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Luca Cantini



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    FP12 - Tumor Biology and Systems Biology - Basic and Translational Science (ID 188)

    • Event: WCLC 2020
    • Type: Posters (Featured)
    • Track: Tumor Biology and Systems Biology - Basic and Translational Science
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      FP12.06 - GRIm-Score Variations Predict Outcome in Metastatic NSCLC Patients Treated with First-Line Pembrolizumab (ID 3363)

      00:00 - 00:00  |  Author(s): Luca Cantini

      • Abstract
      • Slides

      Introduction

      Prompt identification of metastatic non-small cell lung cancer patients (NSCLC) who benefit from first-line pembrolizumab is crucial in clinical practice. The Gustave Roussy Immune Score (GRIm-score) takes into account neutrophil-to-lymphocyte ratio (NLR), serum albumin concentration and lactate dehydrogenase (LDH) and its prognostic score has been investigated in patients treated with immune check-point inhibitors (ICIs). To further assess the predictive value of baseline GRIm-score (GRImT0), we separately investigated two cohorts of metastatic NSCLC patients treated with first-line pembrolizumab immunotherapy or chemotherapy (CHT). We also investigated whether GRIm-score at 45 days since treatment initiation (GRImT1) and GRIm-score deterioration between the two time points may better predict clinical outcomes.

      Methods

      We retrospectively evaluated 222 metastatic NSCLC patients: 135 treated with pembrolizumab and 87 treated with chemotherapy. NLR, serum albumin and LDH concentrations were assessed at T0 and at T1. According to the GRIm-score, patients were assigned 1 point if they had NLR > 6, LDH > upper limit normal or albumin < 3.5 g/dl, for a total of 3 points. Patients with a GRIm-score <2 were considered as having a low Score. Chi-squared test was used to evaluate the association between variables. Median overall survival (OS) and progression free survival (PFS) were estimated by Kaplan-Meier method and log-rank test was used to assess differences by subgroups. The independent prognostic and predictive role of the scores was further analysed by multivariate logistic regression and Cox proportional hazard analyses.

      Results

      Median follow up of the whole population was 24.0 months, median OS and PFS were 12.0 months and 6.5 months, respectively. In both cohorts, no difference in terms of OS between patients with low and high GRImT0 was found. Otherwise, median OS and PFS of the low GRImT1 group were significantly longer than those of the high GRImT1 group in pembrolizumab-treated patients, but not in the CHT cohort (pembrolizumab cohort: low vs. high; median OS not reached vs. 9.2 months, p = 0.004 and median PFS 10.8 vs. 2.3 months, p = 0.002). The outcome of patients receiving pembrolizumab with no GRIm deterioration was better compared to patients with GRIm deterioration in terms of OS (median OS not reached vs. 12.0 months, p < 0.001), PFS (median PFS 20.6 vs. 2.6 months, p < 0.001) and objective response rate (58.2% vs 7.6%, p = 0.003). The prognostic and predictive role of GRImT1 and of GRIm deterioration in the pembrolizumab-cohort was also confirmed at multivariate analyses, after adjusting for performance status (PS), smoking and disease burden (high GRImT1 HR for death: 2.63, 95% CI 1.18-5.86, p = 0.01, GRIm deterioration HR for death: 3.28, 95% CI 1.39-7.74, p = 0.006).

      Conclusion

      Our data shown that GRImT1 and GRIm deterioration are more reliable predictors of outcome compared to GRImT0 in NSCLC patients treated with pembrolizumab. Their prognostic and predictive value was independent of PS, smoking and disease burden. Both GRImT1 and GRIm deterioration represent useful and easy-to-access early indicators of treatment response in metastatic NSCLC patients treated with first-line pembrolizumab and might help guiding clinicians’ choices in this setting.

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