Abstract 108P
Background
The Lung Immune Prognostic Index (LIPI) utilises derived neutrophil-lymphocyte ratio (dNLR) and LDH to define prognostic subgroups associated with overall survival (OS) and overall response rate (ORR) to immune-checkpoint inhibitors (Mezquita L et al, JAMA Oncol 2018).
Methods
Pre-treated advanced NSCLC pts who received Pembrolizumab (P) at The Christie (Jan ’17-July ’19) were identified. Baseline demographics, PD-L1 tumour proportion score (TPS), and LIPI score were collected. We assessed progression free survival (PFS) and OS using Kaplan-Meier method and performed a comparative analysis of LIPI score and PD-L1 TPS on survival.
Results
111 consecutive pts were analysed (Table shows baseline demographics). After a median follow up of 11.2 months, 77.5% of pts progressed. ORR was 26.1%. Median PFS and OS were 4 (1.6-6.4) and 13 (10.2-15.8) months (mos), respectively. OS was 10 vs 19 mos (HR 0.50, 95%CI 0.3-0.8; p=0.006) for TPS 1-49% and ≥50%, respectively. OS for good vs intermediate vs poor LIPI score was 14, 11 and 3 mos (HR 1.5, 95% CI 1.1-2.3; p=0.018), respectively. 36.9% of pts experienced immune related adverse events (irAEs), 10.8% being grade 3-5. Toxicity-related discontinuation rate was 14.4%. LIPI score and high TPS remained prognostic factors in a multivariate model including ECOG, smoking status and irAEs. 40% of pts received ≤ 4 cycles, mostly due to early disease progression (EDP). Pts with EDP had shorter OS (4 vs 19 mos, P<0.005). Next generation sequencing analysis for this subgroup is ongoing. Table: 108P
| Demographics | n (%) |
| Age, mean | 65 |
| ≥ 75 | 20 (18.0%) |
| Sex (male) | 66 (59.5%) |
| ECOG | |
| 0-1 | 108 (97.3) |
| 2 | 3 (2.7) |
| Smoking history | |
| Current/Former | 103 (92.8) |
| Never | 8 (7.2) |
| Histology | |
| Adenocarcinoma | 70 (63.1) |
| Squamous | 34 (31.5) |
| Other/NOS | 6 (5.4) |
| Molecular profile | |
| EGFR | 2 (1.8) |
| ALK/ ROS1 | 0 (0) |
| KRAS | 6 (5.4) |
| Biopsy sample for PD-L1 | |
| Archival | 76 (68.5) |
| Fresh | 35 (31.5) |
| PD-L1 TPS | |
| 1-49% | 62 (55.9) |
| ≥ 50% | 49 (44.1) |
| Previous lines of treatment | |
| 1 | 99 (89.2) |
| ≥2 | 12 (10.8) |
| Stage at P initiation | |
| IIIA/IIIB | 12 (10.8) |
| IV | 99 (89.2) |
| Brain metastasesActive brain metastases |
Conclusions
Our cohort demonstrated similar survival outcomes to KEYNOTE-010, which reflects appropriate patients’ selection. High PD-L1 TPS and LIPI score predicted longer OS.
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.