Sixth-week immune-nutritional-inflammatory biomarkers: Can they predict clinical outcomes in patients with advanced non-small-cell lung cancer treated with immune checkpoint inhibitors?

Abstract

Abstract Background We explored the relationship between inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Lung Immune Prognostic Index (LIPI), and the modified Glasgow Prognostic Score (mGPS) to determine whether they could predict treatment response to pembrolizumab or nivolumab (immunotherapy). The data of 83 patients with non-small-cell lung cancer (NSCLC) treated with immunotherapy as first/second-line treatment were retrospectively analyzed. We conducted a retrospective analysis to investigate the usefulness of NLR, PLR, LIPI, and the mGPS at baseline and 6 weeks after the start of treatment (post-treatment). Methods We included all patients with lung cancer who were treated with immune checkpoint inhibitors (ICIs) from March 2017 to November 2021 at Burhan Nalbantoğlu Government Hospital and Near East University Hospital (North Cyprus). We examined NLR, PLR LIPI, and mGPS trends and explored the association with progression-free survival (PFS) overall survival (OS), and response rates (RR) at 6 weeks.The relationship was evaluated by Cox regression analysis. Results Eighty-three patients were enrolled in the study. The presence of liver metastasis, low post-treatment NLR (< 5), low post-treatment PLR (< 170), intermediate post-treatment LIPI, and immune-related adverse events were significantly associated with response. Patients with a high post-treatment NLR (≥ 5) had significantly shorter PFS (HR: 1.1, p < 0.001), shorter OS (HR: 1.2, p < 0.001). Multivariate analysis demonstrated that high post-treatment NLR was an independent prognostic factor of shorter OS. Patients with a high post-treatment PLR (≥ 170) had significantly shorterPFS (HR: 1.0, p < 0.001) and OS (HR: 0.9, p < 0.001). A high post-treatment PLR remained an independent prognostic factor for OS in multivariate analysis (HR: 0.9, p < 0.001). A good LIPI status was associated with better PFS (p < 0.020)and OS (p < 0.065)in ICI therapy compared with intermediate or poor LIPI status. Post-treatment GPS independently predicted anti-PD1 treatment efficacy; a good post-treatment GPS (GPS 0–2) was significantly associated with improved PFS (p < 0.009) and OS (p < 0.064) Conclusion Posttreatment NLR, PLR, LIPI, and mGPS are associated with worse OS and recurrence. These findings should be validated independently and prospectively in further studies.