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Risk score for non-small cell lung cancer patients starting checkpoint inhibitor treatment

Stefan Diem, Mirjam Fässler, Omar Hasan Ali, Marco Siano, Rebekka Niederer, Fiamma Berner, Guillaume-Alexandre Roux, Christoph Jakob Ackermann, Sabine Schmid, Sabine Güsewell, Martin Früh & Lukas Flatz

abstract

Background
Prognosis of metastatic non-small cell lung cancer significantly improved with the availability of checkpoint inhibitors (anti-PD-1/PD-L1). Unfortunately, reliable biomarkers to predict treatment benefit are lacking.

Patients and methods
We prospectively collected clinical and laboratory data of 56 non-small cell lung cancer patients treated with a checkpoint inhibitor. The aim was to identify baseline parameters correlating with worse outcome and to create a risk score that enabled to stratify patients into different risk groups. As inflammation is known to promote tumor growth, we focused on inflammation markers in the blood. Disease control (DC) was defined as complete response, partial response, and stable disease on CT scan according to RECIST 1.1.

Results
Half of the patients achieved DC. Four parameters differed significantly between the DC group and the no disease control group: Eastern Cooperative Oncology Group performance status (=0.009), number of organs with metastases (=0.001), lactate dehydrogenase (=0.029), and ferritin (=0.005). A risk score defined as the number of these parameters (0= no risk factor) exceeding a threshold (Eastern Cooperative Oncology Group performance status ≥2, number of organs with metastases ≥4, lactate dehydrogenase ≥262U/L, and ferritin ≥241 µg/L) was associated with overall survival and progression-free survival. Overall survival at 6 and 12 months is as follows: Scores 0-1: 95% and 95%; Score 2: 67% and ≤33%; Scores 3-4: 15% and 0%. Progression-free survival at 6 and 12 months is as follows: Scores 0-1: 81% and 50%; Score 2: 25% and ≤25%; Scores 3-4: 0% and 0%.

Conclusion
We propose an easy-to-apply risk score categorizing patients into different risk groups before treatment start with a PD-1/PD-L1 antibody.
   
citation Diem S, Fässler M, Ali O H, Siano M, Niederer R, Berner F, Roux G A, Ackermann C J, Schmid S, Güsewell S, Früh M, Flatz L. Risk score for non-small cell lung cancer patients starting checkpoint inhibitor treatment. Cancer Manag Res 2018; 10:5537-5544.
   
type journal paper/review (English)
date of publishing 08-11-2018
journal title Cancer Manag Res (10)
ISSN print 1179-1322
pages 5537-5544
PubMed 30519101
DOI 10.2147/CMAR.S179767