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评估肺免疫预后指数在接受阿特珠单抗治疗 NSCLC 患者中的生存和反应预测:临床试验的汇总分析。

Evaluation of the Lung Immune Prognostic Index for Prediction of Survival and Response in Patients Treated With Atezolizumab for NSCLC: Pooled Analysis of Clinical Trials.

机构信息

College of Medicine and Public Health, Flinders University, Adelaide, Australia.

College of Medicine and Public Health, Flinders University, Adelaide, Australia.

出版信息

J Thorac Oncol. 2019 Aug;14(8):1440-1446. doi: 10.1016/j.jtho.2019.04.006. Epub 2019 Apr 15.


DOI:10.1016/j.jtho.2019.04.006
PMID:30999110
Abstract

INTRODUCTION: There is substantial variability in survival and response outcomes for patients using immune checkpoint inhibitors (ICIs), and predictive markers are required to guide treatment decisions. A lung immune prognostic index (LIPI) was recently developed to predict ICI treatment outcomes and we aim to evaluate whether LIPI is predictive of survival and response for patients treated with atezolizumab for advanced NSCLC. METHODS: Pooled analysis was performed of patient-level data of four clinical trials of atezolizumab for NSCLC. Based on pre-treatment derived neutrophil-to-lymphocyte ratio greater than 3 and lactate dehydrogenase greater than the upper limit of normal, patients were assigned to one of three groups: good LIPI, 0 risk factors; intermediate LIPI, 1 risk factor; or poor LIPI, 2 risk factors. The primary outcome was overall survival (OS). RESULTS: In a pooled cohort of 1,489 patients treated with atezolizumab, the LIPI group was significantly associated with OS (p < 0.001), progression-free survival (p < 0.001), and response (p < 0.001). Median OS for good (n = 678), intermediate (n = 631), and poor (n = 180) LIPI groups was 18.4 months, 11.3 months, and 4.5 months, respectively. Association between LIPI and OS was consistently identified across a range of atezolizumab-treated subgroups. For docetaxel-treated patients (n = 687), LIPI was similarly associated with survival (p < 0.001) and response (p = 0.005). CONCLUSIONS: Pre-treatment LIPI is a convenient prognostic marker able to identify atezolizumab-treated patient groups with significantly different survival and response outcomes. However, LIPI is also a prognostic marker of survival and response for patients treated with chemotherapy; thus, it is not specifically predictive for ICI treatment.

摘要

简介:使用免疫检查点抑制剂(ICI)的患者的生存和反应结果存在很大差异,需要预测标志物来指导治疗决策。最近开发了肺免疫预后指数(LIPI)来预测 ICI 治疗结果,我们旨在评估 LIPI 是否可预测接受阿特珠单抗治疗的晚期 NSCLC 患者的生存和反应。

方法:对阿特珠单抗治疗 NSCLC 的四项临床试验的患者水平数据进行了汇总分析。根据治疗前中性粒细胞与淋巴细胞比值大于 3 和乳酸脱氢酶大于正常值上限,将患者分为三组:良好 LIPI,无风险因素;中等 LIPI,有一个风险因素;不良 LIPI,有两个风险因素。主要结局是总生存期(OS)。

结果:在接受阿特珠单抗治疗的 1489 例患者的汇总队列中,LIPI 组与 OS(p<0.001)、无进展生存期(p<0.001)和反应(p<0.001)显著相关。良好(n=678)、中等(n=631)和不良(n=180)LIPI 组的中位 OS 分别为 18.4 个月、11.3 个月和 4.5 个月。LIPI 与 OS 的关联在一系列阿特珠单抗治疗亚组中均得到确认。对于多西他赛治疗的患者(n=687),LIPI 与生存(p<0.001)和反应(p=0.005)也有类似的相关性。

结论:治疗前的 LIPI 是一个方便的预后标志物,能够识别接受阿特珠单抗治疗的患者群体,这些患者的生存和反应结果有显著差异。然而,LIPI 也是接受化疗治疗的患者的生存和反应的预后标志物;因此,它不是 ICI 治疗的特异性预测标志物。

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[4]
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