Pretreatment prognostic nutritional index as a novel biomarker in non-small cell lung cancer patients treated with immune checkpoint inhibitors

Fukushima, Shoji; Takeoka, Hiroaki; Kozuma, Yuka; Toyokawa, Gouji; Yamazaki, Koji; Ichiki, Masao; Takeo, Sadanori

doi:10.1016/j.lungcan.2019.08.006

Cited by 88 publications

(105 citation statements)

References 45 publications

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“…[21][22][23] Only one recent study reported that patients with non-small cell lung cancer (NSCLC) with a PNI ≤45.5 had significantly worse ORR, DCR and PFS as compared with patients with PNI >45.5. 24 Yet, there are several reasons that poor nutritional status could impair ICI effectiveness. First, hypercatabolic activity in response to malnutrition could lead to accelerated clearance of monoclonal antibodies, which are primarily eliminated via catabolic degradation.…”

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confidence: 99%

Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

Johannet

Sawyers

Qian

et al. 2020

J Immunother Cancer

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BackgroundRecent research suggests that baseline body mass index (BMI) is associated with response to immunotherapy. In this study, we test the hypothesis that worsening nutritional status prior to the start of immunotherapy, rather than baseline BMI, negatively impacts immunotherapy response.MethodsWe studied 629 patients with advanced cancer who received immune checkpoint blockade at New York University. Patients had melanoma (n=268), lung cancer (n=128) or other primary malignancies (n=233). We tested the association between BMI changes prior to the start of treatment, baseline prognostic nutritional index (PNI), baseline BMI category and multiple clinical end points including best overall response (BOR), objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS).ResultsDecreasing pretreatment BMI and low PNI were associated with worse BOR (p=0.04 and p=0.0004), ORR (p=0.01 and p=0.0005), DCR (p=0.01 and p<0.0001), PFS (p=0.02 and p=0.01) and OS (p<0.001 and p<0.001). Baseline BMI category was not significantly associated with any treatment outcomes.ConclusionStandard of care measures of worsening nutritional status more accurately associate with immunotherapy outcomes than static measurements of BMI. Future studies should focus on determining whether optimizing pretreatment nutritional status, a modifiable variable, leads to improvement in immunotherapy response.

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mentioning

confidence: 99%

Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

Johannet

Sawyers

Qian

et al. 2020

J Immunother Cancer

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“…www.nature.com/scientificreports/ of cancer patients [16][17][18][19][20][21][22] . Malnutrition and low immune function not only affect the treatment effect of patients with malignant tumors, but also make malignant tumors more prone to relapse and metastasis 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Compared with patients with normal nutritional status and immune function, the prognosis of those with poor nutritional status and immune function are also poor. A large number of studies have shown that immune nutrition status can be used as a powerful indicator to predict the survival outcome of patients with malignant tumors [19][20][21][22] . Onodera first confirmed the prognostic role of PNI in gastrointestinal surgery of malnourished cancer patients in 1984 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Immune and nutritional status, as parts of tumor microcirculation, will undoubtedly affect the prognosis of patients. More and more evidence show that basic nutritional status and systemic inflammation are related to the long-term prognosis of cancer patients 16 – 22 . Malnutrition and low immune function not only affect the treatment effect of patients with malignant tumors, but also make malignant tumors more prone to relapse and metastasis 17 .…”

Section: Discussionmentioning

confidence: 99%

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The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy

Zhao

Feiyan

Liang

et al. 2020

Sci Rep

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The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.

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“…[ 13 ] The similar conclusion was also verified in NSCLC stratification of meta-analysis studies focusing on all cancer types (Tan et al [ 14 ] : 4 articles; Sacdalan et al [ 15 ] : 3 articles; Xie et al [ 16 ] : 6 articles). However, the literature size in these meta-analyses seemed to be small and abundant negative associations of NLR with OS or PFS were observed in the recent studies [ 17 – 20 ] published in 2019 which were not included previously. Hereby, the prediction ability of NLR for the therapeutic effects of anti-PD1/PD-L1 antibodies in NSCLC patients remains inconclusive.…”

Section: Introductionmentioning

confidence: 99%

The prediction potential of neutrophil-to-lymphocyte ratio for the therapeutic outcomes of programmed death receptor-1/programmed death ligand 1 inhibitors in non-small cell lung cancer patients

Huang

Shen

2020

Medicine

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Background: Programmed death receptor-1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have been demonstrated to improve the prognosis of patients with advanced non-small cell lung cancer (NSCLC) compared with chemotherapy. However, there were still some non-responders. Thus, how to effectively screen the responder may be an important issue. Recent studies revealed the immune-related indicator, neutrophil-lymphocyte ratio (NLR), may predict the therapeutic effects of anti-PD1/PD-L1 antibodies; however, the results were controversial. This study was to re-evaluate the prognostic potential of NLR for NSCLC patients receiving PD1/PD-L1 inhibitors by performing a meta-analysis. Methods: Eligible studies were identified by searching online databases of PubMed, EMBASE and Cochrane Library. The predictive values of NLR for overall survival, (OS), progression free survival (PFS) and overall response rate (ORR) were estimated by hazard ratio (HR) with 95% confidence interval (CI). Results: Twenty-four studies involving 2196 patients were included. The pooled analysis demonstrated that elevated NLR before PD-1/PD-L1 inhibitor treatment was a predictor of poor OS (HR = 2.17; 95% CI: 1.64 – 2.87, P < .001), PFS (HR = 1.54; 95% CI: 1.34 – 1.78, P < .001) and low ORR (HR = 0.64; 95% CI: 0.44 – 0.95, P = .027) in NSCLC patients. Subgroup analysis revealed the predictive ability of NLR for OS and PFS was not changed by ethnicity, sample size, cut-off, HR source, study design or inhibitor type (except the combined anti-PD-L1 group); while its association with ORR was only significant when the cut-off value was less than 5 and the studies were prospectively designed. Conclusion: Our findings suggest patients with lower NLR may benefit from the use of PD-1/PD-L1 inhibitors to prolong their survival period.

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Pretreatment prognostic nutritional index as a novel biomarker in non-small cell lung cancer patients treated with immune checkpoint inhibitors

Cited by 88 publications

References 45 publications

Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy

The prediction potential of neutrophil-to-lymphocyte ratio for the therapeutic outcomes of programmed death receptor-1/programmed death ligand 1 inhibitors in non-small cell lung cancer patients

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