The Lung Immune Prognostic Index (LIPI) calculated prior to the initiation of treatment may be used to stratify patients with diverse tumour types into groups that significantly associate with outcome following immune checkpoint inhibitor (ICI) therapy, according to a retrospective study presented at the TAT 2019 – International Congress on Targeted Anticancer Therapies in Paris, France.
Dr. Andrea Varga of the Drug Development Department, Gustave Roussy Cancer Campus in Villejuif, France, explained that the LIPI score has shown an association with patient outcomes following ICI treatment regardless of tumour type. This association has been demonstrated in patients with melanoma, non-small cell lung cancer (NSCLC), small-cell lung cancer, head and neck squamous cell carcinoma (HNSCC), and triple negative breast cancer, but not in all tumour types.
The LIPI score combines the pre-treatment derived neutrophil to lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) levels.
For this study, the investigators collected dNLR and LDH retrospectively from 360 patients with metastatic disease who were treated from September 2015 to November 2017 in the Drug Development Department of Gustave Roussy.
The LIPI characterises the patients’ disease into a good group with dNLR <3 and normal LDH, an intermediate group with dNLR >3 or LDH >upper limit of normal (ULN), and into a poor group with dNLR >3 and LDH >ULN. The benefit of ICI treatment was evaluated according to overall survival (OS) and progression-free survival (PFS).
The association of LIPI-stratified patients and outcome was significant in a population of mixed tumour types
The analysis comprised data from 360 patients receiving ICI in early clinical trials. Of these patients, 353 (98%) had been ICI naive, and 209 (58%) patients had a performance status of 1; 322 (89%) patients had been treated with either a PD-1 or PD-L1 inhibitor as monotherapy and 268 (74%) received ICI as combination therapy. The majority (214; 59%) of patients were male, with a median age at the initiation of ICI treatment of 60 (range, 25 to 88) years.
The most frequent tumour types were: 14% of patients each had NSCLC or colorectal cancer, 13% had bladder, 8% had renal, and 7% had breast cancers, 7% had HNSCC, and 6% of patients had cancer of the cervix.
According to LIPI stratification, the good group contained 160 (44%) patients, the intermediate group had 161 (44%) patients, and the poor group contained 39 (11%) patients.
The median duration of follow-up was 14.1 months (95% confidence interval [CI], 12.9-16.1).
Survival was found to correlate well with the LIPI group stratification. Median OS was 17.8 months (95% CI, 13.1-not reached [NR]) in the good group compared to 11.68 months [95%CI, 8.8-15.3) in the intermediate group, and 3.9 months (95%CI, 2.1-6.4) for patients in the poor group.
The median PFS was 4.6 months (95% CI, 4.0-6.2) in the good group, compared to 2.8 months (95% CI, 2.5-3.6) and 1.4 months (95% CI, 1.2-2.0) for patients in the intermediate and poor groups, respectively (both p < 0.0001).
LIPI is a quick and simple tool for clinicians to use on a daily basis and requires a standard blood draw. It can be used to stratify and monitor the population receiving immune checkpoint inhibitors. It’s a ¨host¨ related biomarker and has an independent prognostic value on progression-free and overall survival. © Andrea Varga
Conclusions
The authors concluded that poor LIPI score, comprising pre-treatment dNLR >3 and LDH >ULN is associated with a poorer outcome in patients receiving ICI therapy. These findings suggest that calculating the LIPI prior to starting ICI therapy may be useful in identifying patients that will not benefit from ICI treatment.
Reference
3O – Varga A, Bernard-Tessier A, Auclin E, et al. Applicability of the Lung Immune Prognostic Index (LIPI) in patients with metastatic solid tumors when treated with Immune Checkpoint Inhibitors (ICI) in early clinical trials.
No external funding was reported for this study.