Predictive Value of Modified Glasgow Prognostic Score and Persistent Inflammation among Patients with Non-Small Cell Lung Cancer Treated with Durvalumab Consolidation after Chemoradiotherapy: A Multicenter Retrospective Study

Simple Summary: Durvalumab consolidation after chemoradiotherapy (CRT) is a standard treatment for locally advanced non-small cell lung cancer, which sometimes encounters early recurrence. This retrospective study aimed to identify the predictors of durvalumab consolidation after CRT. A prognostic risk classification was created combining modified Glasgow Prognostic Score (mGPS) before CRT and C-reactive protein (CRP) level after CRT. When patients with pre-CRT mGPS of 0 or mGPS of 1 with post-CRT CRP <= 1 mg/dL were classified as the low-risk group, and patients with pre-CRT mGPS of 2 or mGPS of 1 with post-CRT CRP >1 mg/dL were classified as the high-risk group, the high-risk group had a significantly shorter median progression-free survival (PFS, hazard ratio [HR]: 2.47, p < 0.001) and overall survival (OS, HR: 3.62, p < 0.001) compared with those in the low-risk group. The prognostic risk classification helps to predict the PFS and OS of durvalumab consolidation after CRT. Background: Durvalumab consolidation after chemoradiotherapy (CRT) is a standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, studies on immunological and nutritional markers to predict progression-free survival (PFS) and overall survival (OS) are inadequate. Systemic inflammation causes cancer cachexia and negatively affects immunotherapy efficacy, which also reflects survival outcomes. Patients and Methods: We retrospectively investigated 126 patients from seven institutes in Japan. Results: The modified Glasgow Prognostic Score (mGPS) values, before and after CRT, were the essential predictors among the evaluated indices. A systemic inflammation-based prognostic risk classification was created by combining mGPS values before CRT, and C-reactive protein (CRP) levels after CRT, to distinguish tumor-derived inflammation from CRT-induced inflammation. Patients were classified into high-risk (n = 31) and low-risk (n = 95) groups, and the high-risk group had a significantly shorter median PFS of 7.2 months and an OS of 19.6 months compared with the low-risk group. The hazard ratios for PFS and OS were 2.47 (95% confidence interval [CI]: 1.46-4.19, p < 0.001) and 3.62 (95% CI: 1.79-7.33, p < 0.001), respectively. This association was also observed in the subgroup with programmed cell death ligand 1 expression of >= 50%, but not in the <50% subgroup. Furthermore, durvalumab discontinuation was observed more frequently in the high-risk group than in the low-risk group. Conclusion: Combining pre-CRT mGPS values with post-CRT CRP levels in patients with locally advanced NSCLC helps to predict the PFS and OS of durvalumab consolidation after CRT.

Automated summary

A prognostic risk classification combining pre-chemoradiotherapy (CRT) modified Glasgow Prognostic Score (mGPS) and post-CRT C-reactive protein (CRP) level helps predict progression-free survival (PFS) and overall survival (OS) of durvalumab consolidation after CRT in locally advanced non-small cell lung cancer (NSCLC) patients.