Prognostic Factors of Nintedanib-docetaxel in Patients with Previously Treated Non-small-cell Lung Cancer

Background: In advanced non-small-cell lung cancer (NSCLC), second-line treatment with nintedanib plus docetaxel improves survival compared with docetaxel, especially in patients with adenocarcinoma histology who progressed within 9 months after the start of firstline treatment. It is therefore necessary to identify new biomarkers/prognostic factors that select the patients who benefit from this type of treatment. Patients and Methods: In this single-center retrospective study, we included patients treated NSCLC with nintedanib plus docetaxel in the second/third line and analyzed potential prognostic factors, many of them related to the inflammatory environment; PD-L1 expression levels, Lung Immune Prognostic Index (LIPI), derived neutrophil/lymphocytes ratio (dNLR), etc. Results: Among 16 patients included in this analysis, the overall response rate was 12.5%, median progression-free survival was 2 months (95% CI, 1.22-2.78) and median overall survival was 6 months (95% CI, 2.11-9.89). LDH level is the only variable related to the disease control rate (70% in normal versus 0% in elevated LDH). The variables analyzed with prognostic significance were; no brain metastases (HR 0.33, 95% CI 0.14-0.78; p=0.011), less than 3 metastatic sites (HR 0.33, 95% CI 0.14-0.78; p=0.011), the non-use of antiangiogenic drugs in the first line (HR 0.53, 95% CI: 0.29-0.98; p=0.043), the absence of elevated LDH at the start of treatment (HR 0.55, 95% CI: 0.3-1; p=0.051) and the absence of liver metastases (HR 0.55, 95% CI: 0.29-1; p=0.05). Conclusions: In NSCLC patients with less than three metastatic sites, no brain or liver metastases, normal LDH values and not previously treated with antiangiogenic drugs in the first line showed a better prognosis when treated with second/third line with nintedanib plus docetaxel.