Significance of Glasgow prognostic scores in NSCLC patients treated with immunotherapy after platinum-based cytotoxic chemotherapy

Abstract

Background: The Glasgow prognostic score (GPS) reflects the host’s systemic inflammatory response and is a validated prognostic factor in lung cancer. However, little is known about the prognostic role in non-small cell lung cancer (NSCLC) patients treated with immunotherapy after platinum-based cytotoxic chemotherapy.Methods: This study used a lung cancer cohort of the Catholic Medical Center of Korea between January 2018 and September 2020. We included patients who were diagnosed with unresectable advanced stage NSCLC or recurrent disease after pulmonary resection and had received at least one regimen of platinum-based chemotherapy before the administration of immunotherapy. The prognostic value of the GPS was assessed in patients with NSCLC treated with anti-PD1 or anti-PD-L1 (pembrolizumab, nivolumab, or atezolizumab). The GPS was calculated using C-reactive protein and albumin concentrations within one week before starting anti-PD1 or anti-PD-L1 treatment. Results: A total of 78 patients with NSCLC treated with immunotherapy as second or further-line therapy after platinum-based chemotherapy were included in the study. Kaplan-Meier analysis revealed that higher GPS values were significant predictors of shorter immune-related progression-free survival (irPFS) (log-rank P < 0.001) and overall survival (OS) (log-rank P < 0.001). In the Cox regression multivariate analysis, the hazard ratios for irPFS were 0.249 (95% confidence interval [CI]: 0.084 – 0.739, P = 0.012) for PD-L1 expression ≥ 50% and 9.73 (95% CI: 2.931 – 32.298, P < 0.001) for a GPS of 2 relative to a GPS of 0. Older age (P = 0.033), lower PD-L1 expression (P = 0.036), and higher GPS values (P = 0.007) were independently associated with shorter OS.Conclusions: Higher GPS values were identified as a poor prognostic factor for OS and irPFS in NSCLC patients who received immunotherapy as second or further-line therapy after platinum-based chemotherapy.