies. M. Wislez: Honoraria (self), Non-remunerated activity/ies, outside the submitted work: Roche; Non-remunerated activity/ies, outside the submitted work: Pfizer; Honoraria (self), Non-remunerated activity/ies, outside the submitted work: AstraZeneca; Honoraria (self), Non-remunerated activity/ies, outside the submitted work: MSD; Honoraria (self), Non-remunerated activity/ies, outside the submitted work: BMS; Honoraria (self), Non-remunerated activity/ies, outside the submitted work: Boehringer Ingelheim. J-P. Durand: Honoraria (self), outside the submitted work: Baxter; Honoraria (self), outside the submitted work: Fresenius. F. Goldwasser: Advisory/Consultancy, Research grant/Funding (institution): Baxter; Advisory/Consultancy: Fresenius; Advisory/Consultancy: Nutricia. All other authors have declared no conflicts of interest.