Significance of Glasgow Prognostic Scores in NSCLC Patients Treated With Immunotherapy After Platinum-based Cytotoxic Chemotherapy

Abstract

Background/Aim: Little is known about the prognostic role of the Glasgow prognostic score (GPS) in nonsmall cell lung cancer (NSCLC) patients treated with immunotherapy after platinum-based cytotoxic chemotherapy. Patients and Methods: This study used a lung cancer cohort of the Catholic Medical Center of Korea between January 2018 and September 2020. Results: A total of 78 patients with NSCLC treated with immunotherapy as second or further-line therapy were included. Higher GPS values were significant predictors of shorter immune-related progression-free survival (irPFS) and overall survival (OS). The hazard ratios for irPFS were 0.249 for programmed death-ligand 1 (PD-L1) expression ≥50% and 9.73 for a GPS of 2. Older age, lower PD-L1 expression and higher GPS values were independently associated with shorter OS. Conclusion: 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.The introduction of immune-checkpoint inhibitors (ICIs) into the therapy for non-small cell lung cancer (NSCLC) has transformed the therapeutic landscape of metastatic NSCLC (1). The expression of programmed death-ligand 1 (PD-L1) on tumor cells and tumor mutation burden (TMB) have been used to select patients suitable for ICIs but not all patients with these predictive factors benefit from ICIs (2). However, the proper predictive factors for using ICIs to treat NSCLC patients have not been developed.Inflammation is an important factor in tumor progression and is associated with poor response to treatment. The response to cancer treatment depends not only on the tumor's characteristics and tumor stage but also on patient-related factors including nutrition and inflammation status (3). Recently, systemic inflammatory response to predict progression and survival has been reported in patients with malignancies. Thus, cancer-related prognosis has been validated using inflammatory markers such as the neutrophillymphocyte ratio (NLR) or the lung immune prognostic index 3423 This article is freely accessible online.

Smoking Status at Time of Diagnosis Affects the Efficacy of Anti-PD-1/L1 Therapy in Patients With Advanced NSCLC

“…Clinical information was systematically recorded by qualified managers to improve data accuracy. Researchers were permitted access to newly assigned serial numbers after anonymizing the dataset (22).…”

Prognostic Factors in Advanced Non-Small Cell Lung Cancer Patients Treated with Immunotherapy

“…As of today, several different combined scores have provided interesting results in NSCLC patients receiving ICIs. The Glasgow Prognostic Score (GPS) combines c-reactive protein levels >10 mg/L and hypoalbuminemia (<35 g/L), defining three different scores: 0: CRP < 10 mg/L and albumin > 35 g/L; 1: CRP ≥ 10 mg/L or albumin < 35 g/L; or 2: CRP > 10 mg/L and albumin < 35 g/L; higher GPS are associated with lower PFS and OS results in patients receiving ICIs [106,107]. Similarly, the Lung Immune Prognostic Index (LIPI) takes into account NLR (>3 as cutoff) and LDH (>upper limit of normal as cutoff), defining three scores: good (0 factor), intermediate (1 factor), and poor (2 factors); in several large studies, higher scores represent a poor prognostic factor [108][109][110].…”