Association between the modified lung immune predictive index and clinical outcomes of advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors combined with chemotherapy

Hanyan Xu; Wenyi Tian; Xiuxiu Lin; Tracy L Leong; Nobuhiko Seki; Yoshinobu Ichiki; Shanshan Su; Junjie Chen; Yuping Li; Junru Ye

doi:10.21037/jtd-23-1525

Association between the modified lung immune predictive index and clinical outcomes of advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors combined with chemotherapy

J Thorac Dis. 2023 Nov 30;15(11):6279-6290. doi: 10.21037/jtd-23-1525. Epub 2023 Nov 23.

Authors

Hanyan Xu^#¹, Wenyi Tian^#², Xiuxiu Lin¹, Tracy L Leong³, Nobuhiko Seki⁴, Yoshinobu Ichiki⁵, Shanshan Su¹, Junjie Chen¹, Yuping Li¹, Junru Ye¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
² Department of Pulmonary and Critical Care Medicine, the People's Hospital of Wenshan Prefecture, Wenshan, China.
³ Department of Respiratory Medicine, Austin Hospital, Heidelberg, Australia.
⁴ Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁵ Department of General Thoracic Surgery, Saitama Medical University International Medical Center, Saitama, Japan.

^# Contributed equally.

Abstract

Background: As revealed by previous studies, the modified lung immune predictive index (mLIPI) can predict outcomes in patients with lung cancer receiving single-agent immunotherapy. However, the application value of the mLIPI for patients treated with combination immunotherapy requires further investigation. In this study, we aimed to explore the relationship between the mLIPI and the efficacy of treatment together with the prognosis of patients with advanced non-small cell lung cancer (NSCLC) receiving first-line immune checkpoint inhibitors (ICIs) combined with platinum-based chemotherapy.

Methods: In this retrospective study, we enrolled patients with advanced NSCLC treated with ICIs plus chemotherapy from March 2019 to June 2022. The patients were classified into good, intermediate, and poor/very poor groups according to their mLIPI before treatment. We further calculated the disease control rate (DCR), objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) of the three groups. The predictive ability of the mLIPI was evaluated by plotting a time-dependent receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC).

Results: A total of 209 patients were included in this study. There were 75 patients in the good group, 114 patients in the intermediate group, and 20 patients in the poor/very poor group. The median PFS was 11.2 months [95% confidence interval (CI): 8.763-13.704] in the good group; 8.1 months (95% CI: 7.354-8.846) in the intermediate group; and 5.4 months (95% CI: 2.142-8.658) in the poor/very poor group. The median OS was not reached in the good group, 29.5 months (95% CI: 23.555-35.512) in the intermediate group, and 14.5 months (95% CI: 8.567-20.366) in the poor/very poor group (P<0.05). Multivariate analysis showed that the mLIPI was independently associated with PFS and OS (P<0.05); the AUC values of the mLIPI for predicting PFS at 3, 6, and 9 months were 0.673, 0.637, and 0.614, respectively, and for predicting OS at 6, 12, and 24 months were 0.715, 0.655, and 0.625, respectively.

Conclusions: The pretreatment mLIPI could be used to predict outcomes in patients with NSCLC receiving first-line ICIs plus chemotherapy.

Keywords: Immune checkpoint inhibitors (ICIs); chemotherapy; modified lung immune predictive index (mLIPI); non-small cell lung cancer (NSCLC).