The response to ICI in cervical cancer remains modest and predictive biomarkers to select patients (pts) are needed. An IPI score combining lactate dehydrogenase (LDH) level and the derived neutrophils/ (leucocytes minus neutrophils) ratio (dNLR) has been shown to correlate with ICI outcome in melanoma and lung cancer. We aimed to assess the predictive value of baseline IPI for advanced cervical cancer treated with ICI.
Pre-ICI treatment dNLR and LDH were retrospectively collected for all pts with advanced cervical cancer treated at our institution with PD1/PDL1 inhibitors (n = 48). Patients were divided into three groups: IPI-0 (normal LDH, dNLR<3), IPI-1 (LDH>upper limit or dNLR>3), and IPI-2 (LDH>upper limit and dNLR>3). The primary endpoint was overall survival (OS) and the secondary objective was progression free survival analyzed by Kaplan Meyer and log-rank (PFS).
In our cohort of 48 pts, 37 (77%) had squamous histology, median age was 47 (range 21 to 76), and 46 (95%) had performance status of 0 or 1. Among the 14 pts with papilloma virus (HPV) testing, 100% were HPV+. PDL1 expression >1% was detected in 9 of 13 patients tested (69%). Most patients were previously treated with at least one line of previous systemic therapy (92%). The majority were treated in phase 1 trials (n = 37) and 25 received ICI in combination with antiangiogenic therapy or another ICI. 22 patients were IPI-0, 22 IPI-1, and 4 IPI-2. Median OS and PFS for our cohort were 14.7 and 3.4 months, respectively. Median PFS in the three groups was 4.9 months, 2.6 months and 0.6 months, respectively (p = 0.004). Median OS was 19.3, 10.4, and 0.9 for IPI 0, 1, and 2, respectively (p = 0.003). OS was 8.9 months for patients who received ICI as monotherapy, whereas OS for the combination group had not yet been reached.
Baseline IPI was highly correlated with ICI-treated cervical cancer pt outcomes. Pts with higher IPI had poorer survival and are likely worse candidates for ICI, particularly as monotherapy. IPI score should be considered in addition to PDL1 status before introducing ICI in patients with advanced cervical cancer.
The authors.
Has not received any funding.
F. Blanc-Durand: Speaker Bureau / Expert testimony: Janssen Cylag; Travel / Accommodation / Expenses: Pfizer. P. Pautier: Travel / Accommodation / Expenses, Officer / Board of Directors: AstraZeneca; Travel / Accommodation / Expenses, Officer / Board of Directors: Roche; Travel / Accommodation / Expenses, Officer / Board of Directors: Tesaro; Officer / Board of Directors: MSD; Officer / Board of Directors: Clovis. C. Massard: Advisory / Consultancy: Amgen; Advisory / Consultancy: Astellas; Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Advisory / Consultancy: Bayer; Advisory / Consultancy: Beigene; Advisory / Consultancy, Research grant / Funding (institution): BMS; Advisory / Consultancy: Celgene; Advisory / Consultancy: Debiopharm; Advisory / Consultancy: Genentech; Advisory / Consultancy: Ipsen; Advisory / Consultancy, Research grant / Funding (institution): Janssen; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Medimmune; Advisory / Consultancy, Research grant / Funding (institution): Novartis; Advisory / Consultancy, Research grant / Funding (institution): Pfizer; Advisory / Consultancy, Research grant / Funding (institution): Roche; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Advisory / Consultancy: Orion; Research grant / Funding (institution): Boehringer; Research grant / Funding (institution): Merck. A. Leary: Advisory / Consultancy, Travel / Accommodation / Expenses, PI: Tesaro; Advisory / Consultancy, Travel / Accommodation / Expenses, PI: AstraZeneca; Advisory / Consultancy, Travel / Accommodation / Expenses, PI: Clovis; Advisory / Consultancy, PI: Gammamabs; Advisory / Consultancy, Pi: Grindstone; Advisory / Consultancy, Pi: Seattle Genetics; Advisory / Consultancy, PI: Pfizer; Advisory / Consultancy, PI: MSD; Advisory / Consultancy, PI: BMS. All other authors have declared no conflicts of interest.