Epsilon: A prognostic score for immunotherapy in advanced non-small-cell lung cancer: A validation cohort

Arsela Prelaj, Roberto Ferrara, Sara Elena Rebuzzi, Claudia Proto, Diego Signorelli, Giulia Galli, Alessandro De Toma, Giovanni Randon, Filippo Pagani, Giuseppe Viscardi, Marta Brambilla, Benedetta Trevisan, Monica Ganzinelli, Antonia Martinetti, Rosaria Gallucci, Rosa Maria Di Mauro, Giuliano Molino, Nicoletta Zilembo, Valter Torri, Filippo Maria de BraudMarina Chiara Garassino, Giuseppe Lo Russo

Research output: Contribution to journalArticlepeer-review


Background: Beyond programmed death ligand 1 (PD-L1), no other biomarkers for immunotherapy are used in daily practice. We previously created EPSILoN (Eastern Cooperative Oncology Group performance status (ECOG PS), smoking, liver metastases, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR)) score, a clinical/biochemical prognostic score, in 154 patients treated with second/further-line immunotherapy. This study’s aim was to validate EPSILoN score in a different population group. Methods: 193 patients were included at National Cancer Institute of Milan (second-line immunotherapy, 61%; further-line immunotherapy, 39%). Clinical/laboratory parameters such as neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels were collected. Kaplan–Meier and Cox hazard methods were used for survival analysis. Results: Overall median progression-free survival and median overall survival were 2.3 and 7.6 months, respectively. Multivariate analyses for Progression-Free Survival (PFS) identified heavy smokers (hazard ratio (HR) 0.71, p = 0.036) and baseline LDH < 400 mg/dL (HR 0.66, p = 0.026) as independent positive factors and liver metastases (HR 1.48, p = 0.04) and NLR ≥ 4 (HR 1.49, p = 0.029) as negative prognostic factors. These five factors were included in the EPSILoN score which was able to stratify patients in three different prognostic groups, high, intermediate and low, with PFS of 6.0, 3.8 and 1.9 months, respectively (HR 1.94, p < 0.001); high, intermediate and low prognostic groups had overall survival (OS) of 24.5, 8.9 and 3.4 months, respectively (HR 2.40, p < 0.001). Conclusions: EPSILoN, combining five baseline clinical/blood parameters (ECOG PS, smoking, liver metastases, LDH, NLR), may help to identify advanced non-small-cell lung cancer (aNSCLC) patients who most likely benefit from immune checkpoint inhibitors (ICIs).

Original languageEnglish
Article number1954
Issue number12
Publication statusPublished - Dec 2019


  • Immunotherapy
  • Predictive
  • Prognostic
  • Score

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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