Association of the Immune-Inflammation-Nutritional Parameters with Immune Checkpoint Inhibitor Outcomes in Patients with Advanced Non-Small Cell Lung Cancer

ABS TRACT Objective: Patient prognosis is determined not only based on tumor characteristics, host inflammation and the immune-nutri- tional index are also important. The aim of the study was to investigate the prognostic and predictive role of pretreatment immune-inflam-mation-nutritional biomarkers in patients with advanced non-small cell lung cancer who were treated with immune checkpoint inhibitors (ICIs). Material and Methods: All consecutive patients aged over 18 years who were treated with at least one cycle of ICIs at our centers were retrospectively reviewed. We evaluated modified Glasgow Prognostic Score (mGPS), Lung Immune Prognostic Index, serum C-reac- tive protein (CRP) and lactate dehydrogenase (LDH) as candidate predictors for response and survival. Results: A total of 102 patients who were treated with ICIs between March 2017 and October 2021 were reviewed. Among the patient cohort, 46.1% and 53.9% were treatment- naive and platinum pretreated, respectively. Programmed death ligand-1 positivity (p=0.048), presence of bone metastasis (p=0.048), increasing serum CRP levels (p=0.018), and mGPS 1 (p=0.040) were independently associated with inferior progression-free survival. Presence of liver metastasis (p=0.036), serum LDH level>upper level of normal (p=0.048), Eastern Cooperative Oncology Group Performance Status (ECOG PS)  2 (p=0.026), and increasing CRP levels (p<0.001) were independently associated with poorer overall survival. ECOG PS  2 (p=0.001), the presence of bone metastasis (p=0.049), and mGPS 1 (p=0.016) were independently associated with poorer disease control rate. Conclusion: We found that immune-inflammation-nutritional parameters were reliable prognostic and predictive biomarkers to select pa- tients with a greater likelihood of benefiting