Prognostic Nutritional Index and Lung Immune Prognostic Index as Prognostic Predictors for Combination Therapies of Immune Checkpoint Inhibitors and Cytotoxic Anticancer Chemotherapy for Patients with Advanced Non-Small Cell Lung Cancer

Satomi Tanaka; Junji Uchino; Takashi Yokoi; Takashi Kijima; Yasuhiro Goto; Yoshifumi Suga; Yuki Katayama; Ryota Nakamura; Kenji Morimoto; Akira Nakao; Makoto Hibino; Nozomi Tani; Takayuki Takeda; Hiroyuki Yamaguchi; Yusuke Tachibana; Chieko Takumi; Noriya Hiraoka; Masafumi Takeshita; Keisuke Onoi; Yusuke Chihara; Ryusuke Taniguchi; Takahiro Yamada; Yohei Matsui; Osamu Hiranuma; Yoshie Morimoto; Masahiro Iwasaku; Shinsaku Tokuda; Yoshiko Kaneko; Tadaaki Yamada; Koichi Takayama

doi:10.3390/diagnostics12020423

Prognostic Nutritional Index and Lung Immune Prognostic Index as Prognostic Predictors for Combination Therapies of Immune Checkpoint Inhibitors and Cytotoxic Anticancer Chemotherapy for Patients with Advanced Non-Small Cell Lung Cancer

Diagnostics (Basel). 2022 Feb 6;12(2):423. doi: 10.3390/diagnostics12020423.

Authors

Satomi Tanaka¹, Junji Uchino¹, Takashi Yokoi², Takashi Kijima², Yasuhiro Goto³, Yoshifumi Suga¹, Yuki Katayama¹, Ryota Nakamura¹, Kenji Morimoto¹, Akira Nakao⁴, Makoto Hibino⁵, Nozomi Tani⁶, Takayuki Takeda⁶, Hiroyuki Yamaguchi⁷, Yusuke Tachibana⁸, Chieko Takumi⁸, Noriya Hiraoka⁸, Masafumi Takeshita⁹, Keisuke Onoi¹⁰, Yusuke Chihara¹⁰, Ryusuke Taniguchi¹¹, Takahiro Yamada¹¹, Yohei Matsui¹², Osamu Hiranuma¹², Yoshie Morimoto¹, Masahiro Iwasaku¹, Shinsaku Tokuda¹, Yoshiko Kaneko¹, Tadaaki Yamada¹, Koichi Takayama¹

Affiliations

¹ Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
² Department of Respiratory Medicine and Hematology and Department of Thoracic Oncology, Hyogo College of Medicine, 1-1 Mukogawachō, Nishinomiya 663-8501, Japan.
³ Department of Respiratory Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan.
⁴ Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, 8 Chome-19-1 Nanakuma, Jonan Ward, Fukuoka 814-0180, Japan.
⁵ Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, 1 Chome-5-1 Tsujidokandai, Fujisawa 251-0041, Japan.
⁶ Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, 355-5, Haruobicho, Kamaza Dori Marutamachi Agaru, Kamigyo Ward, Kyoto 602-8026, Japan.
⁷ Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
⁸ Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Higashiyama Ward, Honmachi, Kyoto 605-0981, Japan.
⁹ Department of Respiratory Medicine, Ichinomiya Nishi Hospital, Hira-1 Kaimei, Ichinomiya City 494-0001, Japan.
¹⁰ Uji-Tokushukai Medical Center, Department of Respiratory Medicine, 145 Ishibashi Makishimacho, Uji-shi 611-0041, Japan.
¹¹ Department of Pulmonary Medicine, Matsushita Memorial Hospital, 5-55 Sotojima-cho, Moriguchi 570-8540, Japan.
¹² Department of Pulmonary Medicine, Otsu City Hospital, 2-9-9 Motomiya, Otsu-City 520-0804, Japan.

Abstract

Combination therapy with immune checkpoint inhibitors and cytotoxic chemotherapies (chemoimmunotherapy) is associated with significantly better survival outcomes than cytotoxic chemotherapies alone in patients with advanced non-small cell lung cancer (NSCLC). However, there are no prognostic markers for chemoimmunotherapy. The prognostic nutritional index (PNI) and lung immune prognostic index (LIPI) are prognostic biomarkers for immune checkpoint inhibitor (ICI) monotherapy or cytotoxic chemotherapies. Thus, we aimed to examine whether these factors could also be prognostic markers for chemoimmunotherapy. We retrospectively examined 237 patients with advanced NSCLC treated with chemoimmunotherapy. In the total group, the median overall survival (OS) was not reached, and the median progression-free survival (PFS) was 8.6 months. Multivariate analysis of OS and PFS revealed significant differences based on PNI and LIPI. Programmed cell death ligand 1 (PD-L1) was also significantly associated with OS and PFS. PNI and a PD-L1 tumor proportion score (TPS) of <50% and poor LIPI (regardless of PD-L1 TPS) were associated with poor prognosis. PNI and LIPI predicted survival outcomes in patients with advanced NSCLC treated with chemoimmunotherapy, especially in patients with PD-L1 TPS <50%. For patients in this poor category, chemoimmunotherapy may result in a worse prognosis than expected.

Keywords: advanced non-small cell lung cancer; chemoimmunotherapy; lung immune prognostic index; prognostic nutritional index; programmed cell death ligand 1.