Which factors improve survival in ICI-treated patients with NSCLC?

The survival benefit derived from using immune checkpoint inhibitors (ICIs) is more evident in patients with advanced nonsmall cell lung cancer (NSCLC) who received first-line therapy, showed low neutrophil/lymphocyte ratio (NLR), and had no history of hormone use following initial treatment, suggests a recent study.

A team of investigators conducted this retrospective study to examine the medical history of 111 patients diagnosed with advanced NSCLC in the Affiliated Hospital of Putian University in China from 2018 to 2020.

Enrolled patients with adenocarcinoma (n=69), squamous cell carcinoma (n=28), and other types of lung cancer (n=14) received programmed death-ligand (PD-1) inhibitors. They were categorized based on the following treatment groups: PD-1 inhibitors, PD-1 inhibitors plus chemotherapy, and PD-1 inhibitors combined with chemotherapy and angiogenesis inhibitors according to the treatment regimen.

The investigators collected general clinical data of all patients and estimated progression-free (PFS) and overall survival (OS) using Kaplan-Meier analysis. They also performed univariate and multivariate Cox regression analysis to explore the prognostic factors associated with PFS and OS after treatment.

Of the patients treated with ICIs, six showed full response and 33 partial response, while 55 were stable and 17 progressive. No significant difference was observed among the three groups in terms of the objective response rate (ORR). However, patients receiving first-line treatment had an ORR of 46.7 percent in subgroup analysis. This was markedly greater than that of other treatment groups (p=0.014).

On multivariate Cox regression analysis, PFS after immunotherapy correlated independently with the following factors: history of hormone use (hazard ratio [HR], 1.593; p=0.033), second-line or further lines of therapy (HR, 2.871; p<0.001), and high NLR (HR, 1.498; p=0.045). Hormone use history (HR, 1.518; p=0.015) and high NLR (HR, 3.053; p=0.001) also independently predicted OS after treatment.