Cancer Medicine (Oct 2021)

Pretreatment Glasgow prognostic score predicts survival among patients with high PD‐L1 expression administered first‐line pembrolizumab monotherapy for non‐small cell lung cancer

  • Hisao Imai,
  • Takayuki Kishikawa,
  • Hiroyuki Minemura,
  • Yutaka Yamada,
  • Tatsuya Ibe,
  • Ou Yamaguchi,
  • Atsuto Mouri,
  • Yoichiro Hamamoto,
  • Kenya Kanazawa,
  • Takashi Kasai,
  • Kyoichi Kaira,
  • Takayuki Kaburagi,
  • Koichi Minato,
  • Kunihiko Kobayashi,
  • Hiroshi Kagamu

DOI
https://doi.org/10.1002/cam4.4220
Journal volume & issue
Vol. 10, no. 20
pp. 6971 – 6984

Abstract

Read online

Abstract Background There are no established biomarkers for predicting the efficacy of first‐line pembrolizumab monotherapy in patients with high programmed death‐ligand 1 (PD‐L1) expression. In this study, we investigated whether the Glasgow prognostic score (GPS), neutrophil‐to‐lymphocyte ratio (NLR), and body mass index (BMI) can be used to evaluate the effect of first‐line pembrolizumab monotherapy in patients with advanced non‐small cell lung cancer (NSCLC) who express high levels of PD‐L1. Methods We reviewed data from 142 patients with high PD‐L1 expression who underwent first‐line pembrolizumab monotherapy for NSCLC at six Japanese institutions between February 2017 and June 2019 and assessed the prognostic value of the GPS, NLR, and BMI. The Kaplan–Meier method and Cox proportional hazard models were used to examine differences in progression‐free survival (PFS) and overall survival (OS). The GPS, NLR, and BMI were calculated using C‐reactive protein and albumin concentrations, neutrophil and lymphocyte counts, and body weight and height, respectively. Results The GPS independently predicted the first‐line pembrolizumab monotherapy efficacy, as a good GPS (GPS 0–1) was associated with a significantly better PFS and OS compared to a poor GPS (GPS 2) (PFS: 11.8 vs. 2.9 months, p < 0.0001; OS: not reached vs. 8.3 months, p < 0.0001). Furthermore, BMI independently predicted efficacy, as patients with high BMI (BMI ≥21.4) exhibited significantly better OS compared to those with low BMI (BMI <21.4) (OS: not reached vs. 14.1 months, p = 0.006). Conclusions Among patients with high PD‐L1 expression undergoing first‐line pembrolizumab monotherapy for NSCLC, the GPS is significantly correlated with both PFS and OS, and BMI with OS, indicating that they could be used to predict treatment outcome in these patients. To the best of our knowledge, this is the first study to assess the relationship among the GPS, NLR, and BMI and survival among patients with high PD‐L1 expression undergoing first‐line pembrolizumab monotherapy for NSCLC.

Keywords