Score Model for Prediction and Prognosis of Patients With Advanced NSCLC Treated With Nivolumab or Pembrolizumab

Findings from a study provide further validation of Patras Immunotherapy Score (PIOS) among patients with advanced non-small-cell lung cancer (aNSCLC) treated with anti-programmed-cell death 1 (PD-1) monotherapy. (Ther Adv Med Oncol. 2022;14:17588359221122728. doi:10.1177/17588359221122728).

Recently, the PIOS was developed to assess the survival benefit of patients with aNSCLC treated with nivolumab or pembrolizumab.

Foteinos-Ioannis Dimitropoulos, MD, Division of Oncology, Department of Medicine, University Hospital of Patras, Patras, Greece Molecular Oncology Laboratory, Department of Medicine, University of Patras, Patras, Greece, and colleagues conducted a study to validate the clinical value of PIOS in an external cohort of patients with aNSCLC.

In this multicentre study, 626 patients with confirmed NSCLC pathology who had been treated with nivolumab or pembrolizumab, as well as 444 patients with aNSCLC who had been managed with chemotherapy alone, were retrospectively enrolled. Predictive and prognostic values of PIOS were finally evaluated.

Results revealed that patients treated with immunotherapy and higher PIOS score had an improved progression-free survival not only in univariate [hazard ratio (HR) = 0.621, P = 0.001], but also in multivariable analysis (HR = 0.651, P = 0.003).

In addition, enhanced overall survival with increasing PIOS score was also observed (HR = 0.608, P < 0.001) with this association remaining statistically significant after adjusting for programmed-cell death ligand 1 (PD-L1) expression (HR = 0.620, P < 0.001).

Patients with disease progression (PD) had lower scores compared to those with stable disease (SD), partial response (PR) or complete response (CR) in a two-tier model (P < 0.001) as well as in a four-tier model (PD, SD, PR and CR; P < 0.001). Prognostic significance of PIOS score also persisted using a binary logistic regression analysis, adjusted for disease stage and PD-L1 status (p = 0.002, odds ratio: 0.578).

On the other hand, PIOS had no prognostic significance in the chemotherapy group; however, upon combined analysis of the two cohorts, PIOS was discovered to have a significant interaction with the type of treatment (HR = 0.066 with P < 0.001), validating its predictive value for immunotherapy.

The authors concluded, “We validate in this study the PIOS score, which has been recently generated. This baseline index, which is produced by a combination of non-interventional parameters (PS, BMI, age and LOT), is confirmed to have prognostic and predictive value for aNSCLC patients, treated with anti-PD-1 ICIs as monotherapy.”