dNLR-Based Score Predicting Overall Survival Benefit for The Addition of Platinum-Based Chemotherapy to Pembrolizumab in Advanced NSCLC With PD-L1 Tumor Proportion Score ≥50%

The study represents one of the largest retrospective comparative analyses of first-line pembrolizumab (P) with and without chemotherapy (PCT) in PD-L1 TPS >= 50% aNSCLC. In the propensity score matched cohort, no differences in OS between P and PCT were observed. A predictive score incorporating age, sex, smoking, histology and dNLR was developed, and appeared to predict OS with P and PCT. Introduction: Both pembrolizumab (P) as a monotherapy or in combination with platinum-based chemotherapy (PCT) represent standard first-line treatment options for advanced non-small cell lung cancer (aNSCLC) with PD-L1 tumor proportion score (TPS) >= 50%. No predictive biomarkers exist to guide treatment decisions. Methods: 423 consecutive patients with EGFR/ALK/ROS1-wild-type PD-L1 TPS >= 50% aNSCLC receiving P (n = 302) or PCT (n = 121) as a first-line treatment were identified in the electronic databases of 5 Israeli cancer centers. Overall survival (OS, months [mo]) was assessed in correlation with blood biomarkers (BB: NLR, dNLR, PLR, SII, LIPI, ALI); a predictive score was developed. Results: In the propensity score matching analysis (n = 236; 118 patients in each group matched for age, sex and ECOG PS), mOS was 17.2mo (95% CI, 13.2-36.5) and 21.3mo (95% CI, 14.8-NR) in groups P and PCT, respectively (P = .44). In group P, NLR, dNLR, PLR, LIPI, and ALI significantly correlated with OS in uni- and multivariate COX regression analyses (P < .05), whereas in group PCT, none of the BB demonstrated a significant correlation. A predictive score was developed (each parameter receiving one point): age >= 65, female sex, never-smoking status, adenocarcinoma histology, dNLR >= 3. In patients with predictive score 3-5, OS was significantly longer with PCT as compared to P: mOS NR (95% CI, 15.3-NR) and 8.7mo (95% CI, 5.8-13.7) (P = .0005), while OS didn't differ significantly in patients with predictive score 0-2 (P = .61). Conclusion: With the limitations of the retrospective analysis, the proposed dNLR-based score appears to predict OS with P and PCT. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study retrospectively compared the efficacy of first-line pembrolizumab alone and pembrolizumab in combination with platinum-based chemotherapy in patients with PD-L1 TPS >= 50% non-small cell lung cancer. The results showed no difference in overall survival between the two treatment options. A predictive score incorporating age, sex, smoking, histology, and dNLR was developed to predict patient survival with pembrolizumab alone and pembrolizumab in combination with chemotherapy.