Chemotherapy in non-small cell lung cancer patients after prior immunotherapy: The multicenter retrospective CLARITY study

Bersanelli, Melissa; Buti, Sebastiano; Giannarelli, Diana; Leonetti, Alessandro; Cortellini, Alessio; Russo, Giuseppe Lo; Signorelli, Diego; Toschi, Luca; Milella, Michèle; Pilotto, Sara; Bria, Emilio; Proto, Claudia; Marinello, Arianna; Randon, Giovanni; Rossi, Sabrina; Vita, Emanuele; Sartori, Giulia; D’Argento, Ettore; Qako, Eva; Giaiacopi, Elisa; Ghilardi, Laura; Bettini, Anna; Rapacchi, Elena; Mazzoni, Francesca; Lavacchi, Daniele; Scotti, Vieri; Ciccone, L.P.; Tursi, Michele De; Santini, Daniele; Russano, Marco; Bordi, Paola; Maïo, Massimo Di; Audisio, Marco; Filetti, Marco; Giusti, Raffaele; Berardi, Rossana; Fiordoliva, Ilaria; Cerea, Giulio; Pizzutilo, Elio Gregory; Bearz, Alessandra; Carlo, Elisa De; Cecere, Fabiana Letizia; Renna, Davide; Camisa, Roberta; Caruso, Giuseppe; Ficorella, Corrado; Banna, Giuseppe Luigi; Brighenti, Matteo; Garassino, Marina Chiara; Tiseo, Marcello

doi:10.1016/j.lungcan.2020.10.008

Cited by 14 publications

(16 citation statements)

References 18 publications

(26 reference statements)

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“…In addition, the rate of subsequent therapy was significantly higher in the high GNRI group, and the pronounced difference in chemotherapy use after immunotherapy (high GNRI: 50.0 vs. low GNRI: 25.0%) might have affected the survival outcomes. Several studies have indicated that previous treatment with immunotherapy improved the efficacy of subsequent chemotherapy, and a multicenter retrospective study revealed that the median values were 4.1 months for PFS (95% CI: 3.4–4.8), 6.8 months for OS (95% CI: 5.5–8.1), and 22.8% for ORR among 342 NSCLC patients who underwent salvage chemotherapy after immunotherapy (SCAI) 23 . Park et al also compared the ORRs between SCAI and the last chemotherapy administered before immunotherapy (LCBI), which revealed that SCAI was associated with a significantly higher ORR (53.4 vs. 34.9%, p = 0.03) 24 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have indicated that previous treatment with immunotherapy improved the efficacy of subsequent chemotherapy, and a multicenter retrospective study revealed that the median values were 4.1 months for PFS (95% CI: 3.4-4.8), 6.8 months for OS (95% CI: 5.5-8.1), and 22.8% for ORR among 342 NSCLC patients who underwent salvage chemotherapy after immunotherapy (SCAI). 23 Park et al also compared the ORRs between SCAI and the last chemotherapy administered before immunotherapy (LCBI), which revealed that SCAI was associated with a significantly higher ORR (53.4 vs. 34.9%, p = 0.03). 24 Thus, the longer OS in the high GNRI group might also be explained by its high rate of SCAI, relative to the low GNRI group.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of the geriatric nutritional risk index among patients with previously treated advanced non‐small cell lung cancer who subsequently underwent immunotherapy

et al. 2021

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Background The geriatric nutritional risk index (GNRI) is a simple and useful marker for predicting prognosis and treatment efficacy among patients with various cancers. However, to the best of our knowledge, there are no previous reports regarding the prognostic value of GNRI among patients with non‐small cell lung cancer (NSCLC) who were treated with immune checkpoint inhibitors (ICIs). Methods We retrospectively evaluated 85 patients with previously treated advanced NSCLC who were administered ICIs at Shinshu University Hospital between February 2016 and October 2020. Progression‐free survival (PFS) and overall survival (OS) were compared between groups with high (≥89.5) and low (<89.5) GNRI values. We used univariate and multivariate Cox regression analyses to identify prognostic factors that were associated with PFS and OS. Results The high and low GNRI groups included 61 and 24 patients, respectively. Relative to the low GNRI group, the high GNRI group had significantly longer median PFS (3.7 vs. 2.4 months, p = 0.041) and significantly longer median OS (14.2 vs. 6.1 months, p = 0.008). Multivariate analyses revealed that independent predictors of favorable OS were high GNRI, performance status of 0–1, and age of ≥70 years. The high GNRI group was significantly more likely to undergo subsequent therapy after immunotherapy (68.6 vs. 33.3%, p = 0.008). Conclusions The present study revealed that high GNRI was associated with good outcomes among patients with previously treated NSCLC who were treated with ICIs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic value of the geriatric nutritional risk index among patients with previously treated advanced non‐small cell lung cancer who subsequently underwent immunotherapy

et al. 2021

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“…In the last decade, the development of targeted treatment and immunotherapy based on molecular and immunology research offers abundantly available therapy regimens [ 3 ]. Chemotherapy develops slowly relative to the above therapies, while evidence has demonstrated its crucial role in NSCLC treatment regardless of the clinical stages, histology, mutation subtypes, and immune status [ 4 ]. Furthermore, chemotherapy is also an effective follow-up approach in case of failure of targeted therapy and immunotherapy [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Change Rates of CYFRA21-1 and CEA in Predicting Chemotherapy Efficacy for Non-Small-Cell Lung Cancer

Zhao

Mao

Chen

2021

Computational and Mathematical Methods in Medicine

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Background. Cytokeratin 19 fragment 21-1 (CYFRA21-1) and carcinoembryonic antigen (CEA) are effective prognostic biomarkers for lung cancer. This study investigated the predictive effects of change rates of CYFRA21-1 and CEA before and after the first cycles of chemotherapy on advanced IIIb/IIIc or IV stage non-small-cell lung cancer (NSCLC) patients. Methods. Data of 103 NSCLC patients who received chemotherapy in Zhejiang Provincial People’s Hospital from February 2018 to November 2020 were retrospectively analyzed. All patients received platinum doublet chemotherapy for at least 2 cycles. CYFRA21-1 and CEA levels of patients were detected before and after the first chemotherapy cycle, respectively. After the second cycle, the efficacy was evaluated, and patients were divided into the disease control (DC) and progressive disease (PD) groups. The generalized linear model (GLM) and linear trend test assessed the relationship between change rates of CYFRA21-1 and CEA levels and chemotherapeutic efficacy before and after chemotherapy. Moreover, the receiver operating characteristic (ROC) curve determined the predictive value of change rates of CYFRA21-1 and CEA on chemotherapeutic efficacy. Results. After the second chemotherapeutic cycle, there were 92 patients in the DC group and 11 in the PD group. GLM and linear trend test both indicated that change rates of CYFRA21-1 and CEA were inversely correlated with chemotherapeutic efficacy for NSCLC. Change rates of CYFRA21-1 and CEA were used to predict area under the ROC curve of chemotherapeutic efficacy (0.87, 0.71-1.00), which is better than single index prediction of CYFRA21-1 (0.71, 0.49-0.94) or CEA change rate (0.85, 0.69-1.00) ( p < 0.001 ). Conclusion. Before and after chemotherapy of the first cycle for advanced NSCLC patients, combining serum CYFRA21-1 and CEA levels could increase sensitivity and specificity to predict the chemotherapeutic efficacy and guide the following therapy of advanced NSCLC patients.

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“…Secondly, this study was based on the medical records of a single center and the sample size was relatively small; this may undermine the reliability of the results, particularly of those from the subgroup analyses, which should therefore be considered as hypothesis-generating. Thirdly, the retrospective nature of this study has inherent disadvantages (31). Therefore, our findings warrant further validation in multicenter prospective clinical trials with large cohorts.…”

Section: Discussionmentioning

confidence: 85%

Immunotherapy beyond progression in patients with advanced non-small cell lung cancer

Zhang²,

Zhang³

et al. 2020

Transl Lung Cancer Res

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Background: Immune checkpoint inhibitors (ICIs) represent a great breakthrough in the treatment of advanced non-small cell lung cancer (aNSCLC). However, whether immunotherapy beyond progression (IBP) is effective for aNSCLC has yet to be established. Therefore, a retrospective clinical study was conducted to investigate the efficacy of IBP in patients with aNSCLC under real-world conditions.Methods: A total of 125 Chinese patients with aNSCLC who experienced progressive disease (PD) after receiving monotherapy or combination therapy (combined with chemotherapy or/and antiangiogenic therapy) with programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors between January 2015 and March 2019 were enrolled. Patients who were treated with ICIs for more than 6 weeks after PD were defined as IBP (n=39), while those who received ICI treatment for less than 6 weeks or discontinued it due to PD were defined as non-IBP (n=86). Patient clinical characteristics were evaluated.An optimization-based method was applied to balance the clinical baseline characteristics between the two groups.Results: In total population, the IBP group had longer overall survival (median OS, 26.6 vs. 9.5 months; HR, 0.40; 95% CI: 0.23-0.69; P<0.001) and progression-free survival (median PFS, 8.9 vs. 4.1 months; HR, 0.41; 95% CI: 0.26-0.65; P<0.001), compared with the non-IBP group. Despite no significant difference in objective response rate (ORR, 15.4% vs. 11.6%, P=0.560), disease control rate (DCR) was significantly higher in the IBP group (89.7% vs. 61.6%, P<0.001). After balancing baseline covariates, the IBP group also had longer OS (median: 26.6 vs. 10.7 months; HR, 0.40; 95% CI: 0.19-0.84; P=0.015) and PFS (median: 9.7 vs. 4.3 months; HR, 0.28; 95% CI: 0.15-0.51; P<0.001), with a benefit in either of patients previously treated with ICI monotherapy or in combination therapy and with non-response to the previously ICI.Conclusions: IBP is associated with longer OS and PFS in patients with aNSCLC. Our findings may suggest new therapeutic options for patients with aNSCLC who experienced disease progression after initial immunotherapy.

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Chemotherapy in non-small cell lung cancer patients after prior immunotherapy: The multicenter retrospective CLARITY study

Cited by 14 publications

References 18 publications

Prognostic value of the geriatric nutritional risk index among patients with previously treated advanced non‐small cell lung cancer who subsequently underwent immunotherapy

Prognostic value of the geriatric nutritional risk index among patients with previously treated advanced non‐small cell lung cancer who subsequently underwent immunotherapy

The Role of Change Rates of CYFRA21-1 and CEA in Predicting Chemotherapy Efficacy for Non-Small-Cell Lung Cancer

Immunotherapy beyond progression in patients with advanced non-small cell lung cancer

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