International journal of clinical oncology · 2025
Lung immune prognostic index as a biomarker for predicting the benefit of immune checkpoint inhibitor plus chemotherapy in older patients with non-small cell lung cancer: a secondary analysis of the NEJ057 study.
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Tozuka Takehiro, Tsukita Yoko, Kushiro Kohei, Hosokawa Shinobu, Nogawa Hitomi, Arai Satoshi, Soda Sayo, Arai Daisuke, Takamura Kei, Honda Ryoichi, Hamai Kosuke, Namba Yukiko, Kawai Yasutaka, Kikuchi Takashi, Nakazawa Kensuke, Honda Takayuki, Ebi Noriyuki, Yamada Yutaka, Makiguchi Tomonori, Seike Masahiro, Morita Satoshi, Kobayashi Kunihiko, Asahina Hajime
Аннотация
BACKGROUND: The survival benefit of combining chemotherapy (chemo) with immune checkpoint inhibitors (ICIs) in older patients with advanced non-small cell lung cancer (NSCLC) remains unclear. We evaluated the lung immune prognostic index (LIPI) as a predictive biomarker in this NEJ057 secondary analysis.
METHODS: This analysis included 600 patients aged ≥ 75 years with NSCLC and a programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) ≥ 1% enrolled in the NEJ057 study. LIPI was categorized as good, intermediate, or poor based on derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier analysis and multivariate Cox proportional hazards models. Subgroup analyses focused on patients with a PD-L1 TPS of 1-49% and intermediate/poor LIPI to evaluate predictive factors for ICI-chemo benefit.
RESULTS: The survival outcomes of ICI-chemo and ICI-alone varied across different patient characteristics, with LIPI identified as a predictive biomarker. Among patients with a PD-L1 TPS of 1-49% and intermediate/poor LIPI scores, ICI-chemo was associated with significantly longer OS (median: 18.3 months [95% confidence interval {CI} 10.7-26.7] vs. 8.6 months [95% CI 4.5-12.4], p = 0.007; hazard ratio [HR]: 0.56 [95% CI 0.36-0.86]) and PFS (median: 7.8 months [95% CI 6.2-9.7] vs. 3.3 months [95% CI 1.5-5.0], p = 0.002; HR: 0.56 [95% CI 0.39-0.81]) compared with ICI-alone. No significant survival benefit was observed in patients with a PD-L1 TPS of ≥ 50% or good LIPI scores.
CONCLUSIONS: LIPI is a useful biomarker for guiding treatment decisions in older patients with NSCLC and a PD-L1 TPS of 1-49%, particularly those with intermediate/poor LIPI scores. Its application might facilitate establishing more personalized strategies and improve outcomes.
METHODS: This analysis included 600 patients aged ≥ 75 years with NSCLC and a programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) ≥ 1% enrolled in the NEJ057 study. LIPI was categorized as good, intermediate, or poor based on derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier analysis and multivariate Cox proportional hazards models. Subgroup analyses focused on patients with a PD-L1 TPS of 1-49% and intermediate/poor LIPI to evaluate predictive factors for ICI-chemo benefit.
RESULTS: The survival outcomes of ICI-chemo and ICI-alone varied across different patient characteristics, with LIPI identified as a predictive biomarker. Among patients with a PD-L1 TPS of 1-49% and intermediate/poor LIPI scores, ICI-chemo was associated with significantly longer OS (median: 18.3 months [95% confidence interval {CI} 10.7-26.7] vs. 8.6 months [95% CI 4.5-12.4], p = 0.007; hazard ratio [HR]: 0.56 [95% CI 0.36-0.86]) and PFS (median: 7.8 months [95% CI 6.2-9.7] vs. 3.3 months [95% CI 1.5-5.0], p = 0.002; HR: 0.56 [95% CI 0.39-0.81]) compared with ICI-alone. No significant survival benefit was observed in patients with a PD-L1 TPS of ≥ 50% or good LIPI scores.
CONCLUSIONS: LIPI is a useful biomarker for guiding treatment decisions in older patients with NSCLC and a PD-L1 TPS of 1-49%, particularly those with intermediate/poor LIPI scores. Its application might facilitate establishing more personalized strategies and improve outcomes.