Open AccessPredicting the efficacy of first‐line immunotherapy by combining cancer cachexia and tumor burden in advanced non‐small cell lung cancer
Author(s) -
Miyawaki Taichi,
Naito Tateaki,
Doshita Kosei,
Kodama Hiroaki,
Mori Mikiko,
Nishioka Naoya,
Iida Yuko,
Miyawaki Eriko,
Mamesaya Nobuaki,
Kobayashi Haruki,
Omori Shota,
Ko Ryo,
Wakuda Kazushige,
Ono Akira,
Kenmotsu Hirotsugu,
Murakami Haruyasu,
Mori Keita,
Harada Hideyuki,
Endo Masahiro,
Takahashi Kazuhisa,
Takahashi Toshiaki
Publication year - 2022
Publication title -
thoracic cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 28
eISSN - 1759-7714
pISSN - 1759-7706
DOI - 10.1111/1759-7714.14529
Subject(s) - medicine , pembrolizumab , cachexia , oncology , lung cancer , cancer , immunotherapy , chemotherapy , nivolumab , multivariate analysis
Background Cancer cachexia and tumor burden predict efficacies of programmed cell death‐1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) inhibitors and chemotherapy or pembrolizumab in non‐small cell lung cancer (NSCLC). There are no predictive models that simultaneously assess cancer cachexia and tumor burden. Methods In the present retrospective study, we reviewed the medical records of patients with advanced NSCLC who received cancer immunotherapy as first‐line systemic therapy. Clinical immune predictive scores were defined according to multivariate analysis of progression‐free survival (PFS) and overall survival (OS). Results A total of 157 patients were included in the present study (75 treated with PD‐1/PD‐L1 inhibitors + chemotherapy; 82, pembrolizumab monotherapy). Multivariate analysis for PFS revealed that PD‐L1 tumor proportion scores <50%, a total target lesion diameter ≥76 mm, and cancer cachexia were independently associated with poor PFS. Multivariate analysis for OS revealed that ≥4 metastases and cancer cachexia were significantly associated with poor OS. In the immune predictive model, the median PFS was 21.7 months in the low‐risk group ( N = 41); 7.6 in the medium‐risk group ( N = 64); and 3.0 in the high‐risk group ( N = 47). The median OS were not reached, 22.4 and 9.1 months respectively. Our immune predictive model was significantly associated with PFS ( p < 0.001) and OS ( p < 0.001). Conclusion We proposed the immune predictive model, including tumor burden and cancer cachexia, which may predict the efficacy and survival outcome of first‐line immunotherapy in advanced NSCLC.