Combined LDH Albumin Score (CLAS) and NeutrophilLymphocyte Ratio (NLR) are Predictive for Survival in Patients with Metastatic Non-Small Cell Carcinoma Treated with Nivolumab as Monotherapy

Abstract

L ung cancer is the most common cancer in men worldwide and the leading cause of cancer death (1.8 million deaths) in both sexes. [1] Lung cancer is classified into two main groups as small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) according to the histology of the tumor. NSCLC is the most common (85-90%) group. [2] Without targetable mutation, 5-year survival is 50-82% in early-stage NSCLC and 6-10% in metastatic NSCLC (mNSCLC). [3] In the last decade, the 5-year survival in mNSCLC has increased to 24% due to the use of immunotherapies in the first series. [4] Nivolumab, one of the immune checkpoint inhibitors, inhibits PD-1 receptors and activates the immune system. In 2015, in patients with mNSCLC who progressed after platinum-based chemotherapy, Nivolumab demonstrated a median overall survival of 12.2 months versus 9.4 months. [5] In the first serial, it can be used in combination with ipi-Objectives: It was aimed to investigate the prognostic significance of neutrophil-to-lymphocyte ratio(NLR), plateletto-lymphocyte ratio(PLR), systemic immune-inflammation index(SII), and Combined LDH Albumine Score(CLAS) in metastatic non-small cell lung cancer(mNSCLC) patients receiving nivolumab. Methods: Sixty-five mNSCLC patients who received nivolumab as monotherapy and had a follow-up file in Kocaeli City Hospital were analyzed retrospectively. ROC-curve analysis and median values were used to determine the cut-off. The relationship between overall survival(OS), progression-free survival(PFS) and clinical and laboratory parameters was evaluated by multivariate analyses. Results: Mean age was 62.5±4.5 years, more than half(66%) had denovo metastatic disease. Median follow-up time was 22 (IQR:12-33),median PFS was 6 (95% CI 3.4-8.6),and median OS was 9 (95% CI 5.2-18.1) months. NLR≥3.2, PLR≥199, and SII≥776 were considered as elevated levels. No factor other than NLR could be identified as having an impact on PFS (p=0.015,[HR]:0.46,95%CI: 0.23-0.91). Univariate analyses showed that high baseline NLR, low baseline albumin and CLAS< 2 (0-1) were a significant risk factors for poor OS, but only CLAS<2 was found as an independent prognostic factor for OS in multivariate analyses (p=0.013,[HR]:0.68,95%CI:0.42-0,95). Conclusion: NLR and CLAS were predictive for survival in patients with NSCLC receiving nivolumab.This is the second study on CLAS in the literature.