Lower tumor volume is associated with increased benefit from immune checkpoint inhibitors in patients with advanced
Oded Icht1, Liran Domachevsky2, David Groshar2
1Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Aim:
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment for advanced non-small-cell lung cancer (NSCLC), yet many patients do not benefit from Programmed cell death protein 1 (PD-1) axis inhibitors, emphasizing the need for additional markers for better patient selection. Our aim was to evaluate the association between tumor volume and response to ICI.
Methods:
This retrospective ethically-approved study included all consecutive patients with advanced NSCLC who were evaluated with a fluorodeoxyglucose-positron emission tomography scan, prior to the first administration of a single-agent ICI between 1/2016 and 6/2017. Tumor burden was calculated based on total body metabolic tumor volume and sum of all measurable lesions (SOML).
Results:
Median SOML was 88 mm, and was inversely and significantly associated with progression-free survival (PFS) (hazard ratio [HR] 2, CI 1.28-3.37, P = .003) and overall survival (OS) (HR 2.36, CI 1.13-4.94, P = .02). SOML≤80 mm had a significantly longer PFS compared to patients with a SOML≥80 mm (median PFS 9.7 vs 3.7 months, respectively, HR for progression 2.26, CI 1.1-4.5, P = .02). Patients with a SOML≤80 also had longer median OS compared to patients with SOML≥80 (median OS 12 vs 9.8 months, respectively, HR for death 3.1, CI 1.2-8, P = .018).
Conclusions:
Low tumor burden was associated with higher response rates (RR), and better PFS and OS in advanced NSCLC patients treated with ICI. These results may improve the selection of patients for treatment with single-agent ICI, as opposed to the combination with chemotherapy, which might be more appropriate for patients with high tumor burden. Prospective analysis is warranted.
Insights
Lower tumor burden in advanced non-small-cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) correlates with better survival outcomes. This finding can help select patients for single-agent ICI therapy.
Area of Science:
- Oncology
- Immunotherapy
- Radiology
Background:
- Immune checkpoint inhibitors (ICIs) have transformed advanced non-small-cell lung cancer (NSCLC) treatment.
- However, not all patients respond to Programmed cell death protein 1 (PD-1) axis inhibitors, necessitating better patient selection markers.
Purpose of the Study:
- To investigate the association between tumor volume and treatment response in advanced NSCLC patients receiving ICIs.
- To determine if tumor burden can predict progression-free survival (PFS) and overall survival (OS).
Main Methods:
- Retrospective analysis of advanced NSCLC patients treated with single-agent ICI from January 2016 to June 2017.
- Tumor burden assessed using fluorodeoxyglucose-positron emission tomography (FDG-PET) scans, calculating total body metabolic tumor volume and sum of all measurable lesions (SOML).
Main Results:
- A median SOML of 88 mm was observed.
- Lower SOML (≤80 mm) was significantly associated with longer PFS (9.7 vs 3.7 months) and OS (12 vs 9.8 months) compared to higher SOML (≥80 mm).
- SOML was inversely and significantly associated with PFS and OS (HR 2.0-2.36).
Conclusions:
- Reduced tumor burden in advanced NSCLC patients treated with ICI is linked to higher response rates, improved PFS, and OS.
- Tumor burden may aid in selecting patients for single-agent ICI therapy versus combination chemotherapy.
- Further prospective studies are recommended to validate these findings.
