PIOS (Patras Immunotherapy Score) Score Is Associated with Best Overall Response, Progression-Free Survival, and Post-Immunotherapy Overall Survival in Patients with Advanced Non-Small-Cell Lung Cancer (NSCLC) Treated with Anti-Program Cell Death-1 (PD-1) Inhibitors

Abstract

Immunotherapy with immune checkpoint inhibitors (ICIs) has changed the therapeutic management of advanced non-small cell lung cancer (aNSCLC) over the last decade. However, there is an unmet need for clinically useful biomarkers in this patient subgroup. The aim of this study was to combine baseline clinical characteristics of aNSCLC patients, in the form of a scoring system, and to investigate its predictive and prognostic value in NSCLC patients treated with ICIs. A total of 112 patients with advanced (stages IIIA to IV) NSCLC, treated with nivolumab or pembrolizumab, were enrolled in this study. Patras Immunotherapy Score (PIOS) was developed based on four of the studied parameters (performance status (PS), body mass index (BMI), age, and lines of treatment (LOT), which were incorporated into our formula (PS × BMI/ LOT × age). PIOS score was strongly associated with best overall responses (BOR), with those patients having benefit/good response (stable disease (SD) or partial (PR) or complete response (CR), achieving a higher score compared to patients who developed progressive disease (PD) (p < 0.001). Furthermore, PIOS score was associated with progression-free survival (PFS), since high-score patients had longer PFS (p < 0.001, hazard ratio (HR) = 0.469). Moreover, PIOS was associated with post-immunotherapy overall survival (OS), with high-score patients having improved OS (log-rank p = 0.019). This study suggests that a combination of baseline parameters, which give rise to PIOS score, may predict the best response of NSCLC patients treated with anti-program cell death -1 (PD-1) monotherapy as well as it may have a potent prognostic value for PFS and post immunotherapy OS.

Non-coding RNAs in cancer-associated cachexia: clinical implications and future perspectives

“…Recent studies in non-small cell lung cancer patients, with cachexia presented before therapy or cachexia developed during therapy with immune checkpoint inhibitors, reported lower response rate, shorter disease-free survival and overall survival [ 46 , 47 ]. Besides, high Body Mass Index has been associated with higher response rates to immune therapy and better prognosis of patients with lung or other types of cancer [48] , [49] , [50] . Additionally, in a very recent systematic review published by Guzman-Prado et al.…”

Pretreatment body mass index predicts survival among patients administered nivolumab monotherapy for pretreated non‐small cell lung cancer

“…Table 4 summarizes the results of our study and those of previous studies that have evaluated BMI in patients with advanced NSCLC previously treated with ICIs. 8,[27][28][29][30][31] When comparing the high and low BMI cohorts, the number of nivolumab administration cycles was statistically significantly higher in the high BMI cohort. However, the OS was significantly better in the high BMI cohort, but not the PFS.…”

“…BMI is significantly related with the survival efficacy of ICI therapy in patients with NSCLC treated with second‐line or subsequent‐line PD‐1/PD‐L1 blockade therapy, and is reported to have better outcomes for patients with a high BMI. Table 4 summarizes the results of our study and those of previous studies that have evaluated BMI in patients with advanced NSCLC previously treated with ICIs 8,27–31 …”

Predictive biomarkers of anti-PD-1/PD-L1 therapy in NSCLC

“…The patras immunotherapy score (PIOS) including the patient’s performance status (PS), body mass index (BMI), lines of treatment (LOT) and age was calculated through the formula (PS × BMI/LOT × age). Patients with high PIOS score had the best response to anti-PD-1 treatment (median PFS: 15 months vs. 5 months, HR = 0.469, 95% CI: 0.295–0.747; median OS: 32 months vs. 14 months, HR = 0.539, 95% CI: 0.317–0.918) (Table 1 ) [ 144 ].…”