The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer

G L Banna, A Cortellini, D L Cortinovis, M Tiseo, J G J V Aerts, F Barbieri, R Giusti, E Bria, F Grossi, P Pizzutilo, R Berardi, A Morabito, C Genova, F Mazzoni, V Di Noia, D Signorelli, A Gelibter, M Macerelli, F Rastelli, R ChiariD Rocco, S Gori, M De Tursi, P Di Marino, G Mansueto, F Zoratto, M Filetti, M Montrone, F Citarella, R Marco, L Cantini, O Nigro, E D'Argento, S Buti, G Minuti, L Landi, G Guaitoli, G Lo Russo, A De Toma, C Donisi, A Friedlaender, A De Giglio, G Metro, G Porzio, C Ficorella, A Addeo

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy.

METHODS: Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis.

RESULTS: NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis.

CONCLUSIONS: We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC.

Original languageEnglish
Pages (from-to)100078
JournalESMO Open
Volume6
Issue number2
DOIs
Publication statusPublished - Apr 2021

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