Prognostic impact of the Controlling Nutritional Status score in patients with non-small cell lung cancer treated with pembrolizumab.
Controlling Nutritional Status (CONUT)
Pembrolizumab
neutrophil-to-lymphocyte ratio (NLR)
non-small cell lung cancer (NSCLC)
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
entrez:
29
10
2019
pubmed:
28
10
2019
medline:
28
10
2019
Statut:
ppublish
Résumé
Pembrolizumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody, has been shown to yield a durable response and significant survival benefit in some non-small cell lung cancer (NSCLC) patients. Recent studies have shown that the Controlling Nutritional Status (CONUT) score, a novel nutritional index, can be useful for predicting the prognosis in some malignancies. However, its usefulness in predicting the clinical outcome of immune-checkpoint inhibitor (ICI) treatment in patients with NSCLC has not been clarified. The aim of this study was to investigate the clinical significance of the CONUT score in NSCLC patients treated with pembrolizumab. We conducted a retrospective analysis of the clinical data of 32 patients with advanced NSCLC who received pembrolizumab monotherapy. A cut-off CONUT score of 2 was used to categorize patients into low and high CONUT groups. We evaluated the relation between the clinicopathological factors including CONUT score and neutrophil-to-lymphocyte ratio (NLR) and the prognosis. Twenty-two patients were classified into the low CONUT score group, while 10 were classified into the high CONUT score group. In the univariate and multivariate analyses, the number of prior treatments and the CONUT score were found to independently predict progression-free survival (PFS) (P<0.05), while the CONUT score as well as NLR was an independent prognostic factor for overall survival (P<0.05). In addition, in patients who received pembrolizumab as a first-line treatment, a high CONUT score was associated with a significantly worse PFS and overall survival in comparison to a low CONUT score. The CONUT score has potential application as a predictor of the therapeutic effect and the prognosis of NSCLC patients treated with pembrolizumab. Our findings suggest that in addition to the programmed cell death ligand 1 expression level, the CONUT may also be a useful indicator for selecting NSCLC patients who may benefit from ICI treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Pembrolizumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody, has been shown to yield a durable response and significant survival benefit in some non-small cell lung cancer (NSCLC) patients. Recent studies have shown that the Controlling Nutritional Status (CONUT) score, a novel nutritional index, can be useful for predicting the prognosis in some malignancies. However, its usefulness in predicting the clinical outcome of immune-checkpoint inhibitor (ICI) treatment in patients with NSCLC has not been clarified. The aim of this study was to investigate the clinical significance of the CONUT score in NSCLC patients treated with pembrolizumab.
METHODS
METHODS
We conducted a retrospective analysis of the clinical data of 32 patients with advanced NSCLC who received pembrolizumab monotherapy. A cut-off CONUT score of 2 was used to categorize patients into low and high CONUT groups. We evaluated the relation between the clinicopathological factors including CONUT score and neutrophil-to-lymphocyte ratio (NLR) and the prognosis.
RESULTS
RESULTS
Twenty-two patients were classified into the low CONUT score group, while 10 were classified into the high CONUT score group. In the univariate and multivariate analyses, the number of prior treatments and the CONUT score were found to independently predict progression-free survival (PFS) (P<0.05), while the CONUT score as well as NLR was an independent prognostic factor for overall survival (P<0.05). In addition, in patients who received pembrolizumab as a first-line treatment, a high CONUT score was associated with a significantly worse PFS and overall survival in comparison to a low CONUT score.
CONCLUSIONS
CONCLUSIONS
The CONUT score has potential application as a predictor of the therapeutic effect and the prognosis of NSCLC patients treated with pembrolizumab. Our findings suggest that in addition to the programmed cell death ligand 1 expression level, the CONUT may also be a useful indicator for selecting NSCLC patients who may benefit from ICI treatment.
Identifiants
pubmed: 31656648
doi: 10.21037/jtd.2019.09.29
pii: jtd-11-09-3757
pmc: PMC6790442
doi:
Types de publication
Journal Article
Langues
eng
Pagination
3757-3768Informations de copyright
2019 Journal of Thoracic Disease. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: Dr. T Ohba reports personal fees from AstraZeneca, personal fees from Bristol-Myers Squibb, Chugai Pharmaceutical, and Nippon Boehringer Ingelheim. Dr. R Toyozawa reports personal fees from AstraZeneca, Bristol-Myers Squibb, Chugai Pharmaceutical, Eli Lilly Japan, Kyowa Hakko Kirin, MSD, Nippon Boehringer Ingelheim, Nippon Kayaku, Ono Pharmaceutical, and Taiho Pharmaceutical. Dr. K Nosaki reports personal fees from AstraZeneca, Bristol-Myers Squibb, Chugai Pharmaceutical, Eli Lilly Japan, Kyowa Hakko Kirin, Nippon Boehringer Ingelheim, Nippon Kayaku, Ono Pharmaceutical, Pfizer Japan, Taiho Pharmaceutical, and grants and personal fees from MSD, and Novartis Pharma. Dr. Miura reports personal fees from Ono Pharmaceutical. Dr. M Yamaguchi reports personal fees from Astellas Pharma, AstraZeneca, Chugai Pharmaceutical, Covidien Japan, Daiichi Sankyo, Eli Lilly Japan, Johnson & Johnson, Kyowa Hakko Kirin, Nippon Boehringer Ingelheim, Ono Pharmaceutical, and Taiho Pharmaceutical. Dr. K Taguchi reports personal fees from AstraZeneca, MSD, Ono Pharmaceutical, and Taiho Pharmaceutical. Dr. T Seto reports grants and personal fees from Astellas Pharma, AstraZeneca, Chugai Pharmaceutica, Eli Lilly Japan, Kissei Pharmaceutical, MSD, Nippon Boehringer Ingelheim, Novartis Pharma, Pfizer Japan, Takeda Pharmaceutical, and personal fees from Bristol-Myers Squibb, Kyowa Hakko Kirin, Nippon Kayaku, Ono Pharmaceutical, Roche Singapore, Taiho Pharmaceutical, Thermo Fisher Scientific, YakultHonsha, and grants from Bayer Yakuhin, Daiichi Sankyo, Eisai, LOXO Oncology, and Merck Serono. Dr. M Shimokawa reports consulting fee from Sysmex. Dr. M Takenoyama reports grants and personal fees from AstraZeneca, Bristol-Myers Squibb, Chugai Pharmaceutical, Covidien Japan, Eli Lilly Japan, Kyowa Hakko Kirin, MSD, Nippon Boehringer Ingelheim, Novartis Pharma, Ono Pharmaceutical, Taiho Pharmaceutical, and grants from Johnson & Johnson, Kaketsuken, and personal fees from Pfizer Japan. The other authors have no conflicts of interest to declare.
Références
Clin Lung Cancer. 2017 Jul;18(4):e303-e313
pubmed: 28274690
Ann Oncol. 2016 Jul;27(7):1291-8
pubmed: 27117531
Nat Med. 2016 Apr;22(4):433-8
pubmed: 26901407
Anticancer Res. 2018 Aug;38(8):4883-4888
pubmed: 30061264
N Engl J Med. 2014 Dec 4;371(23):2189-2199
pubmed: 25409260
Science. 2015 Apr 3;348(6230):124-8
pubmed: 25765070
Gastric Cancer. 2018 Mar;21(2):204-212
pubmed: 28656485
J Thorac Oncol. 2017 Dec;12(12):1798-1805
pubmed: 28939128
Lancet. 2016 Apr 9;387(10027):1540-1550
pubmed: 26712084
Anticancer Res. 2017 Feb;37(2):741-747
pubmed: 28179325
Nutr Hosp. 2012 Mar-Apr;27(2):564-71
pubmed: 22732985
N Engl J Med. 2018 Nov 22;379(21):2040-2051
pubmed: 30280635
N Engl J Med. 2015 Jun 25;372(26):2509-20
pubmed: 26028255
J Clin Oncol. 2013 Dec 1;31(34):4311-8
pubmed: 24145345
Lung Cancer. 2017 Sep;111:176-181
pubmed: 28838390
J Thorac Dis. 2017 Sep;9(9):2942-2951
pubmed: 29221266
Urol Oncol. 2017 Sep;35(9):539.e9-539.e16
pubmed: 28499734
N Engl J Med. 2016 Nov 10;375(19):1823-1833
pubmed: 27718847
Lancet. 2017 Jan 21;389(10066):255-265
pubmed: 27979383
Nat Commun. 2016 Jan 29;7:10582
pubmed: 26822383
N Engl J Med. 2015 May 21;372(21):2018-28
pubmed: 25891174
J Clin Oncol. 2016 May 10;34(14):1676-88
pubmed: 26884577
Lancet Oncol. 2010 Feb;11(2):121-8
pubmed: 20022809
Anticancer Res. 2017 May;37(5):2735-2742
pubmed: 28476853
N Engl J Med. 2015 Oct 22;373(17):1627-39
pubmed: 26412456
Nutr Hosp. 2005 Jan-Feb;20(1):38-45
pubmed: 15762418
BMC Cancer. 2018 Jun 28;18(1):699
pubmed: 29954375
Ann Surg Oncol. 2018 Oct;25(11):3316-3323
pubmed: 30051372
World J Surg. 2018 Apr;42(4):1085-1091
pubmed: 28887635
Mol Cancer. 2003 Nov 05;2:36
pubmed: 14613583
N Engl J Med. 2018 May 31;378(22):2078-2092
pubmed: 29658856
N Engl J Med. 2015 Jul 9;373(2):123-35
pubmed: 26028407
Lung Cancer. 2018 Oct;124:179-188
pubmed: 30268458
Am J Clin Nutr. 2006 Jun;83(6):1345-50
pubmed: 16762946
N Engl J Med. 2017 Jun 22;376(25):2415-2426
pubmed: 28636851
Lung Cancer. 2017 Apr;106:1-7
pubmed: 28285682
Lancet. 2019 May 4;393(10183):1819-1830
pubmed: 30955977