The Role of Immune-Inflammation Biomarkers to Predict the Response of Nivolumab in Second Line Treatment of Advanced Stage Non-Small Cell Lung Cancer

Abstract

Objectives: In this study, the relationship between response to second-line nivolumab treatment in advanced non- small cell lung cancer (NSCLC) and systemic immune inflammation index (SII) was investigated. Methods: One hundred and twenty-nine patients with advanced NSCLC who received nivolumab in second line be - tween July 2018 and July 2023 were included. The optimum cutoff value for neutrophil/lymphocyte ratio (NLR), SII, platelet/lymphocyte ratio (PLR) and body mass index (BMI) was calculated. Progression free survival (PFS) and overall survival (OS) were evaluated. Univariate and multivariate analysis were performed for all parameters for prognostic evaluation. Results: In univariate analysis, patients with low SII found longer PFS and OS (HR = 1.762 for PFS, 95% CI 1.053-2.949, p=0.031, for OS HR=1.433, 95% CI 1.011-2.031, p=0.043). However, in multivariate analysis, no significance was found between low SII and OS (HR=1.614 for OS, 95%CI 0.984- 2.648, p=0.058). No statistically significant relationship was found between NLR, PLR, BMI and Glasgow prognostic score (GPS) with OS and PFS. OS was found to be longer in patients with programmed cell death ligand 1 (PD-L1) of 1% and above and without liver metastasis (p=0.031 and p=0.040, respectively). Conclusion: Low SII before nivolumab treatment was associated with long PFS. A significant correlation was found between PD-L1 of 1% and above and OS.