Lung immune prognostic index (LIPI) as a guide for addition of chemotherapy in immunotherapy in elderly patients (Pts) with non-small cell lung cancer (NSCLC): NEJ057

BackgroundImmune checkpoint inhibitor (ICI) plus chemotherapy (ICI-chemo) is a standard treatment for NSCLC without driver oncogene. ICI alone may be favored for elderly pts due to side effects, however, it is necessary to identify the population that would benefit from the addition of chemotherapy to ICI. The Lung Immune Prognostic Index (LIPI) has emerged as a tool to infer immunotherapy response. This study aims to identify elderly pts who would benefit from ICI-chemo using LIPI.MethodsWe analyzed PD-L1-positive cases in a multicenter retrospective study of consecutive pts with advanced NSCLC aged 75 years or older who received the first-line treatment from December 2018 to March 2021. LIPI was calculated based on the derived neutrophil-to-lymphocyte ratio >3 and lactate dehydrogenase greater than the upper limit of normality. The pts were categorized into two LIPI groups: good (0), and intermediate/poor (1/2).ResultsA total of 600 pts was analyzed: median (range) age 78 (75-91) years; 466 (78%) male; 494 (82%) ECOG PS 0-1; 338 (56%) adenocarcinoma; PD-L1 TPS 364 (61%) ≥50% and 236 (39%) 1-49%; 238 (40%) LIPI 0 and 362 (60%) LIPI 1/2; 402 (67%) ICI alone and 198 (33%) ICI-chemo. The median overall survival (OS) and progression free survival (PFS) were 22.3 months (95%CI, 15.0–28.0) and 8.8 months (95%CI, 7.3–10.6) in the ICI-chemo group, and 19.9 months (95%CI, 17.3–24.8) and 7.7 months (95%CI, 6.5–8.8) in the ICI-alone group. In the pts with PD-L1 1-49% cohort, OS and PFS in the ICI-chemo group were significantly longer than those in the ICI-alone group (OS HR, 0.56 [95% CI, 0.36-0.86]; PFS HR 0.56 [95%CI, 0.39-0.81]) in pts with LIPI 1/2. However, there was no difference in OS between the ICI-chemo group and the ICI-alone group (OS HR, 1.66 [95% CI, 0.82-3.36]; PFS HR 1.18 [95%CI, 0.71-1.95]) in pts with LIPI 0. In the PD-L1≥50% cohort, there was no difference in efficacy between ICI-chemo and ICI by LIPI score.ConclusionsIn the cohort of pts with PD-L1 1-49%, ICI-chemo showed significantly longer PFS and OS compared with ICI alone in elderly pts with LIPI poor/intermediate. Our results suggest that LIPI can identify elderly pts who would benefit from the addition of chemotherapy to ICI.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureO. HONJO: Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb. T. Tozuka: Financial Interests, Personal, Invited Speaker: AstraZeneca, Chugai Pharmaceutical. Y. Tsukita: Financial Interests, Institutional, Funding: Chugai Pharma, Lilly; Financial Interests, Personal, Invited Speaker: AstraZeneca, Lilly, MSD, Eisai, Chugai Pharmaceutical, Taiho Pharmaceutical, Daiichi Sankyo, Bristol Myers Squibb, Nippon Boehringer Ingelheim; Financial Interests, Personal, Advisory Board: AstraZeneca. K. Kushiro: Financial Interests, Personal, Invited Speaker: Kyowa Kirin Co., Ltd., AstraZeneca, Taiho Pharmaceutical, Chugai Pharmaceutical Co., Ltd., Merck Biopharma Co., Ltd., Takeda Pharmaceutical Company Limited. S. Hosokawa: Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb, AstraZeneca, Chugai Pharmaceutical, Ono Pharmaceutical. T. Sumi: Financial Interests, Personal, Invited Speaker: Ono Pharmaceutical, AstraZeneca. T. Naito: Financial Interests, Personal, Invited Speaker: AstraZeneca, Chugai Pharmaceutical, Taiho Pharmaceutical, Lilly, MSD. Y. Tsubata: Financial Interests, Personal, Invited Speaker: Daiichi Sankyo Co., Ltd., AstraZeneca, Chugai Pharmaceutical, Kyowa Kirin Co., Ltd., Taiho Pharmaceutical Co., Ltd., Bristol Myers Squibb K.K, Takeda Pharmaceutical Company Limited. E. Miyauchi: Financial Interests, Personal, Funding: Chugai Pharmaceutical Co., Ltd., Eli Lily Japan KK; Financial Interests, Personal, Invited Speaker: Taiho Pharmaceutical Co., Ltd., Bristol Myers Squibb Co., Ltd., MSD, Ono Pharmaceutical Co., Ltd., Daiichi Sankyo KK, Boehringer Ingelheim Japan Inc., Novartis Pharma KK, Kyowa Kirin Co., Ltd., Merck Biopharma Co., Ltd., Pfizer Inc., Eisai Co., Ltd., Otsuka pharmaceutical Co., Ltd., Amgen Inc., Thermo Fisher Scientific K.K., Takeda Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., Sysmex Co, AstraZeneca K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan KK. S. Morita: Financial Interests, Personal, Invited Speaker: AstraZeneca, Eli Lily Japan KK, Chugai Pharmaceutical, Bristol Myers Squibb Co., Ltd., MSD, Ono Pharmaceutical Co., Ltd. K. Kobayashi: Financial Interests, Personal, Funding: Zeria Pharmaceutical Co.; Financial Interests, Personal, Advisory Role: Daiichi Sankyo Pharmaceutical Co.; Financial Interests, Personal, Invited Speaker: AstraZeneca; Non-Financial Interests, Personal, Other, Patent: Japanese patent # 7422498. H. Asahina: Financial Interests, Personal, Invited Speaker: Chugai Pharmaceutical, AstraZeneca, MSD, Ono Pharmaceutical, Kyowahakko Kirin, Eli Lilly, Merck; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Research Grant: AstraZeneca. All other authors have declared no conflicts of interest.