Risk score for non-small cell lung cancer patients starting checkpoint inhibitor treatment
abstract
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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.
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citation
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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.
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type
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journal paper/review (English)
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date of publishing
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08-11-2018
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journal title
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Cancer Manag Res (10)
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ISSN print
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1179-1322
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pages
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5537-5544
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PubMed
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30519101
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DOI
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10.2147/CMAR.S179767
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