Clinical prognostic factors for the effectiveness of immunotherapy in patients with unresectable NSCLC

Purpose: assessment of the prognostic significance of the main clinical factors of patients and division into groups depending on life expectancy. This analysis compared the effectiveness of therapy with the addition of immune checkpoint inhibitors in selected prognostic groups.

Methods: we retrospectively analyzed data from 415 patients with inoperable NSCLC who received first-line systemic drug therapy in accordance with clinical guidelines. Using the Cox proportional hazards model, the prognostic significance of certain clinical factors was determined. Based on individual indicators obtained during multivariate analysis, patients were divided into groups with different prognosis. The improvements in progression-free time and overall survival achieved with the addition of immunotherapy were then compared within prognosis-matched groups using the log-rank method.

Results: based on the univariate Cox regression model, six clinical characteristics showed a statistically significant effect on overall survival: sex, lymph node involvement, use of chemotherapy in the first line of treatment, low neutrophil count and neutrophil/lymphocyte ratio in the peripheral blood sample, which formed the basis for the formation of prognostic groups. This retrospective analysis of the first-line efficacy of patients with unresectable or metastatic NSCLC showed that the poor prognosis group may have a lower OS benefit with the addition of immunotherapy (9.4 months vs 9.8 months, p=0.256), compared with group with a favorable prognosis (19.9 months vs 23.6 months, p=0.045).

Conclusions: definition of prognostic groups can be one of significant factors that could influence necessity of checkpoint inhibitors therapy. Researching of different therapy options efficacy in prognostic groups can lead to more precision usage of novel drugs.