Pembrolizumab In Pre-Treated Advanced Non-Small Cell Lung Cancer (Nsclc) Patients (Pts): Impact Of Blood-Based Biomarkers On Survival Outcomes

The Lung Immune Prognostic Index (LIPI) utilises derived neutrophil-lymphocyte ratio (dNLR) and LDH to define prognostic subgroups associated with overall survival (OS) and overall response rate (ORR) to immune-checkpoint inhibitors (Mezquita L et al, JAMA Oncol 2018). Pre-treated advanced NSCLC pts who received Pembrolizumab (P) at The Christie (Jan ’17-July ’19) were identified. Baseline demographics, PD-L1 tumour proportion score (TPS), and LIPI score were collected. We assessed progression free survival (PFS) and OS using Kaplan-Meier method and performed a comparative analysis of LIPI score and PD-L1 TPS on survival. 111 consecutive pts were analysed (Table shows baseline demographics). After a median follow up of 11.2 months, 77.5% of pts progressed. ORR was 26.1%. Median PFS and OS were 4 (1.6-6.4) and 13 (10.2-15.8) months (mos), respectively. OS was 10 vs 19 mos (HR 0.50, 95%CI 0.3-0.8; p=0.006) for TPS 1-49% and ≥50%, respectively. OS for good vs intermediate vs poor LIPI score was 14, 11 and 3 mos (HR 1.5, 95% CI 1.1-2.3; p=0.018), respectively. 36.9% of pts experienced immune related adverse events (irAEs), 10.8% being grade 3-5. Toxicity-related discontinuation rate was 14.4%. LIPI score and high TPS remained prognostic factors in a multivariate model including ECOG, smoking status and irAEs. 40% of pts received ≤ 4 cycles, mostly due to early disease progression (EDP). Pts with EDP had shorter OS (4 vs 19 mos, P<0.005). Next generation sequencing analysis for this subgroup is ongoing.Table 108PDemographicsn (%)Age, mean65≥ 7520 (18.0%)Sex (male)66 (59.5%)ECOG0-1108 (97.3)23 (2.7)Smoking historyCurrent/Former103 (92.8)Never8 (7.2)HistologyAdenocarcinoma70 (63.1)Squamous34 (31.5)Other/NOS6 (5.4)Molecular profileEGFR2 (1.8)ALK/ ROS10 (0)KRAS6 (5.4)Biopsy sample for PD-L1Archival76 (68.5)Fresh35 (31.5)PD-L1 TPS1-49%62 (55.9)≥ 50%49 (44.1)Previous lines of treatment199 (89.2)≥212 (10.8)Stage at P initiationIIIA/IIIB12 (10.8)IV99 (89.2)Brain metastasesActive brain metastases Open table in a new tab Our cohort demonstrated similar survival outcomes to KEYNOTE-010, which reflects appropriate patients’ selection. High PD-L1 TPS and LIPI score predicted longer OS.