Glasgow prognostic score predicts efficacy and prognosis in patients with advanced non‐small cell lung cancer receiving EGFR‐TKI treatment

Abstract

Background Lung cancer is the leading cause of cancer‐related deaths. Although epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs) are effective for advanced non‐small cell lung cancer (NSCLC) harboring EGFR mutations, some patients experience little or no response. The Glasgow prognostic score (GPS) is an inflammation‐related score based on C‐reactive protein (CRP) and albumin concentrations, and has prognostic value in various cancer settings. This study aimed to evaluate whether GPS could predict response of NSCLC to EGFR‐TKIs. Methods This retrospective multicenter study evaluated patients with NSCLC harboring EGFR mutations who received EGFR‐TKI monotherapy from October 2006 to December 2016. GPS values were determined using CRP and albumin concentrations from before initiation of EGFR‐TKIs. The Kaplan‐Meier method and Cox proportional hazard models were used to evaluate progression‐free survival (PFS) and overall survival (OS). Results In 214 patients, 141, 43, and two patients had GPS values of 0, 1, and 2, respectively. The GPS independently predicted the efficacy of EGFR‐TKIs; good GPS (0–1) conferred significantly better PFS (hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.38–0.96, P = 0.03) and OS (HR: 0.56, 95% CI: 0.33–0.96, P = 0.03). Multivariate analysis confirmed that a good GPS (0–1) independently predicted good PFS and OS among patients who had PS of 0–1. Good GPS (0–1) independently predicted good OS among patients receiving treatment in first‐line settings. Conclusions The GPS independently predicted the efficacy of EGFR‐TKIs for EGFR ‐mutated NSCLC; however, further studies are needed to validate our findings. Key points Significant findings of the study Glasgow prognostic score (GPS) independently predicted the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs) treatment for EGFR ‐mutated NSCLC. What this study adds The findings presented in this paper will help to identify patients who will be expected to experience limited or no response to EGFR‐TKI treatment by using GPS.

Pretreatment Glasgow prognostic score predicts survival among patients with high PD‐L1 expression administered first‐line pembrolizumab monotherapy for non‐small cell lung cancer

“…Table 4 summarizes the studies till date that have evaluated the GPS in patients administered anticancer drug therapy for advanced NSCLC. All reports on studies using cytotoxic anticancer drugs, molecularly targeted drugs, and ICIs have indicated the usefulness of the GPS 5,6,13,14,36‐40 . However, although certain reports have incorporated first‐line pembrolizumab monotherapy, no reports have focused on first‐line pembrolizumab monotherapy in patients with high PD‐L1 expression.…”

Glasgow Prognostic Score predicts chemotherapy‐triggered acute exacerbation‐interstitial lung disease in patients with non‐small cell lung cancer

“…GPS is a proven systemic inflammatory response‐based scoring system, measuring serum CRP and Alb levels 19,20 . It is a reliable prognostic indicator for patients with various forms of cancer including lung cancer 19–23 . There have also been reports showing an association between GPS and chemotherapy‐related adverse events 24,33 .…”

“…Conversely, patients with ILD, NSCLC, and a GPS score of 0 might have a better OS and benefit from a more aggressive chemotherapy regimen because of a lower risk for AE‐ILD. Furthermore, we calculated the GPS from blood test results before the onset of first‐line chemotherapy, according to the existing reports 21–24 . However, the GPS may change upon treatment or tumor activity.…”

“…The inflammation‐based Glasgow Prognostic Score (GPS), is calculated by the C‐reactive protein (CRP) and albumin (Alb) levels and serves as a reliable long‐term prognostic indicator of solid cancers, including lung cancers; a higher GPS score denotes a worse prognosis 19–23 . Gioulbasanis et al .…”

Glasgow prognostic score for prediction of chemotherapy‐triggered acute exacerbation interstitial lung disease in patients with small cell lung cancer

“…28 After its introduction, GPS was reported to be a reproducible predictor of long-term prognosis for NSCLC and SCLC. [29][30][31][32][33][34][35][36][37][38] However, there have been no previous studies examining the relationship between GPS and SCLC with concomitant ILD in patients undergoing chemotherapy. Therefore, the purpose of this study was to determine whether GPS predicts prognosis and chemotherapy-triggered AE-ILD in patients with SCLC and concomitant ILD.…”