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Risk score for non-small cell lung cancer patients starting checkpoint inhibitor treatment

Authors Diem S, Fässler M, Hasan Ali O, Siano M, Niederer R, Berner F, Roux GA, Ackermann CJ, Schmid S, Güsewell S, Früh M, Flatz L

Received 10 July 2018

Accepted for publication 20 August 2018

Published 8 November 2018 Volume 2018:10 Pages 5537—5544

DOI https://doi.org/10.2147/CMAR.S179767

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Beicheng Sun


Stefan Diem,1–3,* Mirjam Fässler,2,* Omar Hasan Ali,2,4 Marco Siano,1 Rebekka Niederer,2 Fiamma Berner,2 Guillaume-Alexandre Roux,2 Christoph Jakob Ackermann,1 Sabine Schmid,1 Sabine Güsewell,5 Martin Früh,1,6 Lukas Flatz1,2,4,5,7

1Department of Oncology/Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; 2Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland; 3Department of Oncology/Haematology, Spital Grabs, St. Gallen, Switzerland; 4Department of Dermatology, University Hospital Zürich, Zürich, Switzerland; 5Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland; 6University of Bern, Bern, Switzerland; 7Department of Dermatology/Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland

*These authors contributed equally to this work

Background: Prognosis of metastatic non-small cell lung cancer significantly improved with the availability of checkpoint inhibitors (anti-PD-1/PD-L1). Unfortunately, reliable biomarkers to predict treatment benefit are lacking.
Patients and methods: We prospectively collected clinical and laboratory data of 56 non-small cell lung cancer patients treated with a checkpoint inhibitor. The aim was to identify baseline parameters correlating with worse outcome and to create a risk score that enabled to stratify patients into different risk groups. As inflammation is known to promote tumor growth, we focused on inflammation markers in the blood. Disease control (DC) was defined as complete response, partial response, and stable disease on CT scan according to RECIST 1.1.
Results: Half of the patients achieved DC. Four parameters differed significantly between the DC group and the no disease control group: Eastern Cooperative Oncology Group performance status (P=0.009), number of organs with metastases (P=0.001), lactate dehydrogenase (P=0.029), and ferritin (P=0.005). A risk score defined as the number of these parameters (0= no risk factor) exceeding a threshold (Eastern Cooperative Oncology Group performance status ≥2, number of organs with metastases ≥4, lactate dehydrogenase ≥262U/L, and ferritin ≥241 µg/L) was associated with overall survival and progression-free survival. Overall survival at 6 and 12 months is as follows: Scores 0–1: 95% and 95%; Score 2: 67% and ≤33%; Scores 3–4: 15% and 0%. Progression-free survival at 6 and 12 months is as follows: Scores 0–1: 81% and 50%; Score 2: 25% and ≤25%; Scores 3–4: 0% and 0%.
Conclusion: We propose an easy-to-apply risk score categorizing patients into different risk groups before treatment start with a PD-1/PD-L1 antibody.

Keywords: NSCLC, checkpoint inhibitor, biomarkers, risk score, response, survival

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