Gustave Roussy immune score is an independent prognostic factor for treatment response and survival in advanced non-small cell lung cancer treated with nivolumab at second-line therapy
Abstract
Introduction. This study aimed to determine the prognostic significance of the Gustave Roussy immune score (GRim score) for patients receiving nivolumab as second-line therapy for advanced non-small cell lung cancer (NSCLC).
Material and methods. We used serum albumin, lactate dehydrogenase (LDH), and the neutrophil-lymphocyte ratio (NLR) obtained 1 to 7 days before treatment to calculate GRim scores for 105 NSCLC patients.
Results. We evaluated the relationship between oncological outcomes and GRim scores. Of the 105 patients, 82 (78.1%) belonged to the low-score group, which had an objective response (OR) of 30 (36.6%), whereas 1 (4.3%) belonged to the high-score group (p = 0.002). In the low-score group, median PFS and OS were 4.7 months (95% CI 3.9–5.4) and 17.9 months (95% CI — NE), respectively, whereas in the high-score group, they were 1.8 months (95% CI 0.1–4.3) and 2.5 months (95% CI 0.1–2.5; p < 0.001), respectively. A low GRim score (HR = 0.30; p = 0.003) and the absence of brain metastases (HR = 0.42; p = 0.02) were essential indicators of PFS in multivariate analysis. From an OS perspective, having an ECOG performance score of 0 (HR = 0.45; p = 0.04), a low GRim score (HR = 0.21; p = 0.001), and a CPS score of ≥ 1 (HR = 0.33; p = 0.01) were independent predictors. Furthermore, there was no discernible relationship (p = 0.73) between the GRim score and the CPS.
Conclusions. The findings of our study demonstrate that the GRim score, which is derived from standard laboratory tests conducted on patients, is an affordable and simple prognostic indicator for treatment response and survival in patients with advanced NSCLC receiving nivolumab as second-line therapy.
Keywords: non-small cell lung cancernivolumabGustave Roussy immune scoreobjective responseand survival
References
- Siegel R, Giaquinto A, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024; 74(1): 12–49.
- Nicholson AG, Tsao MS, Beasley MB, et al. The 2021 WHO Classification of Lung Tumors: Impact of Advances Since 2015. J Thorac Oncol. 2022; 17(3): 362–387.
- https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf (30.05.2024).
- Borghaei H, Gettinger S, Vokes E, et al. Five-Year Outcomes From the Randomized, Phase III Trials CheckMate 017 and 057: Nivolumab Versus Docetaxel in Previously Treated Non–Small-Cell Lung Cancer. J Clin Oncol. 2021; 39(7): 723–733.
- Tsai YT, Schlom J, Donahue RN. Blood-based biomarkers in patients with non-small cell lung cancer treated with immune checkpoint blockade. J Exp Clin Cancer Res. 2024; 43(1): 82.
- Schild SE, Tan AD, Wampfler JA, et al. A new scoring system for predicting survival in patients with non-small cell lung cancer. Cancer Med. 2015; 4(9): 1334–1343.
- Bigot F, Castanon E, Baldini C, et al. Prospective validation of a prognostic score for patients in immunotherapy phase I trials: The Gustave Roussy Immune Score (GRIm-Score). Eur J Cancer. 2017; 84: 212–218.
- Lenci E, Cantini L, Pecci F, et al. The Gustave Roussy Immune (GRIm)-Score Variation Is an Early-on-Treatment Biomarker of Outcome in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Treated with First-Line Pembrolizumab. J Clin Med. 2021; 10(5).
- Minami S, Ihara S, Ikuta S, et al. Gustave Roussy Immune Score and Royal Marsden Hospital Prognostic Score Are Biomarkers of Immune-Checkpoint Inhibitor for Non-Small Cell Lung Cancer. World J Oncol. 2019; 10(2): 90–100.
- Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. N Engl J Med. 2015; 373(2): 123–135.
- Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. N Engl J Med. 2015; 373(17): 1627–1639.
- Horn L, Spigel DR, Vokes EE, et al. Nivolumab Versus Docetaxel in Previously Treated Patients With Advanced Non-Small-Cell Lung Cancer: Two-Year Outcomes From Two Randomized, Open-Label, Phase III Trials (CheckMate 017 and CheckMate 057). J Clin Oncol. 2017; 35(35): 3924–3933.
- Sun KX, Xu RQ, Rong H, et al. Prognostic significance of the Gustave Roussy immune (GRIm) score in cancer patients: a meta-analysis. Ann Med. 2023; 55(2): 2236640.
- Atasever Akkas E, Erdis E, Yucel B. Correction to: Prognostic value of the systemic immune-inflammation index, systemic inflammation response index, and prognostic nutritional index in head and neck cancer. Eur Arch Otorhinolaryngol. 2023; 280(8): 3831–3833.
- Aldea M, Benitez JC, Mezquita L. The Lung Immune Prognostic Index (LIPI) stratifies prognostic groups in advanced non-small cell lung cancer (NSCLC) patients. Transl Lung Cancer Res. 2020; 9(4): 967–970.
- Pelizzari G, Basile D, Zago S, et al. Lactate Dehydrogenase (LDH) Response to First-Line Treatment Predicts Survival in Metastatic Breast Cancer: First Clues for A Cost-Effective and Dynamic Biomarker. Cancers (Basel). 2019; 11(9).
- Ding J, Karp JE, Emadi A. Elevated lactate dehydrogenase (LDH) can be a marker of immune suppression in cancer: Interplay between hematologic and solid neoplastic clones and their microenvironments. Cancer Biomark. 2017; 19(4): 353–363.
- Petrelli F, Cabiddu M, Coinu A, et al. Prognostic role of lactate dehydrogenase in solid tumors: a systematic review and meta-analysis of 76 studies. Acta Oncol. 2015; 54(7): 961–970.
- Tjokrowidjaja A, Lord SJ, John T, et al. Pre- and on-treatment lactate dehydrogenase as a prognostic and predictive biomarker in advanced non-small cell lung cancer. Cancer. 2022; 128(8): 1574–1583.
- Cupp MA, Cariolou M, Tzoulaki I, et al. Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med. 2020; 18(1): 360.
- Li Y, Xu T, Wang X, et al. The prognostic utility of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with colorectal liver metastasis: a systematic review and meta-analysis. Cancer Cell Int. 2023; 23(1): 39.
- Melssen MM, Sheybani ND, Leick KM, et al. Barriers to immune cell infiltration in tumors. J Immunother Cancer. 2023; 11(4).
- Russo A, Russano M, Franchina T, et al. Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Outcomes with Nivolumab in Pretreated Non-Small Cell Lung Cancer (NSCLC): A Large Retrospective Multicenter Study. Adv Ther. 2020; 37(3): 1145–1155.
- Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010; 9: 69.
- Goldschmidt JH, Chou LN, Chan PK, et al. Real-world outcomes of 18,186 metastatic solid tumor outpatients: Baseline blood cell counts correlate with survival after immune checkpoint inhibitor therapy. Cancer Med. 2023; 12(22): 20783–20797.