Correlation of Clinical Parameters with Intracranial Outcome in Non-Small Cell Lung Cancer Patients with Brain Metastases Treated with Pd-1/Pd-L1 Inhibitors as Monotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Patient Characteristics
2.2. Results from Response Assessment
2.3. Creation of Different Predictive Groups Based on I-O CNS Score
3. Discussion
4. Methods
4.1. Patient Eligibility
4.2. Study Design
4.3. Response Assessment
4.4. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | Total (n = 33) | 95% Confidence Intervals | |
---|---|---|---|
Age (years) | Median | 69 | |
Range | 40–84 | ||
Gender (n%) | Male | 16 (48.5%) | |
Female | 17 (51.5%) | ||
ECOG performance status (n%) | 0–1 | 25 (75.8%) | |
2 | 8 (24.2%) | ||
Smoking status (n%) | Former or active smoker | 29 (87.9%) | |
Never smoker | 4 (12.1%) | ||
Histology (n%) | Adenocarcinoma | 29 (87.9%) | |
Non-adenocarcinoma | 4 (12.1%) | ||
Line of treatment of ICIs administration (n%) | 1st line | 5 (15.2%) | |
2nd or subsequent line | 28 (84.8%) | ||
PD-L1 expression in extracranial lesions (n%) | <1% | 2 (6.1%) | |
1% ≤ PDL1 < 50% | 10 (30.3%) | ||
PDL1 ≥ 50% | 14 (42.4%) | ||
Missing data | 7 (21.2%) | ||
CNS metastases at diagnosis | Yes | 24 (72.7%) | |
No | 9 (27.3%) | ||
Neurological symptoms attributed to CNS metastases | Yes | 18 (54.5%) | |
No | 15 (45.5%) | ||
Radiological evaluation method of CNS metastases | MRI | 23 (69.7%) | |
CT | 10 (30.3%) | ||
Size of largest CNS metastasis (mm) | Median | 17 | |
Range | 4–50 | ||
Number of CNS metastases | Median | 2 | |
Range | 1–50 | ||
>3 CNS metastases | Yes | 12 (36.4%) | |
No | 21 (63.6%) | ||
Bone metastases (n%) | Yes | 12 (36.4%) | |
No | 21 (63.6%) | ||
Liver metastases (n%) | Yes | 10 (30.3%) | |
No | 23 (69.7%) | ||
Disease burden (n%) | Number of organs with metastatic disease >2 | 13 (39.4%) | |
Number of organs with metastatic disease ≤2 | 20 (60.6%) | ||
Steroid administration > 10 mg for > 10 days (n%) | Yes | 16 (48.5%) | |
No | 17 (51.5%) | ||
CNS response to previous systemic treatment | PRi or SDi | 7 (21.2%) | |
PDi | 21 (63.6%) | ||
No previous treatment | 4 (12.2%) | ||
Missing data | 1 (3%) | ||
Active CNS metastases | Yes | 25 (75.8%) | |
No | 8 (24.2%) | ||
Previous surgery for CNS metastases | Yes | 4 (12.1%) | |
No | 29 (87.9%) | ||
Previous radiation treatment for CNS metastases | WBRT | 9 (27.3%) | |
SRS | 9 (27.3%) | ||
No RT | 15 (45.5%) | ||
Intracranial response to ICIs* | CRi | 1 (3%) | |
PRi | 7 (21.2%) | ||
SDi | 8 (24.2%) | ||
PDi | 17 (51.5%) | ||
Intracranial response to ICIs in patients with active CNS metastases (n = 25) | CRi | 1 (4%) | |
PRi | 5 (20%) | ||
SDi | 2 (8%) | ||
PDi | 17 (68%) | ||
I-O CNS score | 0.5–1 | 12 (36.4%) | |
1.5–2 | 21 (63.6%) | ||
Duration of intracranial response (months) | Median | 7.53 | 0–18.45 |
Range | 0.5–22.47 | ||
Intracranial progression (n%) | Yes | 28 (84.8%) | |
No | 5 (15.2%) | ||
Death (n%) | Yes | 25 (75.8%) | |
No | 8 (24.2%) | ||
Intracranial TTP (months) | Median | 4.3 | 2.81–5.79 |
Range | 0.17–22.87 | ||
OS (months) | Median | 6.77 | 2.34–11.19 |
Range | 0.5–30.3 | ||
Follow-up (months) | Median | 6.67 | 2.31–11.19 |
Range | 0.13–22.13 |
Univariate | ROC Analysis | ||
---|---|---|---|
Variable | OR (95% CI) | p-Value | AUC (95% CI) |
Age ≥ 70 years old | 6.19 (1.27–30.170) | 0.024 | 0.700 (0.518–0.883) |
Female gender | 1.84 (0.461–7.312) | 0.388 | 0.575 (0.378–0.773) |
Performance status 2 | 3.82 (0.641–22.744) | 0.141 | 0.614 (0.420–0.808) |
>2 organs with metastatic disease | 1.95 (0.471–8.130) | 0.356 | 0.579 (0.382–0.776) |
Non-primary CNS metastases | 13.33 (1.424–124.880) | 0.023 | 0.704 (0.523–0.885) |
>3 CNS metastases | 0.91 (0.220–3.758) | 0.895 | 0.511 (0.311–0.711) |
Largest CNS metastases >3 cm | 0.52 (0.120–2.248) | 0.381 | 0.577 (0.373–0.781) |
Symptoms attributed to CNS metastases | 0.53 (0.133–2.141) | 0.375 | 0.577 (0.380–0.775) |
Previous RT for CNS metastases | 5.49 (1.210–25.000) | 0.027 | 0.699 (0.515–0.882) |
2nd or subsequent line of treatment | 0.22 (0.021–2.191) | 0.195 | 0.586 (0.390–0.783) |
Steroid administration >10 mg for ≥10 days | 2.38 (0.588–9.646) | 0.224 | 0.607 (0.411–0.802) |
I-O CNS score 0–1 | 27.50 (2.883–262.34) | 0.004 | 0.792 (0.631–0.953) |
Parameter | Point Allocation | |
---|---|---|
Age (years) | <70 | 0.5 |
≥70 | 0 | |
CNS metastases at presentation | Yes | 1 |
No | 0 | |
Previous CNS RT | Yes | 0.5 |
No | 0 |
Predictive Groups | I-O CNS Score |
---|---|
Group A (good) | 1.5–2 |
Group B (poor) | 0–1 |
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Rounis, K.; Skribek, M.; Makrakis, D.; De Petris, L.; Agelaki, S.; Ekman, S.; Tsakonas, G. Correlation of Clinical Parameters with Intracranial Outcome in Non-Small Cell Lung Cancer Patients with Brain Metastases Treated with Pd-1/Pd-L1 Inhibitors as Monotherapy. Cancers 2021, 13, 1562. https://doi.org/10.3390/cancers13071562
Rounis K, Skribek M, Makrakis D, De Petris L, Agelaki S, Ekman S, Tsakonas G. Correlation of Clinical Parameters with Intracranial Outcome in Non-Small Cell Lung Cancer Patients with Brain Metastases Treated with Pd-1/Pd-L1 Inhibitors as Monotherapy. Cancers. 2021; 13(7):1562. https://doi.org/10.3390/cancers13071562
Chicago/Turabian StyleRounis, Konstantinos, Marcus Skribek, Dimitrios Makrakis, Luigi De Petris, Sofia Agelaki, Simon Ekman, and Georgios Tsakonas. 2021. "Correlation of Clinical Parameters with Intracranial Outcome in Non-Small Cell Lung Cancer Patients with Brain Metastases Treated with Pd-1/Pd-L1 Inhibitors as Monotherapy" Cancers 13, no. 7: 1562. https://doi.org/10.3390/cancers13071562