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Association of the advanced lung cancer inflammation index (ALI) with immune checkpoint inhibitor efficacy in patients with advanced non-small-cell lung cancer

Background - The advanced lung cancer inflammation index [ALI: body mass index × serum albumin/neutrophil-to-lymphocyte ratio (NLR)] reflects systemic host inflammation, and is easily reproducible. We hypothesized that ALI could assist guidance of non-small-cell lung cancer (NSCLC) treatment with im...

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Main Authors: Mountzios, Giannis (Author) , Samantas, E. (Author) , Senghas, Karsten (Author) , Zervas, E. (Author) , Krisam, Johannes (Author) , Samitas, K. (Author) , Bozorgmehr, Farastuk (Author) , Kuon, Jonas (Author) , Agelaki, S. (Author) , Baka, S. (Author) , Athanasiadis, I. (Author) , Gaißmaier, Lena (Author) , Elshiaty, Mariam (Author) , Daniello, Lea (Author) , Christopoulou, A. (Author) , Pentheroudakis, G. (Author) , Lianos, E. (Author) , Linardou, H. (Author) , Kriegsmann, Katharina (Author) , Kosmidis, P. (Author) , El-Shafie, Rami (Author) , Kriegsmann, Mark (Author) , Psyrri, A. (Author) , Andreadis, C. (Author) , Fountzilas, E. (Author) , Heußel, Claus Peter (Author) , Herth, Felix (Author) , Winter, Hauke (Author) , Emmanouilides, C. (Author) , Oikonomopoulos, G. (Author) , Meister, Michael (Author) , Muley, Thomas (Author) , Bischoff, Helge (Author) , Saridaki, Z. (Author) , Razis, E. (Author) , Perdikouri, E. -I. (Author) , Stenzinger, Albrecht (Author) , Boukovinas, I. (Author) , Reck, M. (Author) , Syrigos, K. (Author) , Thomas, Michael (Author) , Christopoulos, Petros (Author)
Format: Article (Journal)
Language:English
Published: 1 September 2021
In: ESMO open
Year: 2021, Volume: 6, Issue: 5, Pages: 1-10
ISSN:2059-7029
DOI:10.1016/j.esmoop.2021.100254
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.esmoop.2021.100254
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S2059702921002167
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Author Notes:G. Mountzios, E. Samantas, K. Senghas, E. Zervas, J. Krisam, K. Samitas, F. Bozorgmehr, J. Kuon, S. Agelaki, S. Baka, I. Athanasiadis, L. Gaissmaier, M. Elshiaty, L. Daniello, A. Christopoulou, G. Pentheroudakis, E. Lianos, H. Linardou, K. Kriegsmann, P. Kosmidis, R. El Shafie, M. Kriegsmann, A. Psyrri, C. Andreadis, E. Fountzilas, C.-P. Heussel, F.J. Herth, H. Winter, C. Emmanouilides, G. Oikonomopoulos, M. Meister, T. Muley, H. Bischoff, Z. Saridaki, E. Razis, E.-I. Perdikouri, A. Stenzinger, I. Boukovinas, M. Reck, K. Syrigos, M. Thomas & P. Christopoulos
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Summary:Background - The advanced lung cancer inflammation index [ALI: body mass index × serum albumin/neutrophil-to-lymphocyte ratio (NLR)] reflects systemic host inflammation, and is easily reproducible. We hypothesized that ALI could assist guidance of non-small-cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICIs). - Patients and methods - This retrospective study included 672 stage IV NSCLC patients treated with programmed death-ligand 1 (PD-L1) inhibitors alone or in combination with chemotherapy in 25 centers in Greece and Germany, and a control cohort of 444 stage IV NSCLC patients treated with platinum-based chemotherapy without subsequent targeted or immunotherapy drugs. The association of clinical outcomes with biomarkers was analyzed with Cox regression models, including cross-validation by calculation of the Harrell's C-index. - Results - High ALI values (>18) were significantly associated with longer overall survival (OS) for patients receiving ICI monotherapy [hazard ratio (HR) = 0.402, P < 0.0001, n = 460], but not chemo-immunotherapy (HR = 0.624, P = 0.111, n = 212). Similar positive correlations for ALI were observed for objective response rate (36% versus 24%, P = 0.008) and time-on-treatment (HR = 0.52, P < 0.001), in case of ICI monotherapy only. In the control cohort of chemotherapy, the association between ALI and OS was weaker (HR = 0.694, P = 0.0002), and showed a significant interaction with the type of treatment (ICI monotherapy versus chemotherapy, P < 0.0001) upon combined analysis of the two cohorts. In multivariate analysis, ALI had a stronger predictive effect than NLR, PD-L1 tumor proportion score, lung immune prognostic index, and EPSILoN scores. Among patients with PD-L1 tumor proportion score ≥50% receiving first-line ICI monotherapy, a high ALI score >18 identified a subset with longer OS and time-on-treatment (median 35 and 16 months, respectively), similar to these under chemo-immunotherapy. - Conclusions - The ALI score is a powerful prognostic and predictive biomarker for patients with advanced NSCLC treated with PD-L1 inhibitors alone, but not in combination with chemotherapy. Its association with outcomes appears to be stronger than that of other widely used parameters. For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy.
Item Description:Gesehen am 27.01.2022
Physical Description:Online Resource
ISSN:2059-7029
DOI:10.1016/j.esmoop.2021.100254

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