3P Association between inflammation index and nutritional status and the effectiveness of immunotherapy in NSCLC treatment

Abstract

Immunotherapy is an important therapeutic strategy for NSCLC, but only about 20% of patients had benefit. To identify predictive markers is crucial for a proper patient selection. Few trials assessed the correlation between nutritional/inflammation status and the effectiveness of immunotherapy. A retrospective trial included patients (pts) with metastatic lung adenocarcinoma treated with immunotherapy from June 2017 to October 2019. We evaluated the following parameters: body mass index, weight loss, body composition by BIVA and computed tomography (CT) at L3-L4, C-reactive protein (CRP), albumin, hemoglobin, absolute lymphocytes count, patient performance status (PS), anorexia and quality of life (by miniCASCO questionnaire). Clinical response (CR) according iRECIST criteria, overall survival and progression-free survival (PFS) were assessed. All pts were evaluated every 4-6 months. We included 18 patients. CR significantly correlated with CRP (r = 0.4943; CI95% 0.05164-0.7746; p=0.0315) and muscle mass index (MMI) calculated by CT at baseline (r = 0.4955; CI95% 0.05328- 0.7752; p=0.031). We also found a significant correlation between PFS and CRP (r = -0.7304; CI95% -0, 8928 to -0.3999; p = 0.0006), MMI (r = 0.8229; CI95% 0.2119-0.6623; p = 0.0255) and PS at baseline ( r = -0.5101; CI95% -0.7890 to -0.05667; p = 0.0306). OS correlated significantly with baseline CRP (r = -0.6637; CI95% -0.8631 to -0.2851; p = 0.0027) and MMI at CT (r = 0.584; CI95% -0.2370-0.6472; p = 0.0304). At multivariate analysis CRP was an independent predictive factor of CR (p = 0.0213), PFS (p = 0.0006) and OS (p = 0.0027). The miniCASCO correlated positively with PS (r = 0.567; p = 0.036) and negatively with CR (r = -0.438; p = 0.010). Moreover, pts with partial response and stable disease had a significant decrease of CRP and a significant increase of MMI and hemoglobin compared to pts with progressive disease. Our results showed, even in a limited sample size, the negative correlation of inflammation and poor nutritional status with CR in NSCLC pts treated with immunotherapy. Blocking inflammation and the related nutritional impairment may be crucial in improving efficacy of immunotherapy in advanced lung cancer pts.