Background

Most patients with advanced non-small cell lung cancer (NSCLC) treated with first-line pembrolizumab monotherapy will experience progressive disease (PD). Only a minority will go on to receive subsequent systemic anticancer therapy for which outcomes are guarded. We investigated the prognostic significance of biomarkers of systemic inflammation following failure of first-line pembrolizumab for NSCLC to aid subsequent management decisions.

Methods

Patients with radiological and/or clinical evidence of PD on first-line pembrolizumab for advanced NSCLC at a regional Scottish cancer centre were identified. Inflammatory biomarkers at the time of PD, including serum albumin, neutrophil count and the Scottish Inflammatory Prognostic Score (SIPS; combing albumin and neutrophils), and clinicopathological factors, including age, sex, histology, PDL1 expression and time to PD were recorded. The relationship between these and post-progression overall survival (ppOS) were examined.

Results

Data were available for 211 patients. Median ppOS was 2.1 months. Only SIPS was predictive of ppOS on multivariate analysis (HR2.54 (95 %CI 1.81–3.56) (<0.001)), stratifying ppOS from 0.8 months (SIPS2), to 1.8 months (SIPS1), to 8.1 months (SIPS0) (p < 0.001). Thirty (14 %) patients received second-line systemic anticancer therapy with median ppOS 8.7 months. These patients had lower levels of systemic inflammation, as defined by albumin (p < 0.001), neutrophil count (p = 0.002), and SIPS (p = 0.004)), than all other patients.

Conclusions

SIPS, a simple biomarker of systemic inflammation, predicts ppOS after first-line pembrolizumab and may be useful alongside routine assessments of patient fitness to inform individualised discussions about subsequent treatment. We highlight poor outcomes in this patient group and a role for SIPS in signposting transition to best supportive care and early referral to palliative care. It may also help identify a small group of patients most likely to benefit from further lines of therapy.

中文翻译：

---

苏格兰炎症预后评分对一线帕博利珠单抗治疗后进展的表达 PD-L1 ≥ 50% 的 NSCLC 患者的预后价值

背景

大多数接受一线派姆单抗单药治疗的晚期非小细胞肺癌 (NSCLC) 患者都会出现疾病进展 (PD)。只有少数人会继续接受后续的全身抗癌治疗，其结果受到保护。我们研究了一线派姆单抗治疗 NSCLC 失败后全身炎症生物标志物的预后意义，以帮助后续的管理决策。

方法

在苏格兰地区癌症中心，确定了使用一线派姆单抗治疗晚期 NSCLC 时出现放射学和/或临床 PD 证据的患者。记录PD时的炎症生物标志物，包括血清白蛋白、中性粒细胞计数和苏格兰炎症预后评分（SIPS；结合白蛋白和中性粒细胞），以及临床病理因素，包括年龄、性别、组织学、PDL1表达和PD时间。研究了这些与进展后总生存期 (ppOS) 之间的关系。

结果

211 名患者的数据可用。中位 ppOS 为 2.1 个月。在多变量分析中，只有 SIPS 可以预测 ppOS (HR2.54 (95 % CI 1.81–3.56) (<0.001))，将 ppOS 从 0.8 个月 (SIPS2) 分层到 1.8 个月 (SIPS1) 到 8.1 个月 (SIPS0)（ p < 0.001）。 30 名 (14%) 患者接受二线全身抗癌治疗，中位 ppOS 为 8.7 个月。与所有其他患者相比，这些患者的全身炎症水平较低，根据白蛋白 (p < 0.001)、中性粒细胞计数 (p = 0.002) 和 SIPS (p = 0.004) 的定义。

结论

SIPS 是一种简单的全身炎症生物标志物，可预测一线派姆单抗治疗后的 ppOS，并且可能与患者健康状况的常规评估一起发挥作用，为后续治疗的个性化讨论提供信息。我们强调该患者群体的不良预后以及 SIPS 在向最佳支持性护理过渡和早期转诊至姑息治疗方面的作用。它还可能有助于确定一小部分最有可能从进一步治疗中受益的患者。