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J Cancer 2023; 14(5):676-688. doi:10.7150/jca.80517 This issue Cite

Research Paper

Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study

Izumi Nasu1,2, Masahiro Kondo3, Ryuji Uozumi4, Shinya Takada5, Shuichi Nawata6, Hirotoshi Iihara7, Yohei Okumura8, Masashi Takemoto3, Kozo Mino5, Tadanori Sasaki6, Chiemi Hirose7, Tohru Aomori8, Rena Shimano2, Ken Maeno9, Satoshi Oizumi10, Sojiro Kusumoto11, Yasushi Ohno12, Shinnosuke Ikemura13, Daiya Takai14, Azusa Hara15, Hitoshi Kawazoe1✉, Tomonori Nakamura1

1. Division of Pharmaceutical Care Sciences, Keio University Graduate School of Pharmaceutical Sciences, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
2. Department of Pharmacy, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
3. Department of Pharmacy, Nagoya City University Hospital, 1-Kawasumi, Mizuho-cho, Miskuho-ku, Nagoya, Aichi 467-8602, Japan
4. Department of Industrial Engineering and Economics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8552, Japan
5. Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center, 4-2-3-54, Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan
6. Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
7. Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
8. Department of Pharmacy, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
9. Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8602, Japan
10. Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, 4-2-3-54, Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan
11. Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
12. Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
13. Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
14. Department of Respiratory Medicine, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
15. Division of Drug Development and Regulatory Science, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan

✉ Corresponding author: Hitoshi Kawazoe, Ph.D. Division of Pharmaceutical Care Sciences, Keio University Graduate School of Pharmaceutical Sciences, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan Tel: +81-3-5400-2639 Fax: +81-3-5400-2651 E-mail: k More

Citation:
Nasu I, Kondo M, Uozumi R, Takada S, Nawata S, Iihara H, Okumura Y, Takemoto M, Mino K, Sasaki T, Hirose C, Aomori T, Shimano R, Maeno K, Oizumi S, Kusumoto S, Ohno Y, Ikemura S, Takai D, Hara A, Kawazoe H, Nakamura T. Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study. J Cancer 2023; 14(5):676-688. doi:10.7150/jca.80517. https://www.jcancer.org/v14p0676.htm
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Abstract

Graphic abstract

Background: Association between baseline medications plus neutrophil-to-lymphocyte ratio (NLR) and the effectiveness of immune checkpoint inhibitor (ICI) plus platinum doublet remains unknown, despite several reported prognostic models. We used real-world data to investigate whether baseline medications plus NLR predict survival outcomes in patients with advanced non-small-cell lung cancer (NSCLC) receiving ICI plus platinum doublet.

Methods: This multicenter, retrospective, observational study conducted in Japan between December 2018 and March 2021 used real-world data of consecutive patients with advanced NSCLC who received ICI (pembrolizumab or atezolizumab) plus platinum doublet as first-line treatment. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The prognostic score for baseline medications plus NLR was weighted by regression β coefficients and used to categorize patients into good, intermediate, and poor prognoses groups. In addition, time-dependent receiver operating characteristic curve analyses and univariable and multivariable Cox proportional hazards models were constructed.

Results: Overall, 241 patients were included. Poor prognosis was significantly associated with worse PFS (hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.08-2.94; P = 0.025) and OS (HR: 3.59; 95% CI: 2.05-6.28; P < 0.001) than good prognosis. Harrell's C-index for this prognostic model was 0.648.

Conclusions: Baseline medication plus NLR could predict progressively worse survival outcomes in patients with advanced NSCLC receiving ICI plus platinum doublet and could be used as a prognostic index for poor outcomes.

Keywords: pembrolizumab, atezolizumab, immune checkpoint inhibitors, baseline medications, prognostic model, non-small-cell lung cancer

Citation styles

APA
Nasu, I., Kondo, M., Uozumi, R., Takada, S., Nawata, S., Iihara, H., Okumura, Y., Takemoto, M., Mino, K., Sasaki, T., Hirose, C., Aomori, T., Shimano, R., Maeno, K., Oizumi, S., Kusumoto, S., Ohno, Y., Ikemura, S., Takai, D., Hara, A., Kawazoe, H., Nakamura, T. (2023). Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study. Journal of Cancer, 14(5), 676-688. https://doi.org/10.7150/jca.80517.

ACS
Nasu, I.; Kondo, M.; Uozumi, R.; Takada, S.; Nawata, S.; Iihara, H.; Okumura, Y.; Takemoto, M.; Mino, K.; Sasaki, T.; Hirose, C.; Aomori, T.; Shimano, R.; Maeno, K.; Oizumi, S.; Kusumoto, S.; Ohno, Y.; Ikemura, S.; Takai, D.; Hara, A.; Kawazoe, H.; Nakamura, T. Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study. J. Cancer 2023, 14 (5), 676-688. DOI: 10.7150/jca.80517.

NLM
Nasu I, Kondo M, Uozumi R, Takada S, Nawata S, Iihara H, Okumura Y, Takemoto M, Mino K, Sasaki T, Hirose C, Aomori T, Shimano R, Maeno K, Oizumi S, Kusumoto S, Ohno Y, Ikemura S, Takai D, Hara A, Kawazoe H, Nakamura T. Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study. J Cancer 2023; 14(5):676-688. doi:10.7150/jca.80517. https://www.jcancer.org/v14p0676.htm

CSE
Nasu I, Kondo M, Uozumi R, Takada S, Nawata S, Iihara H, Okumura Y, Takemoto M, Mino K, Sasaki T, Hirose C, Aomori T, Shimano R, Maeno K, Oizumi S, Kusumoto S, Ohno Y, Ikemura S, Takai D, Hara A, Kawazoe H, Nakamura T. 2023. Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study. J Cancer. 14(5):676-688.

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