The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer

G. L. Banna, A. Cortellini*, D. L. Cortinovis, M. Tiseo, J. G.J.V. Aerts, F. Barbieri, R. Giusti, E. Bria, F. Grossi, P. Pizzutilo, R. Berardi, A. Morabito, C. Genova, F. Mazzoni, V. Di Noia, D. Signorelli, A. Gelibter, M. Macerelli, F. Rastelli, R. ChiariD. Rocco, S. Gori, M. De Tursi, P. Di Marino, G. Mansueto, F. Zoratto, M. Filetti, M. Montrone, F. Citarella, R. Marco, L. Cantini, O. Nigro, E. D'Argento, S. Buti, G. Minuti, L. Landi, G. Guaitoli, G. Lo Russo, A. De Toma, C. Donisi, A. Friedlaender, A. De Giglio, G. Metro, G. Porzio, C. Ficorella, A. Addeo

*Corresponding author for this work

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Abstract

Background: To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy. Methods: Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis. Results: NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis. Conclusions: We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC.

Original languageEnglish
Article number100078
JournalESMO Open
Volume6
Issue number2
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Acknowledgements:
A special thanks to the ‘Consorzio Interuniversitario Nazionale per la Bio-Oncologia’ for their support in this study.

Publisher Copyright: © 2021 The Author(s)

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