Abstract 791: Advanced lung cancer index at diagnosis is a predicative factor in immunotherapy recipients with stage IV non-small cell lung cancer
Authors: Yang Wei , Trudell Avery M. , Bull Joan M. , Syed Jafri H. 
Published: September 2020

Abstract
Background: Systemic inflammation has been implicated in tumor growth, symptoms of cancer including cachexia and pain, as well as shortened survival. Advanced Lung Cancer Inflammation Index (ALI) is a simple tool for assessing systemic inflammation and has been shown to predict outcome in variety of thoracic malignancies including NSCLC. The purpose of this study was to assess if ALI is a predictive biomarker for checkpoint inhibitors in patients with metastatic NSCLC.
Methods: We evaluated all patients with metastatic NSCLC treated with checkpoint inhibitors (CPI) at our institute between Jan 1st 2015 and June 30th 2019. ALI was calculated (BMI x Alb / NLR) at the time of initiating CPI using patients Body Mass Index (BMI), serum Albumin (Alb), and Neutrophil Lymphocyte Ratio (NLR) to quantify the degree of systemic inflammation. Patients were divided into two groups, based on ALI: ALI &lt; 15 (indicating a relatively high degree of systemic inflammation), and ALI &gt; 15 (indicating a relatively low degree of systemic inflammation). Primary end point was progression-free survival (PFS). Secondary endpoint included overall survival (OS), response rates, and adverse events (AE) from immunotherapy. Chi-squared test was performed to compare clinical characteristics in different groups. Kaplan-Meier and Cox regression model were used to determine independent prognostic factors.
Results: A total of 79 patients were included in the final analysis. The median age was 66. There were 39 males and 40 females. Ethnicities included White (n=40), African American (n=17), and Asian (n=6). Sixty-six had adenocarcinoma, 9 had Squamous cell carcinoma, 2 had neuroendocrine carcinoma, and 11 were NSCLC, Not otherwise specified NOS. Pembrolizumab was used in 43 patients with or without chemotherapy, nivolumab in 34 with and without chemotherapy and durvalumab in 2 patients. PDL-1 expression was available in forty-seven (59%) patients,14 had &gt;50% PDL-1 expression, 27 had (1 - 49%), and 6 had &lt; 1% or none. Thirteen patients had complete response (CR) on first assessment after immunotherapy, 23 had partial response (PR), 9 had stable disease or mixed response, 28 had progression, and 6 could not be assessed due to lack of follow up scan. Thirty-two had an ALI &lt; 15, and 47 had ALI &gt; 15. Patients with ALI &gt; 15 had a significantly longer PFS compared to those with ALI &lt; 15 (7.57 vs 3.17 months, p = 0.0018). Similarly, Patients with ALI &gt; 15 had a significantly longer OS (17.60 vs 6.37 months, p = 0.002) than those with ALI &lt; 15. Of the 43 patients who were treated with Pembrolizumab +/- chemotherapy, 18 had an ALI &lt; 15 and 25 had an ALI &gt; 15, there was no difference in PFS or OS based on ALI. In contrast, amongst those who received nivolumab +/- chemotherapy (n=34), patients with ALI &gt; 15 (n=?) had significantly longer PFS (14.7 vs 6.22 months, p = 0.01), as well as OS (19.68 vs 9.75 months, p = 0.004). Thirty-seven patients had reported AE from immunotherapy. Most common was fatigue (n=17, 21.52%). Others included anorexia (n=4, 5.06%), elevated Liver Function Tests (n=2, 2.53%), and Thrombocytopenia (n=2, 2.53%).
Conclusion: ALI is easy to calculate clinical tool which can help predict response to checkpoint inhibitors in patients with metastatic lung cancer especially in those receiving nivolumab. This should be further validated in a larger prospective study.
Citation Format: Wei Yang, Avery M. Trudell, Joan M. Bull, Jafri H. Syed. Advanced lung cancer index at diagnosis is a predicative factor in immunotherapy recipients with stage IV non-small cell lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 791.