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Early On-Treatment Host Fitness Dynamics Refine Prognostic Stratification in Advanced NSCLC Receiving First-Line
Se-Il Go1, Jinyong Kim2, Sehhoon Park2
1Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea.
Cancer Research and Treatment
|August 13, 2026
Summary
Prognostic Nutritional Index (PNI) measured at baseline and early in treatment offers valuable prognostic insights for advanced non-small cell lung cancer (NSCLC) patients. Early on-treatment PNI is crucial for predicting progression-free survival and response durability.
Area of Science:
- Oncology
- Clinical Research
- Biomarkers
Background:
- Host fitness is a critical factor in advanced non-small cell lung cancer (NSCLC) treatment outcomes.
- The Prognostic Nutritional Index (PNI) is a potential biomarker reflecting host nutritional and immune status.
- Assessing PNI at different time points may offer complementary prognostic information.
Purpose of the Study:
- To evaluate whether baseline and early on-treatment PNI measurements provide complementary prognostic information in advanced NSCLC.
- To determine the association of PNI status with treatment response, progression-free survival (PFS), and overall survival (OS).
Main Methods:
- Analysis of 497 patients with advanced NSCLC from the prospective, multicenter OPTIMUS trial receiving first-line pembrolizumab-based therapy.
- PNI calculated from serum albumin and lymphocyte count at baseline and before cycle 2 (early on-treatment).
- Patients classified into four groups based on paired PNI measurements: high/high, high/low, low/high, and low/low.
Main Results:
- Low baseline PNI correlated with lower objective response rates and higher treatment-related mortality.
- Among responders, low early on-treatment PNI was linked to reduced 6-month response maintenance.
- Low early on-treatment PNI was associated with shorter PFS, while both baseline and early on-treatment PNI were linked to shorter OS.
- The low/low PNI group exhibited the lowest response maintenance rates at 6 and 12 months.
Conclusions:
- PNI assessment at baseline and early during treatment provides complementary prognostic value in advanced NSCLC.
- Early on-treatment PNI is particularly important for predicting PFS and the durability of treatment response.
- PNI serves as a valuable tool for risk stratification and treatment planning in NSCLC management.
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