Prognostic Value of the Lung Immune Prognostic Index May Differ in Patients Treated With Immune Checkpoint Inhibitor Monotherapy or Combined With Chemotherapy for Non-small Cell Lung Cancer

Wenxian Wang; Zhangzhou Huang; Zongyang Yu; Wu Zhuang; Weijun Zheng; Zhijian Cai; Lei Shi; Xinmin Yu; Guangyuan Lou; Wei Hong; Yiping Zhang; Ming Chen; Zhengbo Song

doi:10.3389/fonc.2020.572853

Prognostic Value of the Lung Immune Prognostic Index May Differ in Patients Treated With Immune Checkpoint Inhibitor Monotherapy or Combined With Chemotherapy for Non-small Cell Lung Cancer

Front Oncol. 2020 Oct 9:10:572853. doi: 10.3389/fonc.2020.572853. eCollection 2020.

Authors

Wenxian Wang^{1

2}, Zhangzhou Huang³, Zongyang Yu⁴, Wu Zhuang³, Weijun Zheng⁵, Zhijian Cai⁶, Lei Shi⁷, Xinmin Yu^{1

2}, Guangyuan Lou^{1

2}, Wei Hong^{1

2}, Yiping Zhang^{1

2}, Ming Chen⁸, Zhengbo Song^{1

2}

Affiliations

¹ Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences & Zhejiang Cancer Hospital, Hangzhou, China.
² Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China.
³ Department of Medical Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China.
⁴ Department of Medical Oncology, The 900th Hospital, Fuzhou, China.
⁵ Department of Medical Statistics, College of Public Health, Zhejiang Chinese Medical School, Hangzhou, China.
⁶ Institute of Immunology, Zhejiang University School of Medicine, Hangzhou, China.
⁷ Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou, China.
⁸ Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China.

Abstract

Background: Lung immune prognostic index (LIPI) status was recently developed to predict responses to immune checkpoint inhibitor (ICI) treatments. However, it is unclear whether LIPI is a prognostic index for both patients treated with ICI monotherapy and patients treated with ICIs combined with chemotherapy (ICIs CC).

Methods: This retrospective study established the patterns of LIPI in Chinese patients with advanced non-small cell lung cancer. Lung immune prognostic index based on the derived neutrophil-to-lymphocyte ratio greater than 3 and lactate dehydrogenase greater than the upper limit of normal was developed to characterize good, intermediate, or poor LIPI status. Associations between LIPI status and progression-free survival (PFS) and overall survival (OS) were analyzed. Kaplan-Meier curves and Cox proportional hazards models were used to determine survival differences.

Results: Three hundred thirty patients were included in this study. Of these patients, 216 received ICI monotherapy and 114 received ICIs CC. A good LIPI status was associated with better PFS (6.1 months vs. 2.3 months vs. 2.1 months, P = 0.023) and OS (24.2 months vs. 14.5 months vs. 9.3 months, P < 0.001) in ICI monotherapy compared to intermediate or poor LIPI status. No differences in PFS (17.9 vs. 9.9 months vs. 7.6 months, P = 0.355, respectively) and OS (P = 0.346) were observed in patients who received ICIs CC. Moreover, we found that patients who had an improved LIPI status compared with the baseline value had a longer PFS with ICI monotherapy and LIPI intermediate status (8.4 months vs. 2.1 months vs. 1.4 months, P < 0.001). However, in patients treated with ICIs CC, these dynamic changes were not observed (P = 0.444).

Conclusions: Lung immune prognostic index status and dynamic changes in LIPI could be prognostic markers of treatment response to ICI monotherapy, but not to ICIs CC. In particular, good LIPI status was associated with a better clinical outcome compared with intermediate and poor LIPI status in ICI monotherapy treatment.

Keywords: biomarker; chemotherapy; immune checkpoint inhibitor; lung immune prognostic index; non-small cell lung cancer.