Journal Article

Association of Dynamic Changes in Peripheral Blood Indexes With Response to PD-1 Inhibitor-Based Combination Therapy and Survival Among Patients With Advanced Non-Small Cell Lung Cancer

Du, Xiaoyue, Wen, Shaodi, Zhu, Wei, Pan, Banzhou, Wu, Yuan, Shen, Bo, Xia, Jingwei, Chen, Yuzhong

2021

Overview

BackgroundPD-1 inhibitors have been routinely used in the treatment of advanced non-small cell lung cancer (NSCLC), and have demonstrated to significantly improve survivorship when combining with other conventional therapies, such as chemotherapy and anti-angiogenesis therapy. PD-L1 is the most commonly used biomarker to select benefiting groups, while not all patients with high PD-L1 expression benefit from immunotherapy. Therefore, identifying other prognostic and predictive biomarkers, including peripheral blood indexes, is essential.MethodsWe retrospectively collected medical records and hematological data of 151 patients with advanced NSCLC treated with PD-1 inhibitor-based combination therapy in our hospital. The peripheral blood indexes of interest were NLR, PLR, PAR, Hb, LDH, CEA, and NSE. The association between peripheral blood indexes and treatment responses or survival outcomes was examined by multivariable logistic regression and Cox regression, respectively.ResultsThe decreased CEA at week 6 (OR = 4.209, 95%CI: 1.287-13.758) or 12 (OR = 7.267, 95%CI: 1.508-35.006) post-treatment was related to a higher disease control rate. The decrease or NLR at week 6 (OR = 3.081, 95%CI: 1.464-6.483) or 12 (OR = 3.304, 95%CI: 1.560-7.001) post-treatment, or CEA at week 12 post-treatment (OR = 2.469, 95%CI: 1.134-5.375), was associated with a higher objective response rate. Patients whose NLR (HR = 0.610, 95%CI: 0.411-0.907) or CEA (HR = 0.477, 95%CI: 0.320-0.710) decreased at week 6 post-treatment tended to have longer progression-free survival, and similar results were found in those with decreased NLR (HR = 0.587, 95%CI: 0.388-0.886) or CEA (HR = 0.406, 95%CI: 0.270-0.609) at week 12 post-treatment. Patients whose CEA (HR = 0.543, 95%CI: 0.339-0.871) or NSE (HR = 0.619, 95%CI: 0.386-0.994) decreased after 6 weeks post-treatment appeared to have longer overall survival, and the same was found for those whoseCEA (HR = 0.620, 95%CI: 0.390-0.986) or NSE (HR = 0.578, 95%CI: 0.353-0.947) was decreased at 12 weeks after treatment.ConclusionPost-treatment NLR, CEA and NSE changes are suggestive indicators for the prognosis of NSCLC patients after immunotherapy.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Angiogenesis / Antigens / Biomarkers / Blood platelets / Cancer therapies / carcinoembryonic antigen / Chemotherapy / Combination therapy / Dehydrogenases / Disease control / FDA approval / Hemoglobin / Histology / Immunology / Immunotherapy / Kinases / Lung cancer / Lymphocytes / Medical prognosis / Medical records / Metastasis / Mutation / neuron-specific enolase / neutrophil-to-lymphocyte ratio / Neutrophils / non-small cell lung cancer / Non-small cell lung carcinoma / Oncology / Patients / PD-1 inhibitor / PD-1 protein / PD-L1 protein / Peripheral blood / Radiation therapy / Response rates / Small cell lung carcinoma / Survival / Toxicity