The immune-metabolic-prognostic index and clinical outcomes in patients with non-small cell lung carcinoma under checkpoint inhibitors

Angelo Castello, Luca Toschi, Sabrina Rossi, Emanuela Mazziotti, Egesta Lopci

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: This prospective study evaluated whether peripheral blood biomarkers and metabolic parameters on F-18 fludeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) could be associated with clinical outcome in non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI).

METHODS: Data from 33 patients with NSCLC and treated with ICI were collected. Complete blood cell counts before and at the first restaging were measured. All patients underwent F-18 FDG PET/CT at baseline, while 25 patients at the first restaging. Progression-free survival (PFS) and overall survival (OS) were determined and compared using the Kaplan-Meier and the log-rank test. The median follow-up was 11.3 months (range 1-17 months).

RESULTS: Multivariate analyses demonstrated that low neutrophil-to-lymphocyte ratio (NLR < 4.9) and low total lesion glycolysis (TLG < 541.5 ml) at the first restaging were significantly associated with PFS (both p = 0.019) and OS (p = 0.001 and p = 0.048, respectively). An immune-metabolic-prognostic index (IMPI), based on post-NLR and post-TLG was developed, categorizing 3 groups: high risk, 2 factors; intermediate risk, 1 factor; low risk, 0 factors. Median PFS for low, intermediate and high risk was 7.8 months (95% CI 4.6-11.0), 5.6 months (95% CI 3.8-7.4), and 1.8 months (95% CI 1.6-2.0) (p < 0.001) respectively. Likewise, median OS was 15.2 months (95% CI 10.9-19.6), 13.2 months (95% CI 5.9-20.3), and 2.8 months (95% CI 1.4-4.2) (p < 0.001), respectively.

CONCLUSION: IMPI at the first restaging, combining both inflammatory and metabolic biomarkers, was correlated with PFS and OS. IMPI can be a potentially valuable tool for identifying NSCLC patients who are likely to benefit from ICI.

Original languageEnglish
Pages (from-to)1235-1243
Number of pages9
JournalJournal of Cancer Research and Clinical Oncology
Volume146
Issue number5
DOIs
Publication statusPublished - May 2020

Keywords

  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Humanized/administration & dosage
  • Antineoplastic Agents, Immunological/administration & dosage
  • B7-H1 Antigen/antagonists & inhibitors
  • Biomarkers, Tumor/blood
  • Carcinoma, Non-Small-Cell Lung/blood
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms/blood
  • Male
  • Middle Aged
  • Nivolumab/administration & dosage
  • Positron Emission Tomography Computed Tomography
  • Prognosis
  • Prospective Studies
  • Radiopharmaceuticals
  • Survival Rate

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