Predictive factors for progression‐free survival in non‐small cell lung cancer patients receiving nivolumab based on performance status

• Published in: Cancer medicine (Malden, MA) MA), 2020-02, Vol.9 (4), p.1383-1391
• Main Authors: Adachi, Yuichi, Tamiya, Akihiro, Taniguchi, Yoshihiko, Enomoto, Takatoshi, Azuma, Kouji, Kouno, Shunichi, Inagaki, Yuji, Saijo, Nobuhiko, Okishio, Kyoichi, Atagi, Shinji
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents, Immunological - therapeutic use; Body mass index; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - secondary; Cell survival; Clinical Cancer Research; Dehydrogenases; Epidermal growth factor; Female; Glucocorticoids - therapeutic use; Humans; Immunotherapy; Liver; Liver Neoplasms - drug therapy; Liver Neoplasms - epidemiology; Liver Neoplasms - secondary; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lymphocytes; Lymphoma; Male; Metastases; Metastasis; Middle Aged; Monoclonal antibodies; Multivariate analysis; Mutation; Neutrophils; nivolumab; Nivolumab - therapeutic use; non-small cell lung cancer; Non-small cell lung carcinoma; Original Research; Patients; performance status; Pleural effusion; Pleural Effusion, Malignant - drug therapy; Pleural Effusion, Malignant - epidemiology; Prognosis; Progression-Free Survival; Proportional Hazards Models; Radiation therapy; Retrospective Studies; Risk Factors; Severity of Illness Index; Small cell lung carcinoma; Smoking; Smoking - epidemiology; Steroids; Targeted cancer therapy
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.2807

Background Nivolumab has promising efficacy for the treatment of non‐small cell lung cancer (NSCLC). Various predictive factors for nivolumab response in those with NSCLC have been reported, including performance status (PS). The objective of this retrospective study was to determine the predictive factors for nivolumab response in those with NSCLC with good PS and those with poor PS. Methods We retrospectively collected pretreatment clinical data of 296 consecutive patients with NSCLC treated with nivolumab. We investigated the relationship between progression‐free survival (PFS) and patient characteristics and analyzed predictive factors associated with good PS (PS 0‐1) or poor PS (PS 2‐4). Results The median age of patients was 70 years; 206 patients were male, and 224 were classified as having good PS (PS 0‐1). The median PFS was 3.0 months, 3.7 months, and 1.2 months for all patients, patients with good PS, and patients with poor PS respectively. Multivariate analysis showed that never smoking (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.15‐2.75), high C‐reactive protein (CRP) (HR, 1.39; 95% CI, 1.00‐1.93), liver metastasis (HR, 1.95; 95% CI, 1.24‐3.07), pleural effusion (HR, 1.45; 95% CI, 1.06‐2.00), and steroid use (HR, 2.85; 95% CI, 1.65‐4.94) were associated with significantly shorter PFS in patients with good PS. A high advanced lung cancer inflammation index (ALI) was significantly associated with longer PFS in patients with poor PS (HR, 0.24; 95% CI, 0.08‐0.79). Conclusions In patients with NSCLC treated with nivolumab, the factors found to be predictive of shorter PFS in patients with good PS were never smoking, high CRP, liver metastasis, pleural effusion, and steroid administration, whereas high ALI was predictive of longer PFS in patients with poor PS. PS was associated with PFS in patients with NSCLC receiving nivolumab treatment. Never smoking, high CRP, liver metastasis, pleural effusion, and steroid use at the commencement of nivolumab treatment were predictive of worse PFS in patients with NSCLC who received nivolumab treatment with good PS, and a high ALI was predictive of better PFS in patients with poor PS.