CEA and CYFRA 21-1 as prognostic biomarker and as a tool for treatment monitoring in advanced NSCLC treated with immune checkpoint inhibitors

Author:

Dall’Olio Filippo G.1,Abbati Francesca2,Facchinetti Francesco3,Massucci Maria2,Melotti Barbara2,Squadrilli Anna4,Buti Sebastiano4ORCID,Formica Francesca2,Tiseo Marcello45,Ardizzoni Andrea2

Affiliation:

1. Policlinico Sant’Orsola Malpighi, Division of Oncology, University of Bologna, Via Giuseppe Massarenti, 9, Bologna, 40138, Italy

2. Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia

3. INSERM U981, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France

4. Medical Oncology Unit, University Hospital of Parma, Parma, Italy

5. Department of Medicine and Surgery, University of Parma, Parma, Italy

Abstract

Aims: To assess prognostic value of pre-therapy carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) blood levels in non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors (ICIs) and their early change as predictor of benefit. Materials and methods: This is a retrospective cohort study including patients with stage IIIB–IV NSCLC who received anti PD-1/PD-L1 in first or advanced lines of therapy in two institutions. A control cohort of patients treated only with chemotherapy has been enrolled as well. Results: A total of 133 patients treated with nivolumab or atezolizumab were included in the test set, 74 treated with pembrolizumab first line in the validation set and 89 in the chemotherapy only cohort. CYFRA 21-1 >8 ng/mL was correlated with overall survival (OS) in the test set, validation set and in univariate and multivariate analysis (pooled cohort hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.24–2.93, p 0.003). Early 20% reduction after the third cycle was correlated with OS for CEA (HR 0.12; 95% CI 0.04–0.33; p < 0.001), and for CYFRA 21-1 (HR 0.19; 95% CI 0.07–0.55; p 0.002) Conclusions: CYFRA 21-1 pre-therapy assessment provides clinicians with relevant prognostic information about patients treated with ICI. CEA and CYFRA 21-1 repeated measures could be useful as an early marker of benefit.

Funder

Associazione Italiana per la Ricerca sul Cancro

Publisher

SAGE Publications

Subject

Oncology

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