Patients with mNSCLC benefit in terms PFS and OS of treatment with immunotherapy (IO) in first (1L) and second line (2L); However, the majority of patients do not respond to IO, which, due to the high cost of these new treatments, makes identifying predictive factors of response imperative in order to select the patients who will really respond to this therapy. Bearing in mind that most hospitals do not have the technology to perform high sensitivity techniques such as NGS, it seems prudent to be able to identify these patients using more common, cheap and affordable methods in any hospital.
In all mNSCLC treated with IO in monotherapy in two university hospitals in Spain, from February 2012 to January 2018, a RWD study of predictive factors of response was performed. 198 patients from the University Hospital Arnau de Vilanova of Lleida and the University Hospital Dr. Josep Trueta (ICO Girona) were analyzed. Statistical analysis of the data was performed using IBM SPSS Statistics 23.0 software.
With a median follow-up from the start of treatment with IO of 217 days, it was found that in all treated patients, the overall response rate (ORR = CR + PR) was 26.6%. In 1L the ORR was 56%, in 2L 22.8%, in 3L 15% and in 4L 0%. In 1L, the factor that is associated with a better response is the absence of liver mets: ORR 66.7% vs 16.7% (p: 0.03). The factor associated with a better OS is Hb ≥ 12.5 gr/dl (p 0.001): 495 vs 241 days. Analyzing by treatment lines, we objectify that in 1L, the factors that influence better OS are the absence of liver mets (p 0.003): 421 (CI: 345-497) vs 138 days (CI: 65-212) ) and Hb ≥ 12.5gr dl (p 0.027) 440 (CI: 368-512) vs 215 days (CI: 111-319). In 2L the factors that influence a better OS are younger age with a cutoff point of 70 years (p 0.008): 328 vs 239 days; Hb ≥ 12.5 gr/dl (p 0.001): 512 vs 325 days and lymphocytes > 1450 (p 0.013): 353 vs 241 days.
Methods that are easily available in any hospital can help select the patients that benefit most from immunotherapy in monotherapy. In our series, patients older than 70 years, with Hb ≤ 12.5 gr/dl and lymphocytes ≤1.450, have worse overall survival independently of PDL1.
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All authors have declared no conflicts of interest.