Hopkins Ashley M, Kichenadasse Ganessan, Abuhelwa Ahmad Y, McKinnon Ross A, Rowland Andrew, Sorich Michael J
College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, SA 5042, Australia.
Cancers (Basel). 2021 Mar 9;13(5):1176. doi: 10.3390/cancers13051176.
The lung immune prognostic index (LIPI) is proposed to differentiate prognosis and treatment benefit from immune checkpoint inhibitors (ICIs) in advanced non-small cell lung cancer (NSCLC). There is minimal information on the predictive importance with first-line, combination ICI approaches. In post-hoc analysis of IMpower150, Cox-proportional hazard analysis assessed the association between LIPI groups and overall survival (OS)/progression free survival (PFS). IMpower150 involved chemotherapy-naïve, metastatic non-squamous NSCLC participants randomized atezolizumab-carboplatin-paclitaxel (ACP), bevacizumab-carboplatin-paclitaxel (BCP), or atezolizumab-BCP (ABCP). Good (0 factors), intermediate (1 factor), and poor LIPI (2 factors) were defined via derived neutrophil-to-lymphocyte ratio >3, and lactate dehydrogenase >upper limit of normal. Of 1148 participants, 548 had good, 479 intermediate, and 121 poor LIPI. In 385 participants randomised ABCP, a significant association between LIPI and OS (HR (95%CI): intermediate LIPI = 2.16 (1.47-3.18), poor LIPI = 5.28 (3.20-8.69), < 0.001) and PFS (HR (95%CI): intermediate LIPI = 1.47 (1.11-1.95), poor LIPI = 3.02 (2.03-4.50), < 0.001) was identified. Median OS was 24, 16, and 7 months for good, intermediate, and poor LIPI, respectively. ACP associations were similar. Relative OS treatment effect (HR 95%CI) of ABCP vs. BCP was 0.78 (0.53-1.15), 0.67 (0.49-0.91), and 0.87 (0.51-1.47) for the good, intermediate, and poor LIPI groups, respectively (P(interaction) = 0.66), with no benefit in median OS observed in the poor LIPI group. LIPI identified subgroups with significantly different survival following ABCP and ACP initiation for chemotherapy-naïve, metastatic non-squamous NSCLC. There was insufficient evidence that LIPI identifies patients unlikely to benefit from ABCP treatment.
肺免疫预后指数（LIPI）旨在区分晚期非小细胞肺癌（NSCLC）患者接受免疫检查点抑制剂（ICI）治疗后的预后及治疗获益情况。关于一线联合ICI治疗方法的预测重要性，目前相关信息极少。在IMpower150研究的事后分析中，采用Cox比例风险分析评估LIPI分组与总生存期（OS）/无进展生存期（PFS）之间的关联。IMpower150研究纳入了未经化疗的转移性非鳞状NSCLC患者，将其随机分为阿特珠单抗-卡铂-紫杉醇（ACP）组、贝伐单抗-卡铂-紫杉醇（BCP）组或阿特珠单抗-BCP（ABCP）组。通过推导得出的中性粒细胞与淋巴细胞比值>3且乳酸脱氢酶>正常上限来定义良好（0个因素）、中等（1个因素）和不良LIPI（2个因素）。在1148名参与者中，548人LIPI良好，479人中等，121人不良。在随机接受ABCP治疗的385名参与者中，LIPI与OS（风险比（HR）（95%置信区间）：中等LIPI = 2.16（1.47 - 3.18），不良LIPI = 5.28（3.20 - 8.69），P < 0.001）和PFS（HR（95%置信区间）：中等LIPI = 1.47（1.11 - 1.95），不良LIPI = 3.02（2.03 - 4.50），P < 0.001）之间存在显著关联。LIPI良好、中等和不良者的中位OS分别为24个月、16个月和7个月。ACP组的关联情况与之相似。ABCP组与BCP组相比，良好、中等和不良LIPI组的相对OS治疗效果（HR 95%置信区间）分别为0.78（0.53 - 1.15）、0.67（0.49 - 0.91）和0.87（0.51 - 1.47）（交互作用P = 0.66），不良LIPI组未观察到中位OS有获益。对于未经化疗的转移性非鳞状NSCLC患者，LIPI可识别出在开始ABCP和ACP治疗后生存情况有显著差异的亚组。没有足够证据表明LIPI能识别出不太可能从ABCP治疗中获益的患者。
