MA17.01 Reduced FEV1 as Prognostic Factors in Patients With Advanced NSCLC Receiving Immune Checkpoint Inhibitors

Abstract

The impact of reduced pulmonary function on patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICI) is not fully elucidated. The aim of study is to investigate the influence of pulmonary function on the prognosis and treatment outcome in advanced NSCLC patients receiving ICI. Data were collected retrospectively from 151 patients with stage IV NSCLC who received ICI and completed spirometry before ICI therapy in Taipei Veterans General Hospital between January 2016 and December 2020. The co-primary end points were overall survival (OS) and progression-free survival (PFS) between groups divided by 80% predicted FEV1 since ICI therapy started; the secondary outcomes were objective response rate. Among 151 patients enrolled to this study, 67.5% of patients were men, 75.5% were adenocarcinoma, 24.5% had known targetable driver mutation, 33.8% received first-line ICI, and 62.8% received ICI monotherapy. The objective response rate was 24.5% and disease control rate was 54.3%. In multivariable analysis, patient with reduced FEV1 had inferior PFS (50%≤ FEV1< 80% vs. FEV1≥80%, adjusted HR= 1.67; 30%≤ FEV1< 50% vs. FEV1≥80%, adjusted HR= 1.822, FEV1< 30% vs. FEV1≥ 80%, adjusted HR= 10.39, P=0.003), and OS (50%≤ FEV1<80% vs. FEV1≥ 80%, adjusted HR= 2.10; 30%≤ FEV1< 50% vs. FEV1≥ 80%, adjusted HR= 3.43; FEV1< 30% vs. FEV1≥ 80%, adjusted HR= 14.41, P<0.001). Median PFS and OS in the preserved FEV1 group (≥80% predicted FEV1) compared to the reduced FEV1 group (<80% predicted FEV1) were 5.4 vs. 2.9 months (adjusted HR= 1.80, P=0.006) and 34.9 vs. 11.1 months (adjusted HR=2.50, P<0.001), respectively. The other independent prognostic factors of OS include stage IVA disease (adjusted HR= 0.56, P=0.032), initial liver metastasis (adjusted HR= 2.15, P=0.030), and ICI monotherapy. (adjusted HR= 1.73, P=0.042)View Large Image Figure ViewerDownload Hi-res image Download (PPT) Reduced FEV1 is strongly associated with inferior clinical outcomes in patients with advanced NSCLC treated with ICI.