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Élia Rodrigues Cipriano
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P02 - Diagnostics and Interventional Pulmonology (ID 110)
- Event: WCLC 2020
- Type: Posters
- Track: Diagnostics and Interventional Pulmonology
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P02.21 - The Impact of Inflammatory Serum Biomarkers in Non-Small Cell Lung Cancer Patients Treated With Immune Checkpoint Inhibitors (ID 3557)
00:00 - 00:00 | Presenting Author(s): Élia Rodrigues Cipriano
- Abstract
Introduction
The inflammatory serum biomarkers, that are easily accessed in clinical practice, were studied in various types of cancer in patients treated with immune checkpoint inhibitors (ICIs). The ICIs changed how we manage non-small cell lung cancer (NSCLC) in the last years, as in 1st line or as subsequent lines, with an improvement in progression-free survival (PFS), overall survival (OS) and quality of life. Biomarkers for ICIs that have been most explored are PD-L1 expression and tumor mutational burden, nevertheless, there isn’t an ideal biomarker. The objective of the study is to evaluate the predictive and prognostic impact of the following inflammatory serum biomarkers: neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), prognostic nutritional index (PNI) and advanced lung cancer inflammation index (ALI) in advanced NSCLC patients treated with the ICIs (pembrolizumab, nivolumab, atezolizumab).
Methods
A retrospective study including 52 patients with stage IV NSCLC that started treatment with ICIs between March 2016 and May 2020. The inflammatory serum scores were calculated as following: NLR=total neutrophil count/total lymphocyte count; PLR=total platelet count/total lymphocyte count; PNI=albumin (g/L)+0.005xtotal lymphocyte count/µL; ALI=BMI(Kg/m2)xalbumin(g/dL)/NLR. The cut-offs 5, 200, 50 e 18 were respectively considered. The survival analysis was performed using the Kaplan-Meier method with Log Rank test and Cox regression, with a statistical significance of 5%.
Results
Forty-two patients (n=42, 80.8%) were male, 47 (90.4%) had an ECOG performance status between 0-1, and 19 (36.5%) were treated with ICIs as 1st line. The NLR was ≥5 in 34.6% (n=18); PLR was ≥200 in 38.5% (n=20); PNI was <50 in 53.8% (n=28) and ALI was <18 in 59.6% (n=31). The median follow-up period was 15.9 months. The median PFS was 4.97 months (95%CI 3.49-6.44) and the median OS was 10.80 months (95%CI 3.21-18.39). The median PFS was inferior in patients with PLR≥200: 2.13 months versus 6.60 months, HR 2.04 (95%CI 1.03-4.06), p=0.038, and in patients with PNI<50: 2.30 months versus 8.97 months, HR 3.01 (95%CI 1.47-6.20), p=0.002. There were no differences in PFS regarding the NLR and (p=0.077) and the ALI (p=0.150) scores. The median OS was lower in patients with NLR≥5: 1.83 months versus 16.5 months, HR 2.46 (95%CI 1.17-5.16), p=0.014; in patients with PLR≥200: median OS was 4.97 months versus 16.80 months, HR 2.73 (95%CI 1.31-5.72), p=0.005; and in patients with PNI<50: 6.17 months versus 19.87 months, HR 2.86 (95%CI 1.38-5.95), p=0.003. There weren’t differences in OS taking account of the ALI (p=0.083).
Conclusion
The PLR≥200 and the PNI<50 were markers of a poorer PFS in our population. The NLR≥5, PLR≥200, and PNI<50 were markers of a worse prognosis in our NSCLC population treated with ICIs. The identification of inflammatory serum biomarkers that are easily accessed in daily practice might be important in the future in the identification and orientation of these patients. Nevertheless, these biomarkers should be prospectively studied in further studies in order to validate these results.
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P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)
- Event: WCLC 2020
- Type: Posters
- Track: Targeted Therapy - Clinically Focused
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P76.76 - EGFR Tyrosine Kinase Inhibitors in Patients with Non-Small Cell Lung Cancer and the Role of Diabetes Mellitus and Metformin (ID 3395)
00:00 - 00:00 | Presenting Author(s): Élia Rodrigues Cipriano
- Abstract
Introduction
The EGFR tyrosine kinase inhibitors (TKI) had increased survival in non-small cell lung cancer (NSCLC) patients in the presence of response predictive EGFR mutations. Previously, these drugs were used in wild type patients as a 2nd line or beyond. Some laboratory studies and phase I/II trials had demonstrated a possible synergistic effect between EGFR TKI and metformin. The aim of this study is to analyze patients treated with EGFR TKI and assessing the impact of diabetes mellitus (DM) and metformin on the outcomes.
Methods
A retrospective study including 75 patients with stage IV NSCLC submitted to EGFR TKI between January 2013 and December 2019. Clinicopathological characteristics were described. The progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier with Log Rank test and Cox regression, with 5% statistical significance.
Results
Thirty-one patients (n=31, 41.3%) had EGFR mutations and were treated with EGFR TKI as 1st line treatment (group 1) and 44 (58.7%) were wild type, treated with EGFR TKI in 2nd line or beyond (group 2). Twenty patients had DM and 12 patients were on metformin. The median follow-up time was 54.73 months. In group 1, the median PFS and OS were 10.37 and 18.70 months, respectively. There were no statistically significant differences in PFS and OS between patients with or without DM (p=0.28 and p=0.53), and patients treated or not with metformin (p=0.20 and p=0.50). In group 2, the median PFS and OS were 2.73 and 9.87 months, respectively. Inversely from the group 1, the median PFS was superior in patients with DM: 5.77 vs 2.63 months, HR 0.44 (95%CI 0.21-0.91), p=0.023; and in patients on metformin: 5.77 vs 2.53 months, HR 0.43 (95%CI 0.20-0.95), p=0.031. The median OS was also superior in patients with DM: 14.90 vs 7.10 months, HR 0.44 (95%CI 0.22-0.89), p=0.019. Patients that received metformin had a median OS of 12.57 months vs 7.73 months in the remaining, HR 0.47 (95%CI 0.21-1.02), p=0.051.
Conclusion
In group 1, there were no differences in median survival among patients with DM and on metformin. However, the number of patients with DM and on metformin in this group was very small. In group 2, the median PFS and OS were superior in patients with DM, and the median PFS was superior in patients on metformin. This study has some limitations: it is retrospective, with a limited sample and it includes patients that nowadays wouldn’t be treated with EGFR TKI following the current international guidelines. Nevertheless, it will be important to study the potential association between metformin and EGFR TKI in NSCLC, regarding the fact that this drug is easily accessed in daily practice.
