Pre-treatment immune status predicts disease control in NSCLCs treated with chemoradiation and durvalumab Journal Article
| Authors: | Thor, M.; Shepherd, A. F.; Preeshagul, I.; Offin, M.; Gelblum, D. Y.; Wu, A. J.; Apte, A.; Simone, C. B. 2nd; Hellmann, M. D.; Rimner, A.; Chaft, J. E.; Gomez, D. R.; Deasy, J. O.; Shaverdian, N. |
| Article Title: | Pre-treatment immune status predicts disease control in NSCLCs treated with chemoradiation and durvalumab |
| Abstract: | Background: The impact of peripheral blood immune measures and radiation-induced lymphopenia on outcomes in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiation (cCRT) and immune check point inhibition (ICI) has yet to be fully defined. Methods: Stage III NSCLC patients treated with cCRT and ≥1 dose of durvalumab across a cancer center were examined. Peripheral blood counts were assessed pre-cCRT, during cCRT and at the start of ICI. These measures and risk-scores from two published models estimating radiation dose to immune-bearing organs were tested for association with disease control. Results: We assessed 113 patients treated with cCRT and a median of 8.5 months of durvalumab. Median PFS was 29 months (95% CI 18–35 months). A lower pre-cCRT ALC (HR: 0.51 (95% CI: 0.32–0.82), p = 0.02) and a higher pre-cCRT ANC (HR: 1.14 (1.06–1.23), p = 0.005) were associated with poor PFS. Neither ALC nadir, ALC at ICI start, ANC at ICI start or the normalized change in ALC from pre-cCRT to nadir were significantly associated with PFS (p = 0.07–0.49). Also, risk scores from the two radiation-dose models were not associated with PFS (p = 0.14, p = 0.21) but were so with the ALC Nadir (p = 0.001, p = 0.002). A higher pre-cCRT NLR was the strongest predictor for PFS (HR: 1.09 (1.05–1.14), p = 0.0001). The 12-month PFS in patients with the bottom vs. top NLR tertile was 84% vs 46% (p = 0.000004). Conclusions: Baseline differences in peripheral immune cell populations are associated with disease outcomes in NSCLC patients treated with cCRT and ICI. © 2021 |
| Keywords: | chemoradiation; lymphopenia; non-small cell lung cancers; neutrophil-to-lymphocyte ratio; cardiopulmonary irradiation |
| Journal Title: | Radiotherapy and Oncology |
| Volume: | 167 |
| ISSN: | 0167-8140 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-02-01 |
| Start Page: | 158 |
| End Page: | 164 |
| Language: | English |
| DOI: | 10.1016/j.radonc.2021.12.016 |
| PROVIDER: | scopus |
| PUBMED: | 34942280 |
| PMCID: | PMC9518843 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 February 2022 -- Source: Scopus |
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