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Patrizia Petrillo



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    P3.04 - Immunooncology (Not CME Accredited Session) (ID 970)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.04-12 - Prognostic and Predictive Role of Peripheral Blood Biomarkers in NSCLC Patients Treated with Checkpoint, a Single-Center Experience. (ID 14004)

      12:00 - 13:30  |  Author(s): Patrizia Petrillo

      • Abstract
      • Slides

      Background

      Tumor characteristics and host immune system play a crucial role for the immune response. As reported in preclinical studies, a sustain immune cell proliferation in the periphery is necessary for the immune response and tumor destruction. More evidence in melanoma patients (pts) and less evidence are available in non small cell lung cancer (NSCLC). Aim of this study is to demonstrate the role of the peripheral blood as biomarkers in NSCLC patients treated with checkpoint inhibitors (CPIs).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      94 evaluable patients from one institution NSCLC pts, treated with at least one course immunotherapy (IO) (nivolumab and pembrolizumab) in 2nd or further line, were considered for analysis. Baseline peripheral blood, at week 2 and 4 were collected for each patients. Univariate analysis were performed and correlation between biomarkers and progression free-survival (PFS) and overall survival (OS) are reported.

      4c3880bb027f159e801041b1021e88e8 Result

      median age was 67 years (31-86 years), most pts were male (80%), 35 pts were S and 59 NS. 75,5% of pts were smokers and Eastern Cooperative Oncology Group (ECOG) pre-IO were: 0 (5,3%), 1 (58,5%) and 2 (36,2%). Overall median (m) PFS and mOS were 3,93 months (mo) and 20,7 mo respectively. Baseline absolute neutrophil count (ANC) ≥ 7500/µL and neutrophil to lymphocyte ratio (NLR) >5 correlate with worse PFS (3.3 mo vs 5.5 mo, p=0.04 and 2.8 mo vs 5.4 mo, p=0.006 respectively) and OS ( 15.6 mo vs 34.9 mo p=0.02 and 16.7 vs 34.9 mo p=0.004, respectively ). Poor OS and PFS were persist at week 2 in pts with NLR ≥5 (HR=0.3, p<0.0001 for OS and PFS), this was not significant at week 4. Also, baseline derived neutrophil to lymphocyte ratio (dNLR) >3 correlate with worse PFS ( p=0.01) and OS (p=0.016). Absolute lymphocyte count (ALC) ≥1000/µL at baseline and week 2 confer higher PFS (5.3 mo vs 3.1 mo, p=0.05) and a tred in OS. Interestingly, week-4 absolute monocytic count (AMC)≥ 1000/µL imply a poor PFS and this was not observed at baseline and week 2. Low, absolute eosinophil count (AEC) <50/ µL correlate with worse PFS (p=0.031). Finally, pts with lymphocyte monocyte ratio (LMR)≥ 1.5 at baseline, week 2 and 4 correlate with better survival.

      Table. 1 Univariate analysis of peripheral blood biomarker and survival outcome in NSCLC patients treated with immunotherapy

      Biomarker

      Outcome

      Survival

      (months)

      Impact

      (HR CI95%, p-value)

      Results

      Baseline

      ANC≥ 7500/µL

      OS

      15.6 mo vs 34.9 mo

      HR= 0.43, p=0.002

      Poor OS

      Poor PFS

      PFS

      3.3 mo vs 5.5 mo

      HR= 0.61, p=0.04

      Baseline

      NLR ≥ 5

      OS

      16.7 mo vs 34.9 mo

      HR=0.45, p=0.004

      Poor OS

      Poor PFS

      PFS

      2.8 mo vs 5.4 mo

      HR=0.50, p=0.006

      2 weeks

      NLR≥ 5

      OS

      11.9 mo vs 35 mo

      HR=0.32, p<0.0001

      Poor OS

      Poor PFS

      PFS

      2.6 mo vs 6.1 mo

      HR=0.31, p<0.0001

      Baseline

      dNLR> 3

      OS

      16.7 mo vs 34.8 mo

      HR= 0.51, p=0.016

      Poor OS

      Poor PFS

      PFS

      2.8 mo vs 5.4 mo

      HR= 0.52, p= 0.01

      Baseline

      ALC≥ 1000/µL

      OS

      31.7 mo vs 26.4 mo

      HR=1.23, p=0.54

      Same OS

      Good PFS

      PFS

      5.3 mo vs 3.1 mo

      HR= 1.8, p=0.05

      2 weeks

      ALC≥ 1000/µL

      OS

      34.8 vs 18 mo

      HR=1.4, p=0.14

      Same OS

      Good PFS

      PFS

      8.1 mo vs 3.3 mo

      HR=1.8 , p=0.007

      4 weeks

      AMC≥ 1000/ µL

      OS

      34.8 mo vs 31.7 mo

      HR=1.0, p=0.91

      Same OS

      Poor PFS

      PFS

      3.3 mo vs 8.0 mo

      HR=0.43, p=0.003

      Baseline

      LMR≥ 1.5

      OS

      34.8 mo vs 15.0 mo

      HR=2.1, p=0.007

      Good OS

      Good PFS

      PFS

      5.3 mo vs 2.6 mo

      HR=1.8, p=0.025

      2 weeks

      LMR≥ 1.5

      OS

      34.9 mo vs 15.0 mo

      HR=1.92, p=0.025

      Good OS

      Good PFS

      PFS

      6.1 mo vs 2.8 mo

      HR=3.4, p<0.001

      4 weeks

      LMR≥ 1.5

      OS

      35.1 mo vs 16.7 mo

      HR=2.7, p=0.003

      Good OS

      Good PFS

      PFS

      5.9 mo vs 3 mo

      HR=2, p=0.017

      Baseline

      (AEC) <50/ µL

      OS

      26.4 mo vs 24.6 mo

      HR=0.83, p=0.55

      Same OS

      Poor PFS

      PFS

      3.4 mo vs 5.6 mo

      HR=0.55, p=0.034

      NSCLC non-small cell lung cancer, ALC absolute lymphocyte count, ANC absolute neutrophil count, NLR neutrophil to lymphocyte ratio, dNLR absolute neutrophil count/(white blood cell count-absolute neutrophil count), AEC absolute eosinophil count, AMC absolute monocyte count, LMR lymphocyte monocyte count, OS overall survival, PFS progression free survival, RR response rate, HR hazard ratio,

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite the retrospective nature, in our knowledge, this is the first study to demonstrate the role of AMC in NSCLC pts. Also, LMR could probably reflect the peripheral immune-fitness. However, prospective sudies are needed to confirm their role.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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