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TAT 2019: Use of the Lung Immune Prognostic Index in Stratifying Outcomes in Patients Treated With Immune Checkpoint Inhibitors

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Key Points

  • Survival was found to correlate well with the LIPI group stratification.
  • Median overall survival was 17.8 months in the good group, compared to 11.68 months in the intermediate group and 3.9 months for patients in the poor group. 
  • The median progression-free survival was 4.6 months in the good group, compared to 2.8 months and 1.4 months for patients in the intermediate and poor groups, respectively.

The Lung Immune Prognostic Index (LIPI) calculated prior to the initiation of treatment may be used to stratify patients with diverse tumor types into groups that significantly associate with outcome following immune checkpoint inhibitor therapy, according to a retrospective study presented at the TAT 2019–International Congress on Targeted Anticancer Therapies in Paris. Findings were presented by Varga et al (Abstract 3O).

First study author Andrea Varga, MD, of the Drug Development Department, Gustave Roussy, explained that the LIPI score has shown an association with patient outcomes following immune checkpoint inhibitor treatment, regardless of tumor type. This association has been demonstrated in patients with melanoma, non–small cell lung cancer (NSCLC), small cell lung cancer, head and neck squamous cell carcinoma (HNSCC), and triple-negative breast cancer, but not in all tumor types.

The LIPI score combines the pretreatment-derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) levels.

Methods

For this study, the investigators collected dNLR and LDH retrospectively from 360 patients with metastatic disease who were treated from September 2015 to November 2017 in the Drug Development Department of Gustave Roussy.

The LIPI characterizes the patients’ disease into a good group, with dNLR < 3 and normal LDH; an intermediate group, with dNLR > 3 or LDH > upper limit of normal (ULN); and a poor group, with dNLR > 3 and LDH > ULN. The benefit of immune checkpoint inhibitor treatment was evaluated according to overall survival and progression-free survival.

The analysis comprised data from 360 patients receiving immune checkpoint inhibitors in early clinical trials. Of these patients, 353 (98%) had been immune checkpoint inhibitor–naive, and 209 (58%) patients had a performance status of 1; 322 (89%) patients had been treated with either a programmed cell death protein 1 or programmed cell death ligand 1 inhibitor as monotherapy, and 268 (74%) received immune checkpoint inhibitor treatment as combination therapy. The majority (214; 59%) of patients were male, with a median age at the initiation of immune checkpoint inhibitor treatment of 60 years (range = 25–88 years).

Overall, 14% of patients had NSCLC, 14% had colorectal cancer, 13% had bladder cancer, 8% had renal cancer, 7% had breast cancer, 7% had HNSCC, and 6% of patients had cancer of the cervix. According to LIPI stratification, the good group contained 160 (44%) patients, the intermediate group had 161 (44%) patients, and the poor group contained 39 (11%) patients.

Findings

The median duration of follow-up was 14.1 months (95% confidence interval [CI] = 12.9–16.1). Survival was found to correlate well with the LIPI group stratification.

The median overall survival was 17.8 months (95% CI = 13.1–not reached) in the good group, compared to 11.68 months [95% CI = 8.8–15.3) in the intermediate group and 3.9 months (95% CI = 2.1–6.4) in the poor group. The median progression-free survival was 4.6 months (95% CI = 4.0­–6.2) in the good group, compared to 2.8 months (95% CI = 2.5–3.6) and 1.4 months (95% CI = 1.2–2.0) for patients in the intermediate and poor groups, respectively (both P < .0001).

The authors concluded that poor LIPI score, comprising pretreatment dNLR > 3 and LDH > ULN, is associated with a poorer outcome in patients receiving immune checkpoint inhibitor therapy. These findings suggest that calculating the LIPI score prior to starting immune checkpoint inhibitor therapy may be useful in identifying patients who likely will not benefit from immune checkpoint inhibitor treatment.

Disclosure: The study authors' full disclosures can be found at cslide.ctimeetingtech.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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