Prognostic Nutritional Index and Lung Immune Prognostic Index as Prognostic Predictors for Combination Therapies of Immune Checkpoint Inhibitors and Cytotoxic Anticancer Chemotherapy for Patients with Advanced Non-Small Cell Lung Cancer

Abstract

Combination therapy with immune checkpoint inhibitors and cytotoxic chemotherapies (chemoimmunotherapy) is associated with significantly better survival outcomes than cytotoxic chemotherapies alone in patients with advanced non-small cell lung cancer (NSCLC). However, there are no prognostic markers for chemoimmunotherapy. The prognostic nutritional index (PNI) and lung immune prognostic index (LIPI) are prognostic biomarkers for immune checkpoint inhibitor (ICI) monotherapy or cytotoxic chemotherapies. Thus, we aimed to examine whether these factors could also be prognostic markers for chemoimmunotherapy. We retrospectively examined 237 patients with advanced NSCLC treated with chemoimmunotherapy. In the total group, the median overall survival (OS) was not reached, and the median progression-free survival (PFS) was 8.6 months. Multivariate analysis of OS and PFS revealed significant differences based on PNI and LIPI. Programmed cell death ligand 1 (PD-L1) was also significantly associated with OS and PFS. PNI and a PD-L1 tumor proportion score (TPS) of <50% and poor LIPI (regardless of PD-L1 TPS) were associated with poor prognosis. PNI and LIPI predicted survival outcomes in patients with advanced NSCLC treated with chemoimmunotherapy, especially in patients with PD-L1 TPS <50%. For patients in this poor category, chemoimmunotherapy may result in a worse prognosis than expected.

Pretreatment “prognostic nutritional index” as an indicator of outcome in lung cancer patients receiving ICI-based treatment: Systematic review and meta-analysis

“…So we can infer that there may be a difference in the staging of lung cancer, it is an important source of heterogeneity. Five studies [ 14 , 15 , 17 , 19 , 20 ] were conducted on NSCLC alone, 1 study [ 16 ] was conducted on SCLC, and 1 study [ 21 ] did not distinguish between NSCLC and SCLC. It is known that the OS of SCLC is much worse than that of NSCLC.…”

The landscape of cancer cachexia in advanced non-small cell lung cancer: a narrative review

“…These results indicate that the presence of sarcopenia and cancer cachexia in advanced NSCLC may affect the efficacy of immunotherapycontaining regimens. In addition, inflammatory/ prognostic scores, such as modified Glasgow prognostic score, prognostic nutritional index, nutritional index, and neutrophil/lymphocyte ratio, are associated with cancer cachexia (41,42) and prognosis of advanced NSCLC patients (42)(43)(44)(45).…”

Emerging Blood-Based Biomarkers for Predicting Immunotherapy Response in NSCLC

“…In fact, a combined NLR-HGB biomarker can predict ICI response, showing that patients with pre-treatment high NLR and low HBG present worse OS (N= 123, HR = 2.6, p = 3.5 × 10 −5 ) [ 47 ]. Tanaka et al recently showed that the Lung Immune Prognostic Index (LIPI) could predict resistance to ICI in patients with previously treated advanced NSCLC, finding that in patients with low PD-L1 treated with chemoimmunotherapy (N = 237), LIPI can especially predict both PFS (HR, 2.75; p < 0.001) and OS (HR, 2.01; 95% CI, 1.28–3.15; p < 0.001) [ 48 ]. In addition, the pre-treatment levels of LIPI, combined with N ≥ 4 and high levels of serum Lactate Dehydrogenase (LDH), negatively correlated with the PFS (N = 113, p = 0.0119) [ 49 ].…”