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Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio

INTRODUCTION: Bone metastases (BMs) are a negative prognostic factor in patients with non-small cell lung cancer (NSCLC). Although immune-checkpoint inhibitors (ICIs) have dramatically changed the therapeutic landscape of NSCLC, little information is available on BMs from NSCLC treated with ICIs alo...

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Autores principales: Bongiovanni, Alberto, Foca, Flavia, Menis, Jessica, Stucci, Stefania Luigia, Artioli, Fabrizio, Guadalupi, Valentina, Forcignanò, Maria Rosachiara, Fantini, Manuela, Recine, Federica, Mercatali, Laura, Spadazzi, Chiara, Burgio, Marco Angelo, Fausti, Valentina, Miserocchi, Anna, Ibrahim, Toni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631508/
https://www.ncbi.nlm.nih.gov/pubmed/34858389
http://dx.doi.org/10.3389/fimmu.2021.697298
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author Bongiovanni, Alberto
Foca, Flavia
Menis, Jessica
Stucci, Stefania Luigia
Artioli, Fabrizio
Guadalupi, Valentina
Forcignanò, Maria Rosachiara
Fantini, Manuela
Recine, Federica
Mercatali, Laura
Spadazzi, Chiara
Burgio, Marco Angelo
Fausti, Valentina
Miserocchi, Anna
Ibrahim, Toni
author_facet Bongiovanni, Alberto
Foca, Flavia
Menis, Jessica
Stucci, Stefania Luigia
Artioli, Fabrizio
Guadalupi, Valentina
Forcignanò, Maria Rosachiara
Fantini, Manuela
Recine, Federica
Mercatali, Laura
Spadazzi, Chiara
Burgio, Marco Angelo
Fausti, Valentina
Miserocchi, Anna
Ibrahim, Toni
author_sort Bongiovanni, Alberto
collection PubMed
description INTRODUCTION: Bone metastases (BMs) are a negative prognostic factor in patients with non-small cell lung cancer (NSCLC). Although immune-checkpoint inhibitors (ICIs) have dramatically changed the therapeutic landscape of NSCLC, little information is available on BMs from NSCLC treated with ICIs alone or in association with bone-targeted therapy (BTT) such as zoledronate or denosumab. METHODS: From 2014 to 2020, 111 of the 142 patients with BMs secondary to NSCLC extrapolated from the prospective multicenter Italian BM Database were eligible for analysis. Information on blood count, comorbidities, and toxicity was retrospectively collected. The neutrophil-to-lymphocyte ratio (NLR) pre- and post-treatment was calculated. Survival was analyzed using the Kaplan–Meier method, with statistical significance of survival differences assessed using the log-rank test. RESULTS: Median age was 66 (range, 42–84) years. Performance status (PS) Eastern Cooperative Oncology Group (ECOG) was 0–1 in 79/111 patients. The majority of patients (89.2%) had adenocarcinoma histology. At a median follow-up of 47.4 months, median progression-free (mPFS) and overall survival (mOS) was 4.9 (95%CI, 2.8–10.0) and 11.9 (95%CI, 8.2–14.4) months, respectively. Forty-six (43.4%) patients with BM NSCLC underwent first- or further-line therapy with ICIs: 28 (60.8%) received nivolumab, 9 (19.6%) pembrolizumab, and 9 (19.6%) atezolizumab. Of the 46 patients treated with ICIs, 30 (65.2%) underwent BTT: 24 (80.0%) with zoledronate and 6 (20.0%) with denosumab. The ICI-alone group had an mOS of 15.8 months [95%CI, 8.2–not evaluable (NE)] vs. 21.8 months (95%CI, 14.5–not evaluable) for the ICI plus BTT group and 7.5 (95%CI, 6.1–10.9) months for the group receiving other treatments (p < 0.001). NLR ≤5 had a positive impact on OS. CONCLUSION: BTT appears to have a synergistic effect when used in combination with ICIs, improving patient survival.
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spelling pubmed-86315082021-12-01 Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio Bongiovanni, Alberto Foca, Flavia Menis, Jessica Stucci, Stefania Luigia Artioli, Fabrizio Guadalupi, Valentina Forcignanò, Maria Rosachiara Fantini, Manuela Recine, Federica Mercatali, Laura Spadazzi, Chiara Burgio, Marco Angelo Fausti, Valentina Miserocchi, Anna Ibrahim, Toni Front Immunol Immunology INTRODUCTION: Bone metastases (BMs) are a negative prognostic factor in patients with non-small cell lung cancer (NSCLC). Although immune-checkpoint inhibitors (ICIs) have dramatically changed the therapeutic landscape of NSCLC, little information is available on BMs from NSCLC treated with ICIs alone or in association with bone-targeted therapy (BTT) such as zoledronate or denosumab. METHODS: From 2014 to 2020, 111 of the 142 patients with BMs secondary to NSCLC extrapolated from the prospective multicenter Italian BM Database were eligible for analysis. Information on blood count, comorbidities, and toxicity was retrospectively collected. The neutrophil-to-lymphocyte ratio (NLR) pre- and post-treatment was calculated. Survival was analyzed using the Kaplan–Meier method, with statistical significance of survival differences assessed using the log-rank test. RESULTS: Median age was 66 (range, 42–84) years. Performance status (PS) Eastern Cooperative Oncology Group (ECOG) was 0–1 in 79/111 patients. The majority of patients (89.2%) had adenocarcinoma histology. At a median follow-up of 47.4 months, median progression-free (mPFS) and overall survival (mOS) was 4.9 (95%CI, 2.8–10.0) and 11.9 (95%CI, 8.2–14.4) months, respectively. Forty-six (43.4%) patients with BM NSCLC underwent first- or further-line therapy with ICIs: 28 (60.8%) received nivolumab, 9 (19.6%) pembrolizumab, and 9 (19.6%) atezolizumab. Of the 46 patients treated with ICIs, 30 (65.2%) underwent BTT: 24 (80.0%) with zoledronate and 6 (20.0%) with denosumab. The ICI-alone group had an mOS of 15.8 months [95%CI, 8.2–not evaluable (NE)] vs. 21.8 months (95%CI, 14.5–not evaluable) for the ICI plus BTT group and 7.5 (95%CI, 6.1–10.9) months for the group receiving other treatments (p < 0.001). NLR ≤5 had a positive impact on OS. CONCLUSION: BTT appears to have a synergistic effect when used in combination with ICIs, improving patient survival. Frontiers Media S.A. 2021-11-10 /pmc/articles/PMC8631508/ /pubmed/34858389 http://dx.doi.org/10.3389/fimmu.2021.697298 Text en Copyright © 2021 Bongiovanni, Foca, Menis, Stucci, Artioli, Guadalupi, Forcignanò, Fantini, Recine, Mercatali, Spadazzi, Burgio, Fausti, Miserocchi and Ibrahim https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Bongiovanni, Alberto
Foca, Flavia
Menis, Jessica
Stucci, Stefania Luigia
Artioli, Fabrizio
Guadalupi, Valentina
Forcignanò, Maria Rosachiara
Fantini, Manuela
Recine, Federica
Mercatali, Laura
Spadazzi, Chiara
Burgio, Marco Angelo
Fausti, Valentina
Miserocchi, Anna
Ibrahim, Toni
Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio
title Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio
title_full Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio
title_fullStr Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio
title_full_unstemmed Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio
title_short Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio
title_sort immune checkpoint inhibitors with or without bone-targeted therapy in nsclc patients with bone metastases and prognostic significance of neutrophil-to-lymphocyte ratio
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631508/
https://www.ncbi.nlm.nih.gov/pubmed/34858389
http://dx.doi.org/10.3389/fimmu.2021.697298
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