Development and validation of a new tool to estimate early mortality in patients with advanced cancer treated with immunotherapy.

Autor: De Giglio A; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy. andrea.degiglio2@unibo.it.; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy. andrea.degiglio2@unibo.it., Leonetti A; Medical Oncology Unit, University Hospital of Parma, Parma, Italy., Comito F; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Filippini DM; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Mollica V; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Rihawi K; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Peroni M; Department of Medicine and Surgery, University of Parma, Parma, Italy., Mazzaschi G; Medical Oncology Unit, University Hospital of Parma, Parma, Italy.; Department of Medicine and Surgery, University of Parma, Parma, Italy., Ricciotti I; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Carosi F; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Marchetti A; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Rosellini M; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Gagliano A; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Favorito V; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Nobili E; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Gelsomino F; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Melotti B; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Marchese PV; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Sperandi F; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Di Federico A; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Buti S; Medical Oncology Unit, University Hospital of Parma, Parma, Italy.; Department of Medicine and Surgery, University of Parma, Parma, Italy., Perrone F; Medical Oncology Unit, University Hospital of Parma, Parma, Italy., Massari F; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Pantaleo MA; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Tiseo M; Medical Oncology Unit, University Hospital of Parma, Parma, Italy.; Department of Medicine and Surgery, University of Parma, Parma, Italy., Ardizzoni A; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
Jazyk: angličtina
Zdroj: Cancer immunology, immunotherapy : CII [Cancer Immunol Immunother] 2024 Oct 03; Vol. 73 (12), pp. 246. Date of Electronic Publication: 2024 Oct 03.
DOI: 10.1007/s00262-024-03836-w
Abstrakt: Background: Immune checkpoint inhibitors (ICIs) are standard treatments for advanced solid cancers. Resistance to ICIs, both primary and secondary, poses challenges, with early mortality (EM) within 30-90 days indicating a lack of benefit. Prognostic factors for EM, including the lung immune prognostic index (LIPI), remain underexplored.
Methods: We performed a retrospective, observational study including patients affected by advanced solid tumors, treated with ICI as single agent or combined with other agents. Logistic regression models identified factors associated with EM and 90-day progression risks. A nomogram for predicting 90-day mortality was built and validated within an external cohort.
Results: In total, 637 patients received ICIs (single agent or in combination with other drugs) for advanced solid tumors. Most patients were male (61.9%), with NSCLC as the prevalent tumor (61.8%). Within the cohort, 21.3% died within 90 days, 8.4% died within 30 days, and 34.5% experienced early progression. Factors independently associated with 90-day mortality included ECOG PS 2 and a high/intermediate LIPI score. For 30-day mortality, lung metastasis and a high/intermediate LIPI score were independent risk factors. Regarding early progression, high/intermediate LIPI score was independently associated. A predictive nomogram for 90-day mortality combining LIPI and ECOG PS achieved an AUC of 0.76 (95% CI 0.71-0.81). The discrimination ability of the nomogram was confirmed in the external validation cohort (n = 255) (AUC 0.72, 95% CI 0.64-0.80).
Conclusion: LIPI and ECOG PS independently were able to estimate 90-day mortality, with LIPI also demonstrating prognostic validity for 30-day mortality and early progression.
(© 2024. The Author(s).)
Databáze: MEDLINE
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