Predicting Immunotherapy Outcomes in Older Patients with Solid Tumors Using the LIPI Score

Area of Science:

• Oncology
• Immunotherapy
• Biomarkers

Background:

• Immune checkpoint blockers (ICB) offer therapeutic benefits for various solid cancers in older patients.
• However, limited data exist on ICB efficacy and adverse events in this demographic, necessitating reliable biomarkers for patient selection.
• Older patients are at higher risk for immune-related adverse events (irAEs) impacting quality of life.

Purpose of the Study:

• To assess the prognostic role of the Lung Immune Prognostic Index (LIPI) in older patients (≥70 years) treated with anti-programmed death-(ligand)1 (anti PD-(L)1) therapy.
• To evaluate LIPI's impact on overall survival (OS), progression-free survival (PFS), and overall response rate (ORR).

Main Methods:

• A prospective cohort of 191 older patients (≥70 years) with metastatic disease treated with PD-(L)1 inhibitors was analyzed.
• The Lung Immune Prognostic Index (LIPI) was calculated using pretreatment dNLR and lactate dehydrogenase (LDH) levels.
• Patients were categorized into good, intermediate, and poor LIPI groups, and outcomes were analyzed based on these strata.

Main Results:

• Patients with a good LIPI score had a median OS of 20.7 months, compared to 11.2 months (intermediate) and 4.7 months (poor) (p=0.0003).
• The rate of early death (<3 months) was significantly higher in the poor LIPI group (37%) versus the good LIPI group (5%) (p<0.001).
• Poor LIPI score was strongly associated with poorer outcomes in this cohort of older patients.

Conclusions:

• The LIPI score is a valuable prognostic factor for older patients receiving anti PD-(L)1 therapy.
• LIPI can aid in stratifying patients to better predict benefit from immune checkpoint inhibitor therapy.
• This simple, accessible tool can improve patient selection and treatment planning in elderly cancer patients.