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Ksienski D, Truong PT, Bone JN, Egli S, Clarkson M, Patterson T, Lesperance M, Lakkunarajah S. Advanced cutaneous squamous cell carcinoma: Impact of age on the safety and efficacy of cemiplimab and the prognostic significance of blood biomarkers. J Geriatr Oncol 2024; 15:101789. [PMID: 38710153 DOI: 10.1016/j.jgo.2024.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/23/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Age-related differences in the safety profile of cemiplimab for patients with locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) have not been well described. We investigated the association of increasing age with immune related adverse events (irAE) from cemiplimab, efficacy outcomes, and the prognostic significance of pre-treatment blood biomarkers in contemporary practice. MATERIALS AND METHODS Patients starting first-line cemiplimab for locally advanced or metastatic cSCC at British Columbia Cancer between April 2019 and January 2023 were identified. Landmark four-month logistic regression analysis compared the odds of developing irAE or sequelae amongst patients aged <75 years to those aged 75-84 or ≥ 85. Objective responses were determined using Response Evaluation Criteria in Solid Tumors version 1.1. Univariable Cox proportional hazard (PH) regression modelling of factors associated with overall survival (OS) was performed. RESULTS Of 106 patients, the proportions aged <75, 75-84, and ≥ 85 years were 34%, 45%, and 21%, respectively. Overall, the proportion of patients with irAE ≥ grade 3, cemiplimab discontinuation, and hospitalization for immune toxicity was 27.4%, 31.1%, and 11.3%, respectively. There was no clear association between age and the odds of high grade irAE. However, increased odds of cemiplimab discontinuation was observed in patients aged 75-84 years (p = 0.05). Patients ≥85 years had increased hospitalizations due to irAE (OR = 5.00, 95% CI = 0.97-37.52) with two treatment-related deaths. Objective responses were similar across age cohorts (50.0%, 60.4%, and 54.5%) but progressive disease was higher in the age ≥ 85 group (22.2%, 18.8%, and 31.8%). On Cox PH regression analysis, age ≥ 85 years (vs. <75), Eastern Cooperative Oncology Group performance status 2-3 (vs. 0-1), and neutrophil to lymphocyte ratio (NLR) ≥7.80 (vs. <7.80) were associated with shorter survival. DISCUSSION While the odds of high grade irAE were similar across age groups, significant age-related differences in treatment discontinuation and hospitalization due to immune toxicity were observed. Despite a higher incidence of primary progression and shorter OS in the oldest cohort, cemiplimab yielded robust objective responses regardless of age. Higher pre-treatment NLR was associated with shorter survival and the cut-point identified requires further study.
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Affiliation(s)
- Doran Ksienski
- BC Cancer-Victoria, British Columbia, Canada; University of British Columbia, Victoria, British Columbia, Canada.
| | - Pauline T Truong
- BC Cancer-Victoria, British Columbia, Canada; University of British Columbia, Victoria, British Columbia, Canada
| | - Jeffrey N Bone
- Biostatistics, Clinical Research Support Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sarah Egli
- BC Cancer-Victoria, British Columbia, Canada
| | | | | | - Mary Lesperance
- University of Victoria, Department of Mathematics and Statistics, Victoria, British Columbia, Canada
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De Rosa C, Iommelli F, De Rosa V, Ercolano G, Sodano F, Tuccillo C, Amato L, Tirino V, Ariano A, Cimmino F, di Guida G, Filosa G, di Liello A, Ciardiello D, Martinelli E, Troiani T, Napolitano S, Martini G, Ciardiello F, Papaccio F, Morgillo F, Della Corte CM. PBMCs as Tool for Identification of Novel Immunotherapy Biomarkers in Lung Cancer. Biomedicines 2024; 12:809. [PMID: 38672164 PMCID: PMC11048624 DOI: 10.3390/biomedicines12040809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Lung cancer (LC), including both non-small (NSCLC) and small (SCLC) subtypes, is currently treated with a combination of chemo- and immunotherapy. However, predictive biomarkers to identify high-risk patients are needed. Here, we explore the role of peripheral blood mononuclear cells (PBMCs) as a tool for novel biomarkers searching. METHODS We analyzed the expression of the cGAS-STING pathway, a key DNA sensor that activates during chemotherapy, in PBMCs from LC patients divided into best responders (BR), responders (R) and non-responders (NR). The PBMCs were whole exome sequenced (WES). RESULTS PBMCs from BR and R patients of LC cohorts showed the highest levels of STING (p < 0.0001) and CXCL10 (p < 0.0001). From WES, each subject had at least 1 germline/somatic alteration in a DDR gene and the presence of more DDR gene mutations correlated with clinical responses, suggesting novel biomarker implications. Thus, we tested the effect of the pharmacological DDR inhibitor (DDRi) in PBMCs and in three-dimensional spheroid co-culture of PBMCs and LC cell lines; we found that DDRi strongly increased cGAS-STING expression and tumor infiltration ability of immune cells in NR and R patients. Furthermore, we performed FACS analysis of PBMCs derived from LC patients from the BR, R and NR cohorts and we found that cytotoxic T cell subpopulations displayed the highest STING expression. CONCLUSIONS cGAS-STING signaling activation in PBMCs may be a novel potential predictive biomarker for the response to immunotherapy and high levels are correlated with a better response to treatment along with an overall increased antitumor immune injury.
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Affiliation(s)
- Caterina De Rosa
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Francesca Iommelli
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Naples, Italy;
| | - Viviana De Rosa
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Naples, Italy;
| | - Giuseppe Ercolano
- Department of Pharmacy, School of Medicine, University of Naples Federico II, 80138 Naples, Italy; (G.E.); (F.S.)
| | - Federica Sodano
- Department of Pharmacy, School of Medicine, University of Naples Federico II, 80138 Naples, Italy; (G.E.); (F.S.)
| | - Concetta Tuccillo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Luisa Amato
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Virginia Tirino
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy;
- U.P. Diagnostica Citometrica e Mutazionale, A.O.U. Vanvitelli, Università degli Studi della Campania, 80138 Naples, Italy
| | - Annalisa Ariano
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Flora Cimmino
- Hospital “Martiri Di Villa Malta”, 84087 Sarno, Italy;
| | - Gaetano di Guida
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Gennaro Filosa
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Alessandra di Liello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Davide Ciardiello
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy;
| | - Erika Martinelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Teresa Troiani
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Stefania Napolitano
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Giulia Martini
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Federica Papaccio
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Baronissi, Italy;
| | - Floriana Morgillo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
| | - Carminia Maria Della Corte
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.D.R.); (C.T.); (L.A.); (A.A.); (G.d.G.); (G.F.); (A.d.L.); (E.M.); (T.T.); (S.N.); (G.M.); (F.C.); (F.M.)
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Tsai YT, Schlom J, Donahue RN. Blood-based biomarkers in patients with non-small cell lung cancer treated with immune checkpoint blockade. J Exp Clin Cancer Res 2024; 43:82. [PMID: 38493133 PMCID: PMC10944611 DOI: 10.1186/s13046-024-02969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/30/2024] [Indexed: 03/18/2024] Open
Abstract
The paradigm of non-small cell lung cancer (NSCLC) treatment has been profoundly influenced by the development of immune checkpoint inhibitors (ICI), but the range of clinical responses observed among patients poses significant challenges. To date, analyses of tumor biopsies are the only parameter used to guide prognosis to ICI therapy. Tumor biopsies, however, are often difficult to obtain and tissue-based biomarkers are limited by intratumoral heterogeneity and temporal variability. In response, there has been a growing emphasis on the development of "liquid biopsy"‒ derived biomarkers, which offer a minimally invasive means to dynamically monitor the immune status of NSCLC patients either before and/or during the course of treatment. Here we review studies in which multiple blood-based biomarkers encompassing circulating soluble analytes, immune cell subsets, circulating tumor DNA, blood-based tumor mutational burden, and circulating tumor cells have shown promising associations with the clinical response of NSCLC patients to ICI therapy. These investigations have unveiled compelling correlations between the peripheral immune status of patients both before and during ICI therapy and patient outcomes, which include response rates, progression-free survival, and overall survival. There is need for rigorous validation and standardization of these blood-based assays for broader clinical application. Integration of multiple blood-based biomarkers into comprehensive panels or algorithms also has the potential to enhance predictive accuracy. Further research aimed at longitudinal monitoring of circulating biomarkers is also crucial to comprehend immune dynamics and resistance mechanisms and should be used alongside tissue-based methods that interrogate the tumor microenvironment to guide treatment decisions and may inform on the development of novel therapeutic strategies. The data reviewed here reinforce the opportunity to refine patient stratification, optimize treatments, and improve outcomes not only in NSCLC but also in the wider spectrum of solid tumors undergoing immunotherapy.
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Affiliation(s)
- Yo-Ting Tsai
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey Schlom
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Renee N Donahue
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Krizova L, Benesova I, Zemanova P, Spacek J, Strizova Z, Humlova Z, Mikulova V, Petruzelka L, Vocka M. Immunophenotyping of peripheral blood in NSCLC patients discriminates responders to immune checkpoint inhibitors. J Cancer Res Clin Oncol 2024; 150:99. [PMID: 38383923 PMCID: PMC10881622 DOI: 10.1007/s00432-024-05628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) dramatically changed the prognosis of patients with NSCLC. Unfortunately, a reliable predictive biomarker is still missing. Commonly used biomarkers, such as PD-L1, MSI, or TMB, are not quite accurate in predicting ICI efficacy. METHODS In this prospective observational cohort study, we investigated the predictive role of erythrocytes, thrombocytes, innate and adaptive immune cells, complement proteins (C3, C4), and cytokines from peripheral blood of 224 patients with stage III/IV NSCLC treated with ICI alone (pembrolizumab, nivolumab, and atezolizumab) or in combination (nivolumab + ipilimumab) with chemotherapy. These values were analyzed for associations with the response to the treatment and survival endpoints. RESULTS Higher baseline Tregs, MPV, hemoglobin, and lower monocyte levels were associated with favorable PFS and OS. Moreover, increased baseline basophils and lower levels of C3 predicted significantly improved PFS. The levels of the baseline immature granulocytes, C3, and monocytes were significantly associated with the occurrence of partial regression at the first restaging. Multiple studied parameters (n = 9) were related to PFS benefit at the time of first restaging as compared to baseline values. In addition, PFS nonbenefit group showed a decrease in lymphocyte count after three months of therapy. The OS benefit was associated with higher levels of lymphocytes, erythrocytes, hemoglobin, MCV, and MPV, and a lower value of NLR after three months of treatment. CONCLUSION Our work suggests that parameters from peripheral venous blood may be potential biomarkers in NSCLC patients on ICI. The baseline values of Tregs, C3, monocytes, and MPV are especially recommended for further investigation.
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Affiliation(s)
- Ludmila Krizova
- Department of Oncology, General University Hospital in Prague and First Faculty of Medicine, Charles University, U Nemocnice 499/2, 128 00, Prague 2, Czech Republic
| | - Iva Benesova
- Department of Immunology, Second Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic
| | - Petra Zemanova
- Department of Oncology, General University Hospital in Prague and First Faculty of Medicine, Charles University, U Nemocnice 499/2, 128 00, Prague 2, Czech Republic
| | - Jan Spacek
- Department of Oncology, General University Hospital in Prague and First Faculty of Medicine, Charles University, U Nemocnice 499/2, 128 00, Prague 2, Czech Republic
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic
| | - Zuzana Humlova
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Veronika Mikulova
- Institute of Medical Biochemistry and Laboratory Diagnostics, Laboratory of Clinical Immunology and Allergology, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lubos Petruzelka
- Department of Oncology, General University Hospital in Prague and First Faculty of Medicine, Charles University, U Nemocnice 499/2, 128 00, Prague 2, Czech Republic
| | - Michal Vocka
- Department of Oncology, General University Hospital in Prague and First Faculty of Medicine, Charles University, U Nemocnice 499/2, 128 00, Prague 2, Czech Republic.
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Zhang Y, Huang C, Li S. Influence of treatment-related lymphopenia on the efficacy of immune checkpoint inhibitors in lung cancer: a meta-analysis. Front Oncol 2023; 13:1287555. [PMID: 38107070 PMCID: PMC10722281 DOI: 10.3389/fonc.2023.1287555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Background Treatment-related lymphopenia (TRL) is common in patients with lung cancer, particularly in those with radiotherapy. However, the influence of TRL on the efficacy of immune checkpoint inhibitors (ICIs) for patients with lung cancer remains poorly understood. We performed a systematic review and meta-analysis to investigate the influence of TRL on survival of lung cancer patients on ICIs. Methods In order to accomplish the aim of the meta-analysis, a comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and the Web of Science to identify observational studies with longitudinal follow-up. The Cochrane Q test was employed to evaluate heterogeneity among the included studies, while the I2 statistic was estimated. Random-effects models were utilized to merge the results, considering the potential impact of heterogeneity. Results Ten cohort studies with 1130 lung cancer patients who were treated with ICIs were included. Among them, 427 (37.8%) had TRL. Pooled results showed that compared to patients without TRL, patients with TRL were associated with poor progression-free survival (hazard ratio [HR]: 2.05, 95% confidence interval [CI]: 1.62 to 2.60, p < 0.001; I2 = 22%) and overall survival (HR: 2.69, 95% CI: 2.10 to 3.43, p < 0.001; I2 = 0%). Sensitivity analysis limited to patients with non-small cell lung cancer showed similar results (HR: 2.66 and 2.62, both p < 0.05). Moreover, subgroup analyses according to the diagnostic criteria of TRL, regression analysis model (univariate or multivariate), and indications of ICIs (for locally advanced or advanced lung cancer) showed consistent results (p for subgroup difference all > 0.05). Conclusion TRL was associated with poor survival of lung cancer patients who were treated with ICIs.
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Affiliation(s)
| | | | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Mouritzen MT, Ladekarl M, Hager H, Mattesen TB, Lippert JB, Frank MS, Nøhr AK, Egendal IB, Carus A. Gene Expressions and High Lymphocyte Count May Predict Durable Clinical Benefits in Patients with Advanced Non-Small-Cell Lung Cancer Treated with Immune Checkpoint Inhibitors. Cancers (Basel) 2023; 15:4480. [PMID: 37760450 PMCID: PMC10526901 DOI: 10.3390/cancers15184480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Not all patients with advanced non-small cell lung cancer (NSCLC) benefit from immune checkpoint inhibitors (ICIs). Therefore, we aimed to assess the predictive potential of gene expression profiling (GEP), peripheral immune cell counts, and clinical characteristics. METHODS The primary endpoint of this prospective, observational study was a durable clinical benefit (DCB) defined as progression-free survival >6 months. In a subgroup with histological biopsies of sufficient quality (n = 25), GEP was performed using the nCounter® PanCancer IO 360 panel. RESULTS DCB was observed in 49% of 123 included patients. High absolute lymphocyte count (ALC) and absence of liver metastases were associated with DCB (OR = 1.95, p = 0.038 and OR = 0.36, p = 0.046, respectively). GEP showed clustering of differentially expressed genes according to DCB, and a strong association between PD-L1 assessed by GEP (CD274) and immunohistochemistry (IHC) was observed (p = 0.00013). The TGF-β, dendritic cell, and myeloid signature scores were higher for patients without DCB, whereas the JAK/STAT loss signature scores were higher for patients with DCB (unadjusted p-values < 0.05). CONCLUSIONS ALC above 1.01 × 109/L and absence of liver metastases were significantly associated with DCB in ICI-treated patients with NSCLC. GEP was only feasible in 20% of the patients. GEP-derived signatures may be associated with clinical outcomes, and PD-L1 could be assessed by GEP rather than IHC.
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Affiliation(s)
- Mette T. Mouritzen
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; (M.L.); (A.C.)
- Clinical Cancer Research Centre, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark; (A.K.N.); (I.B.E.)
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
| | - Morten Ladekarl
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; (M.L.); (A.C.)
- Clinical Cancer Research Centre, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark; (A.K.N.); (I.B.E.)
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
| | - Henrik Hager
- Department of Clinical Pathology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark (T.B.M.)
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark
| | - Trine B. Mattesen
- Department of Clinical Pathology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark (T.B.M.)
| | - Julie B. Lippert
- Department of Clinical Pathology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark (T.B.M.)
| | - Malene S. Frank
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark;
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Anne K. Nøhr
- Clinical Cancer Research Centre, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark; (A.K.N.); (I.B.E.)
- Center for Clinical Data Science (CLINDA), Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
| | - Ida B. Egendal
- Clinical Cancer Research Centre, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark; (A.K.N.); (I.B.E.)
- Center for Clinical Data Science (CLINDA), Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
| | - Andreas Carus
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; (M.L.); (A.C.)
- Clinical Cancer Research Centre, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark; (A.K.N.); (I.B.E.)
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
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Teng S, Su Y, Pallantla R, Channavazzala M, Kumar R, Sheng Y, Wang H, Wang C, Tse A. Can a propensity score matching method be applied to assessing efficacy from single-arm proof-of-concept trials in oncology? CPT Pharmacometrics Syst Pharmacol 2023; 12:1347-1357. [PMID: 37528543 PMCID: PMC10508568 DOI: 10.1002/psp4.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
As a result of the escalating number of new cancer treatments being developed and competition among pharmaceutical companies, decisions regarding how to proceed with phase III trials are frequently based on findings from either single-arm phase I expansion cohorts or phase II studies that compare the efficacy of the study drug to a standard-of-care benchmark derived from historical data. However, even when eligibility criteria are matched, differences in the distribution of baseline patient features may influence the outcome of single-arm trials in real-world scenarios. Therefore, novel methods are needed to enhance the accuracy of efficacy prediction from current cohorts relative to historical data. In this study, we demonstrated the feasibility of using the propensity score matching (PSM) method to improve decision making by matching relevant baseline features between current and historical cohorts. According to our findings, utilizing the PSM method may provide a less biased means of comparing outcomes between current and historical cohorts relative to a naïve approach, which relies solely on differences in average outcomes between the cohorts.
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Affiliation(s)
| | | | | | | | | | | | - Hao Wang
- CStone PharmaceuticalsSu ZhouChina
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Marcos Rubio A, Everaert C, Van Damme E, De Preter K, Vermaelen K. Circulating immune cell dynamics as outcome predictors for immunotherapy in non-small cell lung cancer. J Immunother Cancer 2023; 11:e007023. [PMID: 37536935 PMCID: PMC10401220 DOI: 10.1136/jitc-2023-007023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/05/2023] Open
Abstract
The use of immune checkpoint inhibitors (ICIs) continues to transform the therapeutic landscape of non-small cell lung cancer (NSCLC), with these drugs now being evaluated at every stage of the disease. In contrast to these advances, little progress has been made with respect to reliable predictive biomarkers that can inform clinicians on therapeutic efficacy. All current biomarkers for outcome prediction, including PD-L1, tumor mutational burden or complex immune gene expression signatures, require access to tumor tissue. Besides the invasive nature of the sampling procedure, other disadvantages of tumor tissue biopsies are the inability to capture the complete spatial heterogeneity of the tumor and the difficulty to perform longitudinal follow-up on treatment. A concept emerges in which systemic immune events developing at a distance from the tumor reflect local response or resistance to immunotherapy. The importance of this cancer 'macroenvironment', which can be deciphered by comprehensive analysis of peripheral blood immune cell subsets, has been demonstrated in several cutting-edge preclinical reports, and is corroborated by intriguing data emerging from ICI-treated patients. In this review, we will provide the biological rationale underlying the potential of blood immune cell-based biomarkers in guiding treatment decision in immunotherapy-eligible NSCLC patients. Finally, we will describe new techniques that will facilitate the discovery of more immune cell subpopulations with potential to become predictive biomarkers, and reflect on ways and the remaining challenges to bring this type of analysis to the routine clinical care in the near future.
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Affiliation(s)
- Alvaro Marcos Rubio
- VIB UGent Center for Medical Biotechnology, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Gent, Belgium
| | - Celine Everaert
- VIB UGent Center for Medical Biotechnology, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Gent, Belgium
| | - Eufra Van Damme
- VIB UGent Center for Medical Biotechnology, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Gent, Belgium
| | - Katleen De Preter
- VIB UGent Center for Medical Biotechnology, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Gent, Belgium
| | - Karim Vermaelen
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Tumor Immunology Laboratory, Department of Pulmonary Medicine, University Hospital Ghent, Ghent, Belgium
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9
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Yan X, Wang J, Mao J, Wang Y, Wang X, Yang M, Qiao H. Identification of prognostic nutritional index as a reliable prognostic indicator for advanced lung cancer patients receiving immune checkpoint inhibitors. Front Nutr 2023; 10:1213255. [PMID: 37575320 PMCID: PMC10416798 DOI: 10.3389/fnut.2023.1213255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Prognostic nutritional index (PNI) has been identified as a reliable prognostic factor for cancer adjuvant therapy. However, its prognostic value in lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains inconclusive. Method A systematic literature review and meta-analysis was performed based on online databases before March 1th 2023. The correlation of PNI with overall survival (OS) or progression-free survival (PFS) was determined using the hazard ratios (HRs) coupled with 95% confidence intervals (CIs). Then, a retrospective cohort enrolling 123 ICI-treated lung cancer patients from two hospitals was utilized for validation and further investigation. Results A total of 14 studies enrolling 1,260 lung cancer patients were included in the meta-analysis. The high PNI level was significantly correlated with better OS (HR = 2.56, 95% CI = 1.86-3.54) and PFS (HR = 1.91, 95% CI = 1.53-2.40) of the lung cancer patients. The subgroup analysis confirmed the results except for the PFS in patients receiving anti-PD-1 therapy (HR = 1.51, 95% CI = 0.86-2.65). In the retrospective study, the high PNI level was identified as a favorable factor for OS and PFS not only in the whole cohort but also in the subgroups stratified by non-small cell lung cancer and small cell lung cancer. The high PNI was also correlated with better anti-cancer therapy response and performed better than body mass index and serum albumin level in OS prediction. Finally, we established a novel prognostic nomogram based on PNI and other clinical parameters. The nomogram was found to perform well in predicting the 1-year OS of ICI-treated lung cancer patients. Conclusion Both the meta-analysis and retrospective work demonstrate the PNI is a reliable prognostic factor for advanced lung cancer patients receiving ICI-based therapies. Our study further highlights the crucial role of nutrition assessment and intervention in cancer immunotherapy. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023424146.
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Affiliation(s)
- Xuebing Yan
- Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jiaxin Wang
- Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jingxian Mao
- Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Ying Wang
- Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xiangjun Wang
- Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Mengxue Yang
- Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China
| | - Hong Qiao
- Department of Oncology, Baoying Traditional Chinese Medicine Hospital, Yangzhou, China
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10
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Xu XT, Qian Y, Tian MX, Ding CC, Guo H, Tang J, Pi GL, Wu Y, Dai Z, Jin X. Predictive impact of prognostic nutritional index in patients with cancer treated with immune checkpoint inhibitors: a systematic review and meta-analysis. Nutr Cancer 2023:1-14. [PMID: 37140894 DOI: 10.1080/01635581.2023.2203355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A few previous studies have investigated the prognostic value of the prognostic nutritional index (PNI) in patients treated with immune checkpoint inhibitors (ICIs); however, the results are inconsistent. Therefore, this study aimed to clarify the prognostic significance of PNI. The PubMed, Embase, and Cochrane Library databases were searched. A meta-analysis of the impact of PNI on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and rate of adverse events (AEs) in patients treated with ICIs was performed. Twenty-three studies involving 2,386 patients were included. Low PNI was associated with significantly poor OS (hazard ratio [HR] = 2.26, 95% confidence interval [CI]: 1.81-2.82, P < .001) and short PFS (HR = 1.75, 95% CI: 1.54-1.99, P < .001). Patients with low PNI tended to have a low ORR (odds ratio [OR] = 0.47, 95% CI: 0.34-0.65, P < .001) and DCR (OR = 0.43, 95% CI: 0.34-0.56, P < .001). However, the subgroup analysis demonstrated no significant association between PNI and survival time in patients receiving a programmed death ligand-1 inhibitor. PNI was significantly associated with survival time and treatment efficacy in patients treated with ICIs.
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Affiliation(s)
- Xin-Tian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yu Qian
- Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Meng-Xing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chen-Chen Ding
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Huan Guo
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Tang
- Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Guo-Liang Pi
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yuan Wu
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhu Dai
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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11
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Kuge T, Shiroyama T, Tamiya A, Tamiya M, Kanazu M, Kinehara Y, Tanaka T, Morimura O, Taniguchi Y, Niki T, Tetsumoto S, Hayashi K, Nishino K, Nagatomo I, Kumanogoh A. Impact of Lymphopenia Recovery After Chemoradiotherapy on Durvalumab Consolidation Therapy in Stage III NSCLC. JTO Clin Res Rep 2023; 4:100505. [PMID: 37284296 PMCID: PMC10239913 DOI: 10.1016/j.jtocrr.2023.100505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Durvalumab maintenance therapy after definitive concurrent chemoradiotherapy (CRT) is the standard treatment modality for stage III NSCLC. Although severe treatment-related lymphopenia (TRL) during CRT may impair the efficacy of subsequent durvalumab therapy, data on the effect of TRL recovery on consolidation durvalumab therapy are lacking. Methods This retrospective study evaluated patients with unresectable stage III NSCLC treated with durvalumab after concurrent CRT. The patients were enrolled across nine institutes throughout Japan between August 2018 and March 2020. The effect of TRL recovery on survival was evaluated. The patients were divided into two groups on the basis of their lymphocyte recovery status: the recovery group involved patients who did not experience severe TRL or experienced TRL but exhibited lymphocyte count recovery at durvalumab initiation, and the nonrecovery group involved patients who experienced severe TRL and did not exhibit lymphocyte count recovery on durvalumab initiation. Results Among the 151 patients evaluated, 41 (27%) and 110 (73%) patients were classified into the recovery and the nonrecovery groups, respectively. The nonrecovery group had significantly worse progression-free survival than the recovery group (21.9 mo versus not reached, p = 0.018). Recovery from TRL (p = 0.027) and high pre-CRT lymphocyte count (p = 0.028) independently influenced progression-free survival. Conclusions Baseline lymphocyte count and recovery from TRL at the start of durvalumab therapy were predictive factors for survival outcomes in patients with NSCLC treated with durvalumab consolidation after concurrent CRT.
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Affiliation(s)
- Tomoki Kuge
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masaki Kanazu
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Yuhei Kinehara
- Department of Respiratory Medicine and Clinical Immunology, Nippon Life Hospital, Osaka, Japan
| | - Tsunehiro Tanaka
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Osamu Morimura
- Department of Internal Medicine, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Toshie Niki
- Department of Respiratory Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan
| | - Satoshi Tetsumoto
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Osaka, Japan
| | - Kazuhiko Hayashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Izumi Nagatomo
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Immunopathology, World Premier International (WPI), Immunology Frontier Research Center (iFReC), Osaka University, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan
- Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
- Japan Agency for Medical Research and Development – Core Research for Evolutional Science and Technology (AMED–CREST), Osaka University, Osaka, Japan
- Center for Advanced Modalities and DDS (CAMaD), Osaka University, Osaka, Japan
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12
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Xie J, Xiao X, Dong Z, Wang Q. The Systemic Inflammation Score is Associated with the Survival of Patients with Prostate Cancer. J Inflamm Res 2023; 16:963-975. [PMID: 36915616 PMCID: PMC10007981 DOI: 10.2147/jir.s385308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/02/2023] [Indexed: 03/09/2023] Open
Abstract
Background The systemic inflammation score (SIS) based on the albumin (Alb) level and lymphocyte-to-monocyte ratio (LMR), has been associated with survival in some cancers. However, its prognostic role in prostate cancer (PCa) remains unclear. Methods The associations between the SIS and the clinicopathological features of PCa were evaluated. The correlations between the SIS and overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier analysis and the Log rank test. Univariate and multivariate Cox analyses were conducted to determine the prognostic factors for PCa. Hazard ratios and 95% confidence intervals were calculated. Results A total of 253 patients with PCa were included in this study. The Kaplan-Meier analysis and Log rank test suggested that patients with a higher Alb level, higher LMR, or a lower SIS had better 5-year OS and PFS compared with patients with a lower Alb level or lower LMR or higher SIS. Univariate and multivariate Cox analyses showed that drinking, prostate-specific antigen level >100 ng/mL, and neutrophil-to-lymphocyte ratio >2.09 were significant prognostic factors for OS and PFS in patients with PCa. Nomograms for 5-year OS and PFS were established with concordance index values of 0.888 and 0.824, respectively. The calibration curve was consistent between the actual observations and the prediction nomogram for OS and PFS probability at 5 years. Conclusion A high SIS is associated with unfavorable survival in patients with PCa. The SIS serves as a novel independent prognostic factor for OS in patients with PCa.
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Affiliation(s)
- Jie Xie
- Department of Urology, the Fifth People's Hospital of Huai'an, Huai'an City, People's Republic of China
| | - Xu Xiao
- Department of Urology, the Fifth People's Hospital of Huai'an, Huai'an City, People's Republic of China
| | - Zhenjia Dong
- Department of Urology, the Fifth People's Hospital of Huai'an, Huai'an City, People's Republic of China
| | - Qiangdong Wang
- Department of Urology, the Fifth People's Hospital of Huai'an, Huai'an City, People's Republic of China
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13
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Kageyama S, Yoshida T, Kobayashi K, Wada A, Nagasawa M, Kubota S, Kusaba T, Jo F, Nakagawa S, Johnin K, Narita M, Kawauchi A. Prognostic nutritional index of early post-pembrolizumab therapy predicts long-term survival in patients with advanced urothelial carcinoma. Oncol Lett 2022; 25:49. [PMID: 36644144 PMCID: PMC9811626 DOI: 10.3892/ol.2022.13635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Pembrolizumab has been widely used to treat advanced urothelial carcinoma that has progressed after first-line platinum-based chemotherapy. Because its clinical benefits are limited, biomarkers that can predict a good response to pembrolizumab are required. The prognostic nutritional index (PNI), calculated using the serum albumin level and peripheral lymphocyte count, has been evaluated as a predictive biomarker in cancer immunotherapy. The present study investigated the application of PNI as a predictive biomarker for pembrolizumab response in patients with advanced urothelial cancer. A retrospective study was conducted on 34 patients treated with pembrolizumab at Shiga University of Medical Science Hospital between January 2018 and July 2022. The posttreatment PNI (post-PNI) was calculated within 2 months of starting pembrolizumab. The present study investigated the association between post-PNI and objective response, overall survival (OS) and progression-free survival (PFS). The patient cohort was stratified into two categories, high and low post-PNI groups, with a cutoff value of post-PNI at 40. The higher post-PNI group demonstrated a better disease control rate than the lower post-PNI group (complete response + partial response + stable disease, 75 vs. 21%, P=0.004). Regarding median OS, the higher post-PNI group exhibited a significantly longer survival time than the lower post-PNI group (23.1 vs. 2.9 months, P<0.001). Similarly, the higher post-PNI group exhibited a significantly longer PFS than the lower post-PNI group (10.2 vs.1.9 months, P<0.001). Multivariate analysis showed that a higher post-PNI value was an independent predictor for OS (hazard ratio, 0.04; 95% confidence interval, 0.01-0.14; P<0.001) and PFS (hazard ratio, 0.12; 95% confidence interval, 0.04-0.35; P<0.001). The present study indicated that the post-PNI was a predictor of favorable clinical outcomes in patients treated with pembrolizumab for advanced urothelial carcinoma.
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Affiliation(s)
- Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan,Correspondence to: Dr Susumu Kageyama, Department of Urology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan, E-mail:
| | - Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Akinori Wada
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Masayuki Nagasawa
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shigehisa Kubota
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Takuto Kusaba
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Fumiyasu Jo
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shota Nakagawa
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Kazuyoshi Johnin
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Mitsuhiro Narita
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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14
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Matsuzawa R, Morise M, Kinoshita F, Tanaka I, Koyama J, Kimura T, Kondoh Y, Tanaka T, Shima K, Hase T, Wakahara K, Ishii M, Hashimoto N. Non-invasive early prediction of immune checkpoint inhibitor efficacy in non-small-cell lung cancer patients using on-treatment serum CRP and NLR. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04300-x. [PMID: 36006483 DOI: 10.1007/s00432-022-04300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We determined the clinical relevance of early C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) change in blood as surrogate markers of pro-tumor inflammation (PTI) for predicting clinical outcome of programmed cell death (PD)-1/programmed cell death ligand (PD-L) 1 inhibitor treatment in non-small-cell lung carcinoma (NSCLC). METHODS We retrospectively reviewed NSCLC patients treated with anti-PD-1 or PD-L1 inhibitors. Early CRP change was defined as the ratio of 6 weeks CRP to baseline CRP, and early NLR change was defined as that of the 6 weeks NLR to baseline NLR. PTI index was determined by combinatorial evaluation of early CRP change and early NLR change, PTI index low: both of these were low, intermediate: either of these was low, high; both of these were high. RESULTS The study included 217 patients. Early CRP change and early NLR change were both associated with PFS and OS. The combinatorial evaluation using these two markers enabled the clear stratification of PFS and OS. The median PFS in patient with PTI index low was 13.9 months, while the median PFS in those with PTI index high was 2.5 months (p < 0.01, log-rank test). The median OS in patients with PTI index low was not reached; the median OS in those with PTI index high was only 15.4 months (p < 0.01, log-rank test). CONCLUSIONS The combinatorial early CRP change and early NLR change as PTI biomarkers have clinical potential in identifying NSCLC patients who can achieve a durable response and long-term survival using PD-1/PD-L1 inhibitors.
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Affiliation(s)
- Reiko Matsuzawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan.
| | - Fumie Kinoshita
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Ichidai Tanaka
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
| | - Junji Koyama
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Taro Tanaka
- Department of Respiratory Medicine, Ekisaikai Hospital, Nagoya, Japan
| | - Koichiro Shima
- Department of Respiratory Medicine, Ekisaikai Hospital, Nagoya, Japan
| | - Tetsunari Hase
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
| | - Keiko Wakahara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 tsurumai, Showa-ku, Nagoya, 466-8560, Japan
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15
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Guven DC, Sahin TK, Erul E, Cakir IY, Ucgul E, Yildirim HC, Aktepe OH, Erman M, Kilickap S, Aksoy S, Yalcin S. The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy. J Clin Med 2022; 11:jcm11154523. [PMID: 35956139 PMCID: PMC9369683 DOI: 10.3390/jcm11154523] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 02/05/2023] Open
Abstract
Dynamic changes in the blood-based biomarkers could be used as a prognostic biomarker in patients treated with immune checkpoint inhibitors (ICIs), although the data are limited. We evaluated the association between the neutrophil−lymphocyte ratio (NLR) and early NLR changes with survival in ICI-treated patients. We retrospectively evaluated the data of 231 patients with advanced-stage cancer. We recorded baseline clinical characteristics, baseline NLR and fourth-week NLR changes, and survival data. A compound prognostic score, the NLR2-CEL score, was developed with the following parameters: baseline NLR (<5 vs. ≥5), ECOG status (0 vs. ≥1), Charlson Comorbidity Index (CCI, <9 vs. ≥9), LDH (N vs. ≥ULN), and fourth-week NLR change (10% or over NLR increase). In the multivariable analyses, higher NLR (HR: 1.743, p = 0.002), 10% or over NLR increase in the fourth week of treatment (HR: 1.807, p = 0.001), higher ECOG performance score (HR: 1.552, p = 0.006), higher LDH levels (HR: 1.454, p = 0.017), and higher CCI (HR: 1.400, p = 0.041) were associated with decreased OS. Compared to patients with the lowest scores, patients in the highest score group had significantly lower OS (HR: 7.967, 95% CI: 3.531−17.979, p < 0.001) and PFS. The composite score had moderate success for survival prediction, with an AUC of 0.702 (95% CI: 0.626−0.779, p < 0.001). We observed significantly lower survival in patients with higher baseline NLR values and increased NLR values under treatment.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
- Correspondence:
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Enes Ucgul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Mustafa Erman
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Saadettin Kilickap
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
- Department of Medical Oncology, Faculty of Medicine, Istinye University, 34396 Istanbul, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Suayib Yalcin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
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Castagnoli F, Doran S, Lunn J, Minchom A, O’Brien M, Popat S, Messiou C, Koh DM. Splenic volume as a predictor of treatment response in patients with non-small cell lung cancer receiving immunotherapy. PLoS One 2022; 17:e0270950. [PMID: 35797413 PMCID: PMC9262211 DOI: 10.1371/journal.pone.0270950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
The spleen is a lymphoid organ and we hypothesize that clinical benefit to immunotherapy may present with an increase in splenic volume during treatment. The purpose of this study was to investigate whether changes in splenic volume could be observed in those showing clinical benefit versus those not showing clinical benefit to pembrolizumab treatment in non-small cell lung cancer (NSCLC) patients.
Materials and methods
In this study, 70 patients with locally advanced or metastatic NSCLC treated with pembrolizumab; and who underwent baseline CT scan within 2 weeks before treatment and follow-up CT within 3 months after commencing immunotherapy were retrospectively evaluated. The splenic volume on each CT was segmented manually by outlining the splenic contour on every image and the total volume summated. We compared the splenic volume in those achieving a clinical benefit and those not achieving clinical benefit, using non-parametric Wilcoxon signed-rank test. Clinical benefit was defined as stable disease or partial response lasting for greater than 24 weeks. A p-value of <0.05 was considered statistically significant.
Results
There were 23 responders and 47 non-responders based on iRECIST criteria and 35 patients with clinical benefit and 35 without clinical benefit. There was no significant difference in the median pre-treatment volume (175 vs 187 cm3, p = 0.34), post-treatment volume (168 vs 167 cm3, p = 0.39) or change in splenic volume (-0.002 vs 0.0002 cm3, p = 0.97) between the two groups. No significant differences were also found between the splenic volume of patients with partial response, stable disease or progressive disease (p>0.017). Moreover, there was no statistically significant difference between progression-free survival and time to disease progression when the splenic volume was categorized as smaller or larger than the median pre-treatment or post-treatment volume (p>0.05).
Conclusion
No significant differences were observed in the splenic volume of those showing clinical benefit versus those without clinical benefit to pembrolizumab treatment in NSCLC patients. CT splenic volume cannot be used as a potentially simple biomarker of response to immunotherapy.
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Affiliation(s)
- Francesca Castagnoli
- Department of Radiology, Royal Marsden Hospital, Sutton, United Kingdom
- * E-mail:
| | - Simon Doran
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Jason Lunn
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Anna Minchom
- Drug Development Unit, Royal Marsden/Institute of Cancer Research, Sutton, United Kingdom
| | - Mary O’Brien
- Lung Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, United Kingdom
| | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
| | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, United Kingdom
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