Abstract 74P
Background
ICI is proposed as the standard treatment for metastatic NSCLC in first-line and subsequent indications. It has different adverse effects with respect to traditional antineoplastics, given the stimulation of the immune system. Objective: analyze whether patients with a good prognosis lung cancer immunotherapy prognostic index (LIPI) have a better response to ICI and also to evaluate the relation of immune-related adverse events (irAEs) and response in patients with NSCLC in real clinical practice.
Methods
Observational, retrospective, single-center study. Cohort of stage IV NSCLC patients between 2016 and 2021. Toxicity grade (1–4) according to The Common Terminology Criteria for Adverse Events version 4.0. Response assessment according to RECIST 2.0 and immuno-related criteria. ICI in first (65%) or second (35%) line. Descriptive and survival analysis. Degree of toxicity and response to treatment (overall results and according to treatments and histology). LIPI index and response. LIPI defined as: dNLR (absolute neutrophil count/[white blood cell count − absolute neutrophil count]) ≥3 and lactate dehydrogenase (LDH) greater than the upper limit of normal; stratifies patients in “good” (G), “intermediate” (I) and “poor” (P) prognostic groups.
Results
N = 168 patients (p) (130 men/38 woman). Mean age 64.3 years. Mean dNLR 2.46. Average LDH 244U/L. Response: 15 (9%) complete response (CR), 50 (30%) partial response (PR), 39 (22%) stable disease (SD), 45 (28%) progression disease (PD) and 19 (11%) not evaluated (NE). 114 deaths (56% G, 76% I, 93% P). PFS (G 19 months, I 6, P 2) and OS (G 27 months, I 8, P 3). Adenocarcinoma 116 [77 with irAES G1-4 (13 CR, 31 PR, 21 SD, 8 PD, 4 NE), 39 without (3 PR, 6 SD, 21 PD, 9 NE]. Squamosus 52 [27 with irAES G1-4 (2 CR, 12 PR, 9 SD, 4 PD), 25 without (4 PR, 3 SD, 12 PD, 6 NE).] irAES appearance: longer PFS (19 vs 2 months) and OS (27 vs 4 months) p < 0.0001.
Conclusions
Good prognosis LIPI score patients (dNRL<3 and normal LDH) present a better response to ICI. LIPI index is a positive predictor of response to ICI. The presence of irAES is related with a better immune system response. In contrast, the absence of toxicity predicts a worse prognosis.
Legal entity responsible for the study
Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.