The predictive role of inflammation indices in patients treated with immunotherapy or chemotherapy for advanced non-small cell lung cancer

Lung cancer is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths, and non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 84% of all lung cancer diagnoses. Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in 15; for a woman, the risk is about 1 in 17.
Unfortunately, patients with advanced NSCLC are not deemed suitable for radical/curative treatments, however they can currently benefit from several immunotherapy options with immune checkpoint inhibitors (ICIs). The mechanism of action of ICIs is based on the dis-inhibition of patient's own immune systems, to make it able to recognize the tumour and control its growth as if it was an external threat. This has been shown to extend patients' life-expectancy as compared to standard chemotherapy in different treatment settings. To further improve the benefit from ICIs, recent clinical trials have confirmed that the combination of a chemotherapy backbone with a single agent ICI can lead to even greater improved outcomes.
However, against this background of increasing treatment options, there is still a need for additional and reliable information that could help improving the decision-making process when planning a therapeutic strategy. Among the alleged prediction tools in clinical practice, blood immune-inflammatory indices computed from routinary available full blood count values are one of the most investigated, because they are easily accessible and reproducible. These indices include the neutrophil-to-lymphocyte ratio (NLR), which consists of the ratio between the absolute neutrophil count and the absolute lymphocyte count. The NLR has been also combined with other routinely available bloods tests, including the serum lactate dehydrogenase (LDH) and the absolute plates count, to form other indices, such as the Systemic Inflammation Index (SII).
OAK is a randomised, open-label, international phase 3 study which enrolled patients with advanced NSCLC to receive either atezolizumab (immunotherapy, programmed death ligand-1/PD-L1 inhibitor) or docetaxel (chemotherapy), confirming a survival benefit for immunotherapy over chemotherapy. Our aim is to access to the OAK study dataset and analyse patients’ clinical outcomes across both the cohorts according to the baseline NLR and other blood immune-inflammatory indices. We will be able to evaluate their differential prognostic ability between two prospectively randomized cohorts, eventually confirming the differential impact on clinical outcomes for patients treated with atezolizumab and docetaxel.
The overarching goal of this analysis is to provide an easily accessible tool that might assist clinicians in their decision-making process and identify patients more (or less) likely to benefit from immunotherapy, as compared to chemotherapy.