dNLR-Based Score Predicting Overall Survival Benefit for The Addition of Platinum-Based Chemotherapy to Pembrolizumab in Advanced NSCLC With PD-L1 Tumor Proportion Score ≥50%

Systemic Inflammation/Nutritional Status Scores Are Prognostic but Not Predictive in Metastatic Non-Small-Cell Lung Cancer Treated with First-Line Immune Checkpoint Inhibitors

“…Scores were thus prognostic in the three cohorts. However, as opposed to the others, the prognostic value of the score developed by Holtzman et al [ 36 ] appeared poorer in the cohort of patients treated with ICI in monotherapy, as the one-year OS/six-month PFS of patients with high values at baseline (thus with an unfavorable status at baseline) were surprisingly better than the one-year OS/six-month PFS of patients with low values at baseline (thus with a presumed favorable status at baseline). Please note that, in contrast to the other scores, for the Advanced Lung Cancer Inflammation Index (ALI) and the Prognostic Nutritional Index (PNI), higher values were associated with lower systemic inflammation and better nutritional status, respectively.…”

“…Their prognostic performance was generally poor ( Table 3 ), as the highest c-index value was only at 0.66, meaning that more favorable score values were associated with better survival in only 66% of the pairs of patients. The score developed by Holtzman et al [ 36 ] had the poorest prognostic performance with a c-index value below 0.5, meaning that the more favorable score values were more associated with shorter survival.…”

“…However, their prognostic performance was poor, as the highest c-index was calculated at 0.66, which is close to 0.50, i.e., the absence of concordance between the score values and the survival. The score developed by Holtzman et al [ 36 ] had the poorest prognostic performance, with a c-index even below 0.50. For patients with higher scores at baseline, the one-year OS was also curiously higher for patients treated with ICI in monotherapy (65%) than with ICI + CT (48%), whereas it was the opposite in the study that established this score [ 36 ].…”

“…The score developed by Holtzman et al [ 36 ] had the poorest prognostic performance, with a c-index even below 0.50. For patients with higher scores at baseline, the one-year OS was also curiously higher for patients treated with ICI in monotherapy (65%) than with ICI + CT (48%), whereas it was the opposite in the study that established this score [ 36 ]. The scores were also not specifically predictive of the response to a particular treatment modality, except maybe for the SIPS score, for which higher scores were associated with a greater risk of death in the cohort treated with ICI + CT than in the one treated with ICI in monotherapy.…”

“…In contrast with more experimental biomarkers, these are derived from basic, routinely collected biological or clinical parameters that are widely available, such as hemogram, albumin, C-reactive protein (CRP), lactate dehydrogenase (LDH), or body mass index (BMI) [ 25 , 27 , 28 ]. Meanwhile, several scores, based on biomarkers of systemic inflammation and nutritional status, have also been developed and studied in patients with NSCLC treated with ICIs, such as the Lung Immune Prognostic Index (LIPI) [ 29 ], the Modified Lung Immune Prognostic Index (mLIPI) [ 30 ], the Scottish Inflammatory Prognostic Score (SIPS) [ 31 ], the EPSILoN [ 32 ], the Gustave Roussy Immune Score (GRIm) [ 33 ], the Royal Marsden Hospital Prognostic Score (RMH) [ 34 ], the Lung Immune Prognostic Score (LIPS) [ 35 ], the score developed by Holtzman et al [ 36 ], and the Glasgow Prognostic Score (GPS) [ 37 ]. Many of these scores demonstrated a prognostic effect, as they were generally associated with outcomes.…”