Validation of a clinical blood-based decision aid to guide immunotherapy treatment in patients with non-small cell lung cancer.

Autor: Muller M; Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Hoogendoorn R; Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Moritz RJG; Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands., van der Noort V; Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Lanfermeijer M; Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Korse CM; Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands., van den Broek D; Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Ten Hoeve JJ; Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Baas P; Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., van Rossum HH; Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands., van den Heuvel MM; Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.; Department of Respiratory Diseases, Radboud Medical Center, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine [Tumour Biol] 2021; Vol. 43 (1), pp. 115-127.
DOI: 10.3233/TUB-211504
Abstrakt: Background: The widespread introduction of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC) has led to durable responses but still many patients fail and are treated beyond progression.
Objective: This study investigated whether readily available blood-based tumor biomarkers allow accurate detection of early non-responsiveness, allowing a timely switch of therapy and cost reduction.
Methods: In a prospective, observational study in patients with NSCLC treated with nivolumab or pembrolizumab, five serum tumor markers were measured at baseline and every other week. Six months disease control as determined by RECIST was used as a measure of clinical response. Patients with a disease control <  6 months were deemed non-responsive. For every separate tumor marker a criterion for predicting of non-response was developed. Each marker test was defined as positive (predictive of non-response) if the value of that tumor marker increased at least 50% from the value at baseline and above a marker dependent minimum value to be determined. Also, tests based on combination of multiple markers were designed. Specificity and sensitivity for predicting non-response was calculated and results were validated in an independent cohort. The target specificity of the test for detecting non-response was set at >  95%, in order to allow its safe use for treatment decisions.
Results: A total of 376 patients (training cohort: 180, validation cohort: 196) were included in our analysis. Results for the specificity of the single marker tests in the validation set were CEA: 98·3% (95% CI: 90·9-100%), NSE: 96·5% (95% CI: 87·9-99·6%), SCC: 96·5% (95% CI: 88·1-99·6%), Cyfra21·1 : 91.8% (95% CI: 81·9-97·3%), and CA125 : 86·0% (95% CI: 74·2-93·7%). A test based on the combination of Cyfra21.1, CEA and NSE accurately predicted non-response in 32.3% (95% CI 22.6-43.1%) of patients 6 weeks after start of immunotherapy. Survival analysis showed a significant difference between predicted responders (Median PFS: 237 days (95% CI 184-289 days)) and non-responders (Median PFS: 58 days (95% CI 46-70 days)) (p <  0.001).
Conclusions: Serum tumor marker based tests can be used for accurate detection of non-response in NSCLC, thereby allowing early and safe discontinuation of immunotherapy in a significant subset of patients.
Databáze: MEDLINE
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