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Background: Dissociated responses (DR) are phenomena in which some tumors shrink, whereas others progress during treatment of patients with cancer. The purpose of the present study was to evaluate the frequency and prognosis of DR in non-small cell lung cancer (NSCLC) patients treated with anti-programmed cell death-1/ligand 1 (anti-PD-1/L1) inhibitors. Methods: This retrospective study included NSCLC patients who received anti-PD-1/L1 inhibitor as second-or laterline treatment. We excluded patients without radiological evaluation. In patients who showed progressive disease (PD) according to the RECIST 1.1 at the initial CT evaluation, we evaluated all measurable lesions in each organ to identify DR independently of RECIST 1.1. We defined DR as a disease with some shrinking lesions as well as growing or emerging new lesions. Cases not classified as DR were defined as 'true PD'. Overall survival was compared between patients with DR and those with true PD using Cox proportional hazards models. Results: The present study included 62 NSCLC patients aged 27-82 years (median: 65 years). DR and true PD were observed in 11 and 51 patients, respectively. The frequency of DR in NSCLC patients who showed PD to anti-PD-1/ L1 was 17.7%. Median overall survival was significantly longer in patients with DR versus true PD (14.0 vs. 6.6 months, respectively; hazard ratio for death: 0.40; 95% confidence interval: 0.17-0.94). Conclusions: Patients with DR exhibited a relatively favorable prognosis.

Background: This study aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) reflected poor treatment benefits in patients with tumor proportion score (TPS) ≥50% and who under went first-line pembrolizumab monotherapy. Patients and Methods: This study retrospectively analyzed patients with untreated stage III/IV or recurrent non-small cell lung cancer (NSCLC) with TPS ≥50% and who received pembrolizumab monotherapy at two hospitals between February 2017 and April 2019. The NLR was calculated from pre-treatment complete blood counts. Results: A total of 51 previously untreated patients with NSCLC who had TPS ≥50% and who underwent pembrolizumab monotherapy were evaluated. Multivariate analysis revealed that high NLR, Eastern Cooperative Oncology Group performance status (PS) ≥2, stage IV or recurrent cancer, and TPS=50−74% were significantly and independently associated with poor progression-free survival. Moreover, high NLR and PS ≥2 were significantly associated with short overall survival. Conclusion: A high pre-treatment NLR was associated with significantly short progression-free and overall survival in previously untreated patients with NSCLC with high expression of programmed cell-death ligand 1 treated with pembrolizumab monotherapy.Lung cancer remains the leading cause of cancer-related death worldwide (1) despite dramatic advances in cutting edge and radical treatments, including targeted therapies for advanced non-small cell lung cancer (NSCLC). Targeted therapies have improved the survival of patients with driver oncogenes and are standard first-line therapies. However, for patients without driver oncogenes, improvements in survival were minimal until immunotherapeutic alternatives became available.Therapeutic agents such as nivolumab, pembrolizumab, and atezolizumab, which are antibodies that target programmed death 1 (PD1) or its ligand (PD-L1), have significantly improved survival compared with docetaxel as a second-line treatment for advanced NSCLC without any selection or with a PD-L1 tumor proportion score (TPS) of ≥1% (2-5). However, in studies with the aforementioned results, the objective response was low at 15%, indicating that only few patients benefited from the treatment, warranting the need for precise patient selection and additional efficacy studies. Selection of patients based on PD-L1 expression in tumor tissue is perhaps the best biomarker for treating advanced NSCLC with anti-PD1/L1 antibody. Two phase III studies compared pembrolizumab monotherapy with platinum-based chemotherapy as the firstline treatment in patients with untreated NSCLC who had TPS ≥50% [KEYNOTE-024 (6)] and >1% [KEYNOTE-042 (7)]. Pembrolizumab monotherapy significantly prolonged overall survival (OS) and progression-free survival (PFS) and has become a standard, first-line treatment. However, in KEYNOTE-042 (7), the PFS and OS curves of patients with TPS ≥50% suggested that certain patients were unlikely to benefit from pembrolizumab monotherapy. The KEYNOTE-189 and KEYNOTE-407 studies (8) revealed...