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Jose Ruffinelli
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FP07 - Pathology (ID 109)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP07.06 - Lung Immune Prognostic Index (LIPI) in Advanced NSCLC Patients Treated with Immunotherapy, Chemotherapy and both Combined Upfront. (ID 823)
00:00 - 00:00 | Author(s): Jose Ruffinelli
- Abstract
Introduction
The Lung Immune Prognostic Index (LIPI) that combines the neutrophils/[leucocytes minus neutrophils] ratio (dNLR) and lactate dehydrogenase (LDH), is associated with outcomes in pretreated advanced NSCLC patients receiving single agent immune checkpoint inhibitors (ICI). However, its role in first line treatment of advanced NSCLC patients has not been explored yet. We assessed the value of baseline LIPI in the first line setting, for ICI-monotherapy, ICI-combination or platinum-based chemotherapy alone (CT).
Methods
We retrospectively collected data of patients treated with first-line ICI between 2016 and 2019 as single agent if PD-L1 ≥50% (ICI-cohort), or in combination with a CTLA4-inhibitor (ICI+ICI cohort), or with chemotherapy (ICI+CT cohort), from 18 centers worldwide. A control cohort of patients treated with platinum-based CT (CT-cohort) was also collected between 2011 and 2019 from 2 centers. Baseline LIPI was calculated as previously reported and correlated with overall survival (OS) and progression-free survival (PFS) in each treatment cohort.
Results
Overall, 930 patients were enrolled, 561 in the ICI-cohort, 186 in the combo ICI+CT, 55 in the ICI+ICI and 128 in the CT-cohort. Median (m) follow-up was 12.5 months. In the whole cohort, median age was 66 years, 70% male, 80% had non-squamous histology, and 84% had PS ≤1. Based on LIPI (available for 792 patients): 305 (38%) were considered good, 331 (42%) intermediate and 156 (20%) poor group.
Treatment outcomes according to LIPI scores are depicted in Table 1. The LIPI poor population had significantly worse OS compared with other LIPI groups, in the whole cohort (P<0.001) as well as in the ICI monotherapy and combo ICI+CT cohorts (both P<0.0001); and in the CT cohort (P=0.004). In term of PFS, we observed correlation between LIPI groups and outcomes in the whole cohort (P<0.001) and in the ICI- monotherapy cohort (P=0.008); however, no differences were observed in the cohorts of patients receiving chemotherapy regimens, alone (P=0.08) or combined with ICI (P=0.08). The analysis by PD-L1 expression in 756 patients with available data will be presented in the Congress.
Table 1: Median OS and PFS according to LIPI subgroups. NR = non reached.
ConclusionOutcomes
LIPI
subgroups
Overall cohort
N= 925
ICI-cohort
N=558
ICI + CT-cohort
N= 185
ICI + ICI cohort
N= 55
CT-cohort
N=127
Median OS
(95% CI)
All
16.3 (14.7-18.8)
21.0 (17.1-NR)
24.7 (16.9-27.1)
20.5 (14.1-NR)
9.79 (8.3-14.4)
LIPI good, 38.5%
19.8 (17.2-25.7)
NR (NR-NR)
25.7 (25.6-NR)
33.6 (14.7-NR)
14.42 (8.9-17.9)
LIPI interm, 41.8%
15.8 (14.3-20.3)
21.2 (17.1-NR)
20.3 (12.8-NR)
14.6 (5.5-NR)
9.30 (7.0-14.5)
LIPI poor, 19.7%
6.96 (5.6-12.5)
8.5 (3.4-13.7)
6.1 (4.9-NR)
14.1 (10.3-NR)
6.1 (5.0-NR)
Global LogRank P value
<0.0001
<0.0001
<0.0001
0.4
0.004
Overall cohort
N= 909
ICI-cohort
N=543
ICI + CT-cohort
N= 185
ICI + ICI cohort
N= 54
CT-cohort
N=127
Median PFS
(95% CI)
All
6.5 (5.9-7.1)
6.3 (5.0-7.6)
8.9 (6.80-10.9)
7.2 (5.7-30.6)
5.7 (5.3-6.4)
LIPI good, 38.7%
7.0 (5.9-8.5)
6.4 (4.5-10.8)
9.8 (7.8-13.0)
9.2 (5.7-NR)
6.0 (5.3-7.8)
LIPI interm, 41.6%
6.6 (6.1-7.6)
6.6 (5.6-8.1)
10.4 (6.4-12.4)
5.5 (2.5-NR)
6.1 (4.3-7.6)
LIPI poor, 19.7%
3.6 (3.1-5.6)
3.3 (1.9-6.7)
4.5 (2.8-8.2)
7.1 (2.56- NR)
3.7 (3.4-NR)
Global LogRank P value
<0.0001
0.008
0.08
0.4
0.08
Pretreatment LIPI was prognostic in untreated advanced NSCLC patients regardless of the type of therapy. However, LIPI was associated with PFS only in patients receiving ICI-monotherapy, with no statistically significant differences in CT-containing cohorts (alone or combined with ICI). This value of LIPI to guide treatment selection should be further explored in prospective studies.
