Predicting the efficacy of <scp>first‐line</scp> immunotherapy by combining cancer cachexia and tumor burden in advanced <scp>non‐small cell</scp> lung cancer
Taichi Miyawaki, Tateaki Naito, Kosei Doshita, Hiroaki Kodama, Mikiko Mori, Naoya Nishioka, Yuko Iida, Eriko Miyawaki, Nobuaki Mamesaya, Haruki Kobayashi, Shota Omori, Ryo Ko, Kazushige Wakuda, Akira Ono, Hirotsugu Kenmotsu, Haruyasu Murakami, Keita Mori, Hideyuki Harada, Masahiro Endo, Kazuhisa Takahashi, Toshiaki Takahashi
Abstract
BACKGROUND: Cancer cachexia and tumor burden predict efficacies of programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors and chemotherapy or pembrolizumab in non-small cell lung cancer (NSCLC). There are no predictive models that simultaneously assess cancer cachexia and tumor burden. METHODS: In the present retrospective study, we reviewed the medical records of patients with advanced NSCLC who received cancer immunotherapy as first-line systemic therapy. Clinical immune predictive scores were defined according to multivariate analysis of progression-free survival (PFS) and overall survival (OS). RESULTS: A total of 157 patients were included in the present study (75 treated with PD-1/PD-L1 inhibitors + chemotherapy; 82, pembrolizumab monotherapy). Multivariate analysis for PFS revealed that PD-L1 tumor proportion scores <50%, a total target lesion diameter ≥76 mm, and cancer cachexia were independently associated with poor PFS. Multivariate analysis for OS revealed that ≥4 metastases and cancer cachexia were significantly associated with poor OS. In the immune predictive model, the median PFS was 21.7 months in the low-risk group (N = 41); 7.6 in the medium-risk group (N = 64); and 3.0 in the high-risk group (N = 47). The median OS were not reached, 22.4 and 9.1 months respectively. Our immune predictive model was significantly associated with PFS (p < 0.001) and OS (p < 0.001). CONCLUSION: We proposed the immune predictive model, including tumor burden and cancer cachexia, which may predict the efficacy and survival outcome of first-line immunotherapy in advanced NSCLC.