Prognostic factors in immunotherapy for advanced lung cancer

A retrospective analysis has associated first-line therapy with immune checkpoint inhibitors (ICIs) for advanced lung cancer with a positive prognosis. However, the use of high-dose corticosteroids and a high neutrophil-to-lymphocyte ratio (NLR) at best response were both associated with a negative prognosis [1].

Prof. Kan Wu (Zhejiang University School of Medicine, China) and colleagues sought to analyse the efficacy of ICIs in advanced lung cancer and to identify factors that could inform prognosis. They retrospectively reviewed the records of 84 patients who had been diagnosed with advanced lung cancer (adenocarcinoma, squamous carcinoma, non-small-cell lung cancer, or small-cell lung cancer) and undergone treatment with an ICI. Most patients (75/89.3%) did not have brain metastases, and over half (45/53.6%) had a positive PD-L1 status.

Among the 84 patients, only 33 (39.3%) received an ICI as first-line therapy, and 34 (40.5%) underwent combination therapy. Most patients were not given a steroid (67/79.8%) or an antibiotic (45/53.6%). The median overall survival (OS) of the entire patient population was 25.93 months, and the median progression-free survival (PFS) was 6.90 months.

A Cox regression analysis was performed on factors influencing PFS, and then PFS was stratified according to these prognostic indicators. The investigators found that the use of high-dose corticosteroids, use of ICIs in late-line treatment, and a higher NLR at best response were all associated with shorter PFS. The same analysis was performed on factors influencing OS, and the use of high-dose corticosteroids and a higher NLR at best response were both associated with shorter OS.

The researchers concluded that ICIs are most effective in advanced lung cancer when given as first-line therapy, and that the prognosis is better when patients are not given high-dose corticosteroids and have a low NLR at best response. However, future research will need to answer: is this a result of a corticosteroid-related blunting of the antitumor immune response to ICIs? Or is it due to an individual’s sensitivity to immune-related adverse events that need to be palliatively treated with corticosteroids?

1. Wu K. Prognosis factors in advanced lung cancer patients treated with checkpoint inhibitor-based immunotherapy. P42.04, WCLC 2021, 8–14 September.

 

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Posted on 21 September 2021