Prognostic Potential of the Prognostic Nutritional Index in Non-Small Cell Lung Cancer Patients Receiving Pembrolizumab Combination Therapy with Carboplatin and Paclitaxel/Nab-Paclitaxel

Fuyumi Nishihara-Kato; Hisao Imai; Takeshi Tsuda; Satoshi Wasamoto; Yoshiaki Nagai; Takayuki Kishikawa; Yosuke Miura; Akihiro Ono; Yutaka Yamada; Ken Masubuchi; Takashi Osaki; Junichi Nakagawa; Yukihiro Umeda; Hiroyuki Minemura; Yuki Kozu; Hirokazu Taniguchi; Hiromitsu Ohta; Kyoichi Kaira; Hiroshi Kagamu

doi:10.1159/000533604

Prognostic Potential of the Prognostic Nutritional Index in Non-Small Cell Lung Cancer Patients Receiving Pembrolizumab Combination Therapy with Carboplatin and Paclitaxel/Nab-Paclitaxel

Oncology. 2024;102(1):30-42. doi: 10.1159/000533604. Epub 2023 Aug 18.

Authors

Fuyumi Nishihara-Kato¹, Hisao Imai^{1

2}, Takeshi Tsuda³, Satoshi Wasamoto⁴, Yoshiaki Nagai⁵, Takayuki Kishikawa⁶, Yosuke Miura⁷, Akihiro Ono⁸, Yutaka Yamada⁹, Ken Masubuchi², Takashi Osaki¹⁰, Junichi Nakagawa¹¹, Yukihiro Umeda¹², Hiroyuki Minemura¹³, Yuki Kozu⁴, Hirokazu Taniguchi³, Hiromitsu Ohta⁵, Kyoichi Kaira¹, Hiroshi Kagamu¹

Affiliations

¹ Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan.
² Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan.
³ Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan.
⁴ Division of Respiratory Medicine, Saku Central Hospital Advanced Care Center, Saku, Japan.
⁵ Department of Respiratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama, Japan.
⁶ Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan.
⁷ Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan.
⁸ Division of Internal Medicine, Kiryu Kosei General Hospital, Kiryu, Japan.
⁹ Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan.
¹⁰ Division of Respiratory Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan.
¹¹ Division of Respiratory Medicine, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.
¹² Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
¹³ Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.

PMID: 37598676
DOI: 10.1159/000533604

Abstract

Introduction: Pembrolizumab (Pemb) therapy in conjunction with carboplatin and paclitaxel (PTX)/nab-PTX has been efficacious in treating non-small cell lung cancer (NSCLC). However, the response predictors of this combination therapy (Pemb-combination) remain undetermined. We aimed to evaluate whether Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) are potential factors in prognosticating the response to Pemb-combination therapy in advanced NSCLC patients.

Methods: We retrospectively recruited 144 NSCLC patients receiving first-line treatment with Pemb-combination therapy from 13 institutions between December 1, 2018, and December 31, 2020. GPS, NLR, BMI, PLR, and PNI were assessed for their efficacy as prognostic indicators. Cox proportional hazard models and the Kaplan-Meier method were used to compare the progression-free survival (PFS) and overall survival (OS) of the patients.

Results: The treatment exhibited a response rate of 63.1% (95% confidence interval [CI]: 55.0-70.6%). Following Pemb-combination administration, the median PFS and OS were 7.3 (95% CI: 5.3-9.4) and 16.5 (95% CI: 13.9-22.1) months, respectively. Contrary to PNI, NLR, GPS, BMI, and PLR did not display substantially different PFS in univariate analysis. However, multivariate analysis did not identify PNI as an independent prognostic factor for PFS. Furthermore, univariate analysis revealed that GPS, BMI, and PLR exhibited similar values for OS but not NLR and PNI. Patients with PNI ≥45 were predicted to have better OS than those with PNI <45 (OS: 23.4 and 13.9 months, respectively, p = 0.0028). Multivariate analysis did not establish NLR as an independent prognostic factor for OS.

Conclusion: The PNI evidently predicted OS in NSCLC patients treated with Pemb-combination as first-line therapy, thereby validating its efficiency as a prognostic indicator of NSCLC.

Keywords: Immune checkpoint inhibitor; Non-small cell lung cancer; Pembrolizumab; Prognostic nutritional index.

MeSH terms

Albumins*
Antibodies, Monoclonal, Humanized*
Carboplatin
Carcinoma, Non-Small-Cell Lung* / drug therapy
Humans
Lung Neoplasms* / drug therapy
Lymphocyte Count
Neutrophils
Nutrition Assessment
Paclitaxel
Prognosis
Retrospective Studies

Substances

Carboplatin
130-nm albumin-bound paclitaxel
pembrolizumab
Paclitaxel
Albumins
Antibodies, Monoclonal, Humanized