Pembrolizumab in pre-treated advanced non-small cell lung cancer (NSCLC) patients (pts): Impact of blood-based biomarkers on survival outcomes

Abstract

Background: The Lung Immune Prognostic Index (LIPI) utilises derived neutrophillymphocyte ratio (dNLR) and LDH to define prognostic subgroups associated with overall survival (OS) and overall response rate (ORR) to immune-checkpoint inhibitors (Mezquita L et al, JAMA Oncol 2018). Methods: Pre-treated advanced NSCLC pts who received Pembrolizumab (P) at The Christie (Jan ’17-July ’19) were identified. Baseline demographics, PD-L1 tumour proportion score (TPS), and LIPI score were collected. We assessed progression free survival (PFS) and OS using Kaplan-Meier method and performed a comparative analysis of LIPI score and PD-L1 TPS on survival. Results: 111 consecutive pts were analysed (Table shows baseline demographics). After a median follow up of 11.2 months, 77.5% of pts progressed. ORR was 26.1%. Median PFS and OS were 4 (1.6-6.4) and 13 (10.2-15.8) months (mos), respectively. OS was 10 vs 19 mos (HR 0.50, 95%CI 0.3-0.8; p¼0.006) for TPS 1-49% and 50%, respectively. OS for good vs intermediate vs poor LIPI score was 14, 11 and 3 mos (HR 1.5, 95% CI 1.1-2.3; p¼0.018), respectively. 36.9% of pts experienced immune related adverse events (irAEs), 10.8% being grade 3-5. Toxicity-related discontinuation rate was 14.4%. LIPI score and high TPS remained prognostic factors in a multivariate model including ECOG, smoking status and irAEs. 40% of pts received 4 cycles, mostly due to early disease progression (EDP). Pts with EDP had shorter OS (4 vs 19 mos, P<0.005). Next generation sequencing analysis for this subgroup is ongoing