Efficacy and Prognostic Factors of Immune Checkpoint Inhibitors in the Treatment of Advanced Non-small Cell Lung Cancer.

Abstract

To discuss the efficacy and potential prognostic factors of immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC). A retrospective study was conducted to analyze the medical history of patients (n=111) confirmed with advanced NSCLC in the Affiliated Hospital of Putian University from 2018 to 2020. All enrolled patients with adenocarcinoma (n=69), squamous cell carcinoma (n=28), and other types of lung cancer (n=14) were treated with the programmed death-ligand 1 (PD-1) inhibitors. They were divided into groups of PD-1 inhibitors, PD-1 inhibitors in combination with chemotherapy, and PD-1 inhibitors in combination with chemotherapy and angiogenesis inhibitors according to the treatment regimen. General clinical data of all patients were collected, and the Kaplan-Meier analysis was applied to estimate progression-free survival (PFS) and overall survival (OS). In addition, univariate and multivariate Cox regression analyses were performed to analyze prognostic factors associated with PFS and OS after treatment. Of 111 patients with advanced NSCLC treated with ICIs, 6 were fully responsive, 33 were partially responsive, 55 were stable, and 17 were progressive. There was no significant difference in objective response rate between the 3 groups. In the subgroup analysis according to the lines of therapy, the objective response rate of patients receiving first-line treatment was 46.7%, which was significantly higher than that of other line treatment groups ( P =0.014). The results of multivariate Cox regression analysis indicated that the history of hormone use (HR=1.593; P =0.033), second-line or further lines of therapy (HR=2.871; P <0.001), and high neutrophil/lymphocyte ratio (NLR; HR=1.498; P =0.045) were independent risk factors for PFS after immunotherapy for advanced NSCLC. And the history of hormone use (HR=1.518; P =0.015) and high NLR (HR=3.053; P =0.001) were as well the independent risk factors for OS after immunotherapy for advanced NSCLC. ICIs therapy clearly had a greater survival benefit in patients who received first-line therapy, had no history of hormone use, and showed low NLR after initial treatment. ICIs can be an effective treatment for advanced NSCLC.