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Arsela Prelaj



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    Lunch & Poster Display session (ID 58)

    • Event: ELCC 2019
    • Type: Poster Display session
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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      156P - Peripheral blood biomarkers as prognostic factors for immunotherapy in advanced non-small cell lung cancer (aNSCLC) patients (ID 579)

      12:30 - 13:00  |  Presenting Author(s): Arsela Prelaj

      • Abstract
      • Slides

      Background

      Second-line immunotherapy showed an overall survival (OS) benefit, but only a low percentage of aNSCLC patients (pts) respond to therapy. The identification of new biomarkers to select patients for immunotherapy (IO) is a crucial topic. In our study we aim to investigate the role of peripheral blood biomarkers (PBBs) that can predict response and outcome in aNSCLC pts treated with IO.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      We conducted a retrospective analysis on 154 aNSCLC patients receiving single-agent nivolumab or pembrolizumab as second-line (68%) and >3rd line (32%) therapy. We recorded complete blood cell count at baseline (T0), at second (T1) and third cycle (T2), assessing absolute blood count and their ratio such as neutrophil-lymphocyte ratio (NLR), derived-NLR (dNLR) and lymphocyte-monocyte ratio (LMR). Univariate and multivariate analysis were performed to evaluate the correlation between overall response rate (ORR), PFS and OS and PBBs.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      The univariate analysis for PFS and OS showed that, at T1 and T2, ANC≥7000/µL, AMC≥900/µL, NLR≥4, dNLR>2.2 were statistically significantly associated with worse survival outcomes and increased LMR>1.8 with better survival outcomes. ALC≥1200/µL was associated with higher PFS and OS at T1; AEC<100/µL was associated with worse PFS and OS at T1 and only PFS at T2. The multivariate analysis for PFS confirmed as statistically significant independent predictive factors ANC, ALC and dNLR at both T1 and T2, and AEC at T1, AMC and LMR at T2. The multivariate analysis for OS confirmed as statistically significant independent prognostic factors ANC, ALC, AMC and LMR at both T1 and T2 while dNLR only at T1 and NLR at T2.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      In conclusion, factors such as high ANC, AMC, NLR and dNLR level can be considered as negative prognostic factors, and high AEC and LMR as positive prognostic factors in NSCLC patients treated with immunotherapy in ≥ second line setting and their change after IO could help monitoring the response and outcome. Further prospective analyses are needed.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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      160P - EPSILoN score: Validation cohort of a prognostic score in advanced non-small cell lung cancer (aNSCLC) patients treated with immunotherapy (ID 494)

      12:30 - 13:00  |  Presenting Author(s): Arsela Prelaj

      • Abstract
      • Slides

      Background

      Despite the benefit in overall survival (OS), only 18-20% of aNSCLC patients (pts) respond to immunotherapy (IO) in second-line (2nd) with a median progression-free survival (mPFS) of 2-4 months (mo). We previously reported the role of EPSILoN score (Ecog-Ps, Smoke, lIver, Ldh, Nlr) as a clinical and biochemical prognostic score of survival in 154 pts treated with 2nd IO. In this study we aim to validate the EPSILoN score in a different patient population group treated with IO in the same setting.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      We enrolled 193 eligible patients at the National Cancer Institute of Milan, Italy. From 193 aNSCLC patients receiving single-agent anti-PD-(L)-1 as 2nd (61%) and ≥ 3rd line (39%) we collected baseline complete blood cell count and estimated their ratio such as neutrophil-lymphocyte ratio (NLR). Also we evaluated baseline LDH level. Survival analyses using Kaplan–Meier method and multivariate analysis (Cox progression model) were performed to identify and confirm independent variables.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      Of 193 pts mPFS and mOS were 2.3 and 7.6 mo, respectively. Univariate and multivariate analyses for PFS adjusted for age, sex, smoke status, ECOG-PS, histology, disease site, confirmed heavy smoking status (≥40 pack/years) (HR 0.71, p = 0.036) and baseline LDH <400 mg/dl (HR 0.66, p = 0.026) as independent positive factors while ECOG-PS 2 (HR 1.79, p < 0.001), baseline liver mets (HR 1.48, p = 0.04) and NLR≥4 (HR 1.49, p = 0.029) as negative factors. The five baseline clinical and blood biomarkers (smoking status, ECOG PS, liver metastases, LDH and NLR), were included in the EPSILoN score to validate it in this cohort. Finally, three different survival groups defined as high, intermediate and low for PFS (6.0 vs 3.8 vs 1.9 mo respectively, HR 1.94 95% IC 1.51–2.48, p < 0.001) and OS (24.5 vs 8.9 vs 3.4 months, respectively HR 2.40, 95% IC 1.82–3.17, p < 0.001) were identified.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      EPSILoN score which combine five baseline clinical and blood biomarkers may help identify patients who most likely will benefit or not from IO in clinical practice in aNSCLC patients treated with second-line IO. Furthermore, it seems to play an important role in both PFS and OS.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      M.C. Garassino: Consultancies, honoraria: AstraZeneca, Roche, Boehringer Ingelheim, BMS, MSD, Eli Lilly, Novartis, Bayer, Pfizer, Sanofy, Italfarmaco. D. Signorelli: Consultancies, honoraria: AstraZeneca. All other authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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      87P - Time-series of peripheral blood biomarkers as biomarkers for immunotherapy in advanced non-small cell lung cancer (aNSCLC) patients (ID 503)

      12:30 - 13:00  |  Presenting Author(s): Arsela Prelaj

      • Abstract
      • Slides

      Background

      Immune-checkpoint inhibitors (ICIs) as second-line therapy showed an overall survival (OS) benefit, but only 18-20% of aNSCLC patients respond with a median progression-free survival (mPFS) of 2-4 months. The identification of biomarkers to select patients most likely to benefit from ICIs is still an unmet need in clinical practice.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      We conducted a retrospective monocentric analysis in 154 aNSCLC patients receiving single-agent nivolumab or pembrolizumab as second-line (68%) and >3rd line (32%) therapy. We recorded complete blood cell count at baseline (T0), before second (T1) and third cycle (T2), assessing neutrophil-lymphocyte ratio (NLR), derived-NLR (dNLR) and lymphocyte-monocyte ratio (LMR). Statistical analyses (univariate and multivariate analysis) were performed to evaluate the correlation between overall response rate (ORR), PFS and OS and the change from baseline of NLR, dNLR and LMR at second (T0-T1) and third cycle (T0-T2). We divided biomarker time-series into two groups of > 30% increase and <30% increase or decrease from baseline value.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      The only biomarker statistically significantly associated with survival outcomes was NLR. An increase of > 30% of NLR from baseline to the second cycle (NLR T0-T1) was associated with a worse PFS (3.7 vs 4.9 months, HR 1.52 95% CI 1.02 – 2.24; p = 0.04). We also observed a statistically significant correlation between ORR and the >30% increase of LMR from baseline to the second (LMR T0-T1; p < 0.001) and the third cycle (LMR T0-T2; p = 0.001).

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      According to the prognostic value of time-series of biomarkers at second and third cycle from baseline, patients who experienced an increase of > 30% of NLR after the first ICI cycle were associated with a worse PFS; also, an increase of > 30% of LMR after the first and second ICI administration lead to a better ORR.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      D. Galetta: Medical advisor: Bristol-Myers Squibb. All other authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.