November 15, 2021
Faculty of Pharmacy, Keio University
A research group from the Faculty of Pharmacy, Keio University and the National Cancer Center Hospital has discovered that the prognosis of immune checkpoint inhibitor treatment can be predicted in advance by using an index that combines concomitant medications and the neutrophil-to-lymphocyte ratio at the start of treatment. This research is the result of a group led by Toshiki Ogiwara, a sixth-year student in the Department of Pharmacy, Faculty of Pharmacy, Keio University; Hitoshi Kawazoe, Senior Assistant Professor at the same faculty; Tomonori Nakamura, Professor at the same faculty; and the National Cancer Center Hospital.
We are now in a super-aging society where one in two people develops cancer and one in three dies from it. Among all cancers, lung cancer has the highest number of deaths, with approximately 75,000 people dying from it annually. The immune checkpoint inhibitors nivolumab and pembrolizumab are the standard of care for unresectable advanced/recurrent non-small cell lung cancer. However, because the response rate to immune checkpoint inhibitor treatment varies among individuals, an indicator to predict patients with low efficacy would be very useful. Although the association between concomitant medications and prognosis, and the association between the neutrophil-to-lymphocyte ratio and prognosis have been reported to date, no studies have combined these factors.
In this study, we retrospectively reviewed the medical records of patients who received nivolumab or pembrolizumab therapy for unresectable advanced/recurrent non-small cell lung cancer at the National Cancer Center Hospital. Using the aforementioned index, patients were classified into high-, intermediate-, and low-risk groups. Of the 259 patients in the cohort, 104 (40.2%) were classified into the high-risk group. Statistical analysis revealed that the high-risk patient group had shorter overall survival compared to the low-risk patient group. On the other hand, no significant association was found for progression-free survival.
These findings suggest that the prognosis of nivolumab or pembrolizumab therapy can be predicted by using an index that combines concomitant medications and the neutrophil-to-lymphocyte ratio at the start of treatment for unresectable advanced/recurrent non-small cell lung cancer. The results of this study indicate the possibility of detecting the prognosis of immune checkpoint inhibitor treatment in advance, and we believe this will lead to the early identification and treatment of "high-risk patients." Further elucidation of these mechanisms and the development of new methods to improve the efficacy of immune checkpoint inhibitor treatment are expected in the future.
The results of this research were published in the online edition of the international academic journal "Frontiers in Oncology" on November 8, 2021.
For the full press release, please see below.