medwireNews: An exploratory pooled analysis indicates that the Lung Immune Prognostic Index (LIPI) score is associated with overall survival (OS) and progression-free survival (PFS) in metastatic non-small-cell lung cancer patients (NSCLC) receiving immune checkpoint inhibitors, targeted therapy, or cytotoxic chemotherapy.
Dickran Kazandjian (US FDA, Silver Spring, Maryland, USA) and colleagues extracted data on 3987 patients from 11 trials that had been submitted to the FDA, and calculated LIPI composite scores based on the baseline lactate dehydrogenase (LDH) level and derived neutrophil-to-lymphocyte ratio (dNLR).
For patients receiving immune checkpoint inhibitors, a good LIPI score – defined as an LDH level lower than the upper limit of normal and dNLR of 3 or less – was associated with an estimated median OS of 15.6 months, compared with 4.5 months for a poor score – defined as both an LDH level above the threshold and a dNLR greater than 3 (hazard ratio [HR]=0.34). Corresponding estimates for patients receiving cytotoxic therapy were 10.4 vs 5.3 months (HR=0.49), and similar results were found for PFS in both treatment groups.
These associations also held for patients with tumors harboring ALK alterations or activating EGFR mutations, with a median OS with targeted therapy of 46.5 months for those with a good LIPI score versus 16.6 months for those with a poor score (HR=0.28), and 33.4 versus 17.1 months with cytotoxic chemotherapy (HR=0.41). Again, similar relationships were seen for PFS in these treatment groups.
Although a previous study found that the LIPI score was associated with survival only in patients treated with immune checkpoint inhibitors, the current analysis “suggests that baseline LIPI score may be a prognostic biomarker irrespective of treatment for patients with [metastatic] NSCLC,” write the researchers in JAMA Oncology.
Kazandjian and colleagues acknowledge that their post-hoc analysis is limited by potential biases from missing data and lack of information on the number of sites of metastases.
Nevertheless, they suggest that if further validated, “the LDH level and the dNLR could be considered an inexpensive and practical prognostic marker for potential stratification and enrichment in prospective trials independent of pharmacologic drug class.”
Future research should include determining the relative contributions of LDH level and dNLR to the LIPI score and identifying their optimal thresholds, the investigators say, as well as the potential for including other known prognostic factors in the scoring system, such as performance status and molecular biomarkers.
By Catherine Booth
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