Abstract 140P
Background
Different blood markers have been investigated as prognostic indexes in NSCLC. Neutrality trial wants to analyze how NLR (Neutrophil to Lymphocytes ratio) and SII (Systemic Inflammatory Index - NLR x platelets) impact on outcomes of patients treated in accordance with Pacific regimen. In the last years new indexes such as the dNLR (neutrophil to leukocytes - neutrophil ratio) and the LIPI (Lung Immune Prognostic Index) have been validated in advanced NSCLC and are considered in the present analysis.
Methods
Patients were enrolled in two cohorts: those who received Durvalumab within the Italian EAP, and those treated with RCT alone. This analysis will focus on Durvalumab group. Blood count tests were recorded at established time points from the start of Durvalumab. Different cut-offs of NLR, dNLR and SII were considered, based on the median values observed in our population at baseline. We divided patients in 3 LIPI index prognostic groups: good (dNLR <3 and LDH ≤ UNL), intermediate (dNLR> 3 or LDH ≥ UNL) and poor (dNLR > 3 and LDH ≥ UNL). We performed a Cox-Regression analysis on the different parameters modeled as time-variables.
Results
Data about 96 patients from 34 Italian Oncology Centers were evaluable. Details of patients are shown in the table. The baseline NLR significantly correlates with PFS: for a cut-off of 5, the HR was 1.93 CI (1.12-3.30) p: 0.017, and for each increase of 1 point of NLR, the HR was 1.07 CI (1-1.14) p: 0.04. The baseline SII and dNLR values significantly correlate with PFS too, p: 0.08, and p: 0.018, respectively. The PFS of the good prognostic LIPI index group was significantly better than the intermediate group (p: 0.004), and the poor group (p: 0.039), as expected.
Table: 140P
| Patients (%)96 | |
| Sex | |
| M | 62 (64.5%) |
| F | 34 (35.5%) |
| Smoke | |
| Yes | 85 (88%) |
| No | 9 (12%) |
| Age years | |
| Median | 68 y |
| Range | 44-83 |
| Histology | |
| Adenocarcinoma | 54 (56%) |
| Squamocellular | 39 (41%) |
| Others | 3 (3%) |
| PD-L1 Expression | |
| 0 | 12 (12.5%) |
| 1-49 | 41 (43%)) |
| ≥ 50 | 30 (31%) |
| Not tested | 13 (13.5%) |
| Stage Disease | |
| IIIA | 35 (36.5%) |
| IIIB | 48 (50%) |
| IIIC | 13 (13.5%) |
| ECOG PS | |
| 0 | 59 (61.5%) |
| 1 | 35 (37.5%) |
| 2 | 1 (1%) |
| Radiotherapy | |
| Concomitant | 49 (51%) |
| Sequential | 47 (49%) |
| DTF | |
| 60 Gy | 73 (76%) |
| 66 Gy | 5 (5%) |
| 60-66 Gy | 4 (4%) |
| < 60 Gy | 14 (15%) |
| Time to Durvalumab | |
| < 40 days | 16 (17%) |
| 40-90 days | 58 (60%) |
| > 90 days | 22 (23%) |
Conclusions
Our study confirms the prognostic role of blood inflammatory indexes in unresectable stage III NSCLC. These could be possible biomarkers to guide intensification or de-escalation of treatments. Further analysis are still ongoing.
Clinical trial identification
EudraCT: ESR-19-20410.
Editorial acknowledgement
Dr. P. Borghetti, Dr. F. Meriggi, Dr. G. Farina, Dr. S. Pilotto, Dr. F. Grossi, Dr. A. Del Conte, Dr. F. Petrelli, Dr. M. Manzoni, Dr. M. Cergnul, Dr. A. Cammerini, Dr. E. Vasile, Dr. M. Iannopollo, Dr. A. Tartarone, Dr P. Taveggia, Dr A. Inno, Dr. A. Favaretto, Dr. E. Baldini, Dr. E. Quaquarini, Dr. A. Ponzanelli, Dr. A. Veccia, Dr. L. La Torre, Dr. A. Lugini.
Legal entity responsible for the study
Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Università degli Studi di Firenze, Florence, Italy.
Funding
AstraZeneca.
Disclosure
All authors have declared no conflicts of interest.