medwireNews: The iSEND risk prediction model, which uses clinical and analytical variables to classify PD-1/PD-L1 monotherapy response in patients with platinum-refractory advanced non-small-cell lung cancer (NSCLC), better predicts survival outcome than PD-L1 negativity, say researchers.
The model, developed by Gilberto Lopes (University of Miami, Florida, USA) and colleagues, categorizes advanced NSCLC patients as having a good, intermediate, or poor response to PD-1/PD-L1 monotherapy on the basis of their sex, ECOG performance status, neutrophil-to-lymphocyte ratio (NLR) and post-treatment change in NLR.
In the current study, they validated the model’s performance in a cohort of 439 patients (median age 66 years, 56% men) with advanced NSCLC who underwent treatment with nivolumab (74.5%), pembrolizumab (14.6%), or atezolizumab (10.9%) between 2015 and 2017.
One third (33%) of the patients were placed into the iSEND good category, with a score of 0, 40% were in the intermediate category, with a score of 1, and 27% were in the poor category, with a score of 2 or more.
After a median follow-up of 18.4 months, median progression-free survival (PFS) differed significantly among the groups, at 6.5, 4.0, and 1.9 months in the good, intermediate, and poor categories, respectively.
There was also a corresponding significant intergroup difference in median overall survival, at 23.0, 13.4, and 4.5 months.
Of note, median PFS in an independent cohort of 68 patients who received chemotherapy without immunotherapy was similar among those categorized as iSEND good, intermediate, and poor, at 9.6, 9.8 and 9.9 months, respectively.
“This highlights that the iSEND model selectively associates with PD-1/L1 monotherapy in [the] post-platinum setting but not with second-line post-platinum chemotherapy treatment,” Lopes and co-investigators remark.
When the researchers compared the prediction performance of the iSEND poor category with that of negative PD-L1 expression (0%), they found that the time-dependent positive predictive value for mortality of iSEND poor was significantly better than that of PD-L1 negativity at 12 (75 vs 53%), 18 (85 vs 65%), and 24 months (85 vs 65%).
Writing in the British Journal of Cancer, Lopes et al say their research shows that “the iSEND Poor group would not benefit from PD-1/L1 monotherapy and it suggests that this population may benefit from different treatment options.”
The authors point out that “the rapidly reshaping landscape of lung cancer immunotherapy with new FDA approvals” means that “most patients would have used PD-1/L1 chemoimmunotherapy as first line in advanced setting.”
They therefore conclude: “Evaluation of the iSEND model in this first-line chemoimmunotherapy population is warranted.”
By Laura Cowen
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