Predicting the efficacy of first‐line immunotherapy by combining cancer cachexia and tumor burden in advanced non‐small cell lung cancer. Issue 14 (13th June 2022)

• Record Type: Journal Article
• Authors: Miyawaki, Taichi; Naito, Tateaki; Doshita, Kosei; Kodama, Hiroaki; Mori, Mikiko; Nishioka, Naoya; Iida, Yuko; Miyawaki, Eriko; Mamesaya, Nobuaki; Kobayashi, Haruki; Omori, Shota; Ko, Ryo; Wakuda, Kazushige; Ono, Akira; Kenmotsu, Hirotsugu; Murakami, Haruyasu; Mori, Keita; Harada, Hideyuki; Endo, Masahiro; Takahashi, Kazuhisa; Takahashi, Toshiaki
• Is Part Of: Thoracic cancer. Volume 13:Issue 14(2022)
• Page Start: 2064
• Page End: 2074
• Publication Date: 2022-06-13
• Subjects: cancer cachexia -- immune checkpoint inhbitor -- non‐small cell lung cancer -- predictive model -- tumor burden; Chest -- Cancer -- Periodicals; Chest -- Cancer -- Treatment -- Periodicals; Chest -- Surgery -- Periodicals; 616.99494005
• DOI: 10.1111/1759-7714.14529
• Languages: English
• ISSNs: 1759-7706

Abstract

Abstract: Background: Cancer cachexia and tumor burden predict efficacies of programmed cell death‐1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) inhibitors and chemotherapy or pembrolizumab in non‐small cell lung cancer (NSCLC). There are no predictive models that simultaneously assess cancer cachexia and tumor burden. Methods: In the present retrospective study, we reviewed the medical records of patients with advanced NSCLC who received cancer immunotherapy as first‐line systemic therapy. Clinical immune predictive scores were defined according to multivariate analysis of progression‐free survival (PFS) and overall survival (OS). Results: A total of 157 patients were included in the present study (75 treated with PD‐1/PD‐L1 inhibitors + chemotherapy; 82, pembrolizumab monotherapy). Multivariate analysis for PFS revealed that PD‐L1 tumor proportion scores <50%, a total target lesion diameter ≥76 mm, and cancer cachexia were independently associated with poor PFS. Multivariate analysis for OS revealed that ≥4 metastases and cancer cachexia were significantly associated with poor OS. In the immune predictive model, the median PFS was 21.7 months in the low‐risk group ( N = 41); 7.6 in the medium‐risk group ( N = 64); and 3.0 in the high‐risk group ( N = 47). The median OS were not reached, 22.4 and 9.1 months respectively. Our immune predictive model was significantly associated with PFS ( p < 0.001) and OS ( p < 0.001). Conclusion: We proposed the immune predictive model, including tumor burden and cancer cachexia, which may predict the efficacy and survival outcome of first‐line immunotherapy in advanced NSCLC. Abstract : We proposed the immune predictive model, including tumor burden and cancer cachexia, which may predict the efficacy and survival outcome of first‐line immunotherapy in advanced non‐small‐cell lung cancer (NSCLC). A total of 157 patients were included in the present study (75 treated with programmed cell death‐1 [PD‐1] / programmed death‐ligand 1 [PD‐L1] inhibitors + chemotherapy; 82, pembrolizumab monotherapy). Multivariate analysis for PFS revealed that PD‐L1 tumor proportion scores <50%, a total target lesion diameter ≥ 76 mm, and cancer cachexia were independently associated with poor progression‐free survival (PFS). Multivariate analysis for overall survival (OS) revealed that ≥4 metastases and cancer cachexia were significantly associated with poor OS. The clinical immune predictive scores were constructed based on the HR in the multivariate analysis of PFS or OS. Based on the multivariate analysis of PFS or OS, the score of cancer cachexia was 2 points. PD‐L1 TPS >50%, sum of target lesion diameters >76 mm, and number of metastases ≥4 were scored as 1 point. In the immune predictive model, the median PFS was 21.7 months in the low‐risk group ( N = 41); 7.6 in the medium‐risk group ( N = 64); and 3.0 in the high‐risk group ( N = 47). The median OS were not reached, 22.4 and 9.1 months respectively. Our immune predictive model was significantly associated with PFS ( p < 0.001) and OS ( p < 0.001). Furtermore, the trend towards better OS and PFS were demonstrated by a decrease in the clinical immuno‐predictive score risk.