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Background: Immunotherapy (IO) single agent or combined with chemotherapy (CT-IO) is the standard treatment for advanced non-small-cell lung cancer (aNSCLC) without driver alterations. IO efficacy in patients with novel driver alterations is not well reported., Materials and Methods: Data of aNSCLC patients treated with IO or CT-IO in any line from January 2016 to September 2022 were retrospectively collected. Patients harboring novel driver alterations (m-cohort), including MET exon 14 skipping, BRAF (V600E or atypical), RET rearrangements, HER2 point mutations/exon 20 insertions or uncommon EGFR mutations/EGFR exon 20 insertions, and wild type patients (wt-cohort) were eligible. Clinico-pathological data were extracted from Institutional databases and compared through chi square or Fisher's exact test. Survivals were estimated through Kaplan-Meier method and compared by log-rank test., Results: m-cohort and wt-cohort included 84 and 444 patients, respectively. Progression free survival (PFS) was 5.53 vs. 4.57 months (P= .846) and overall survival (OS) was 25.1 vs. 9.37 months, (P < .0001) for m-cohort compared to wt-cohort. Within the m-cohort, BRAF atypical mutations had the better outcomes (Overall Response Rate [ORR], PFS), targeted agents timing did not affect response to IO and CT-IO had better ORR and disease control rate (DCR) compared to IO single agent (P = .0160 and P = .0152). In the PD-L1≥50% group, first line IO single agent resulted in inferior ORR (P = .027) and PFS (P = .022) in m-cohort compared to wt-cohort., Conclusion: IO based treatments seem not detrimental for patients harboring novel driver alteration. Adding CT could improve modest responses to IO alone. Confirmation on larger datasets is required., Competing Interests: Disclosure Diego Signorelli declares personal fees from AstraZeneca, Merck Sharp and Dohme, Boehringer Ingelheim, BMS, Roche and Sanofy. Arsela Prelaj declares personal fees from AstraZeneca, Italfarmaco, F. Hoffmann-La Roche, BMS. Roberto Ferrara declares advisory role from Merck Sharp and Dohme. Claudia Proto declares personal fees from Italfarmaco, AstraZeneca, BMS and Merck Sharp and Dohme. Giuseppe Lo Russo provided consultation, attended advisory boards and/or provided lectures for the following organizations, from whom received honoraria or education grants: Merck Sharp and Dohme, Takeda, Amgen, Eli Lilly, B.M.S., F. Hoffmann-La Roche, Italfarmaco, Novartis, Sanofi, Pfizer, G.S.K. and AstraZeneca. Marina Chiara Garassino declares personal financial interests with the following organizations: AstraZeneca, Merck Sharp and Dohm, International GmbH, BMS, Boehringer Ingelheim Italia S.P.A, Celgene, Eli Lilly, Ignyta, Incyte, Inivata, MedImmune, Novartis, Pfizer, F. Hoffmann-La Roche, Takeda, Seattle Genetics, Mirati, Daiichi Sankyo, Regeneron, Merck, Ose Immuno Therapeutics, Blueprint, Jansenn, Sanofi; she also declares Institutional financial interests with the following organizations: Eli Lilly, Merck Sharp and Dohm, Pfizer (MISP); AstraZeneca, MSD International GmbH, BMS, Boehringer Ingelheim Italia S.P.A, Celgene, Eli Lilly, Ignyta, Incyte, MedImmune, Novartis, Pfizer, Roche, Takeda, Tiziana, Foundation Medicine, Glaxo Smith Kline GSK, Spectrum pharmaceuticals. Paolo Marchetti provided consultation, attended advisory boards and/or provided lectures for the following organizations, from whom received honoraria or education grants: F. Hoffmann-La Roche, Merck Sharp and Dohme, BMS, AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Novartis and Pfizer. Filippo de Braud provided consultation, attended advisory boards and/or provided lectures for the following organizations, from whom received honoraria or education grants: Amgen, AstraZeneca, Boehringer-Ingelheim, BMS, Eli Lilly, F. Hoffmann-La Roche, Ignyta, Merck Sharp and Dohme, Merck Serono, Novartis, Pfizer. Sara Manglaviti: advisory board for Italpharma; travel accommodation by MSD and Sanofi outside the submitted work. Mario Occhipinti: advosry board for BMS and personal fee by MSD. Laura Mazzeo: travel accomodation by Sanofi. Marta Brambilla: travel accomodation by Lilli and Leo Pharma, Teresa Beninato: travel accomodation by Lilli, MSD, BMS and Sanofi. The other authors report no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Beyond programmed death ligand 1 (PD-L1), no other biomarkers for immunotherapy are used in daily practice. We previously created EPSILoN (Eastern Cooperative Oncology Group performance status (ECOG PS), smoking, liver metastases, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR)) score, a clinical/biochemical prognostic score, in 154 patients treated with second/further-line immunotherapy. This study's aim was to validate EPSILoN score in a different population group., Methods: 193 patients were included at National Cancer Institute of Milan (second-line immunotherapy, 61%; further-line immunotherapy, 39%). Clinical/laboratory parameters such as neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels were collected. Kaplan-Meier and Cox hazard methods were used for survival analysis., Results: Overall median progression-free survival and median overall survival were 2.3 and 7.6 months, respectively. Multivariate analyses for Progression-Free Survival (PFS) identified heavy smokers (hazard ratio (HR) 0.71, p = 0.036) and baseline LDH < 400 mg/dL (HR 0.66, p = 0.026) as independent positive factors and liver metastases (HR 1.48, p = 0.04) and NLR ≥ 4 (HR 1.49, p = 0.029) as negative prognostic factors. These five factors were included in the EPSILoN score which was able to stratify patients in three different prognostic groups, high, intermediate and low, with PFS of 6.0, 3.8 and 1.9 months, respectively (HR 1.94, p < 0.001); high, intermediate and low prognostic groups had overall survival (OS) of 24.5, 8.9 and 3.4 months, respectively (HR 2.40, p < 0.001)., Conclusions: EPSILoN, combining five baseline clinical/blood parameters (ECOG PS, smoking, liver metastases, LDH, NLR), may help to identify advanced non-small-cell lung cancer (aNSCLC) patients who most likely benefit from immune checkpoint inhibitors (ICIs)., Competing Interests: F.M.d.B.: provided consultation, attended advisory boards and/or provided lectures for the following organizations, from whom received honoraria or education grants: Amgen, AstraZeneca, Boehringer-Ingelheim, B.M.S, Eli Lilly, F. Hoffmann-La Roche, Ignyta, Merck Sharp and Dohme, Merck Serono, Novartis, Pfizer. M.C.G: declares personal financial interests with the following organizations: AstraZeneca, MSD International GmbH, BMS, Boehringer Ingelheim Italia S.p.A, Celgene, Eli Lilly, Ignyta, Incyte, Inivata, MedImmune, Novartis, Pfizer, Roche, Takeda; she also declares Institutional financial interests with the following organizations: Eli Lilly, MSD, Pfizer (MISP), AstraZeneca, MSD International GmbH, B.M.S., Boehringer Ingelheim Italia S.p.A, Celgene, Ignyta, Incyte, Inivata, MedImmune, Novartis, Pfizer, Roche, Takeda, Tiziana, Foundation Medicine; at the end, she has received research funding from the following organizations: AIRC, AIFA, Italian Moh, TRANSCAN. G.L.R. declares personal fees from Eli Lilly, B.M.S. and AstraZeneca, outside the submitted work. C.P. declares personal fees from B.M.S. and M.S.D., outside the submitted work. D.S. declares personal fees from AstraZeneca, Boehringer Ingelheim and B.M.S., outside the submitted work. All the authors declare no conflict of interest.

Tyrosine kinase inhibitors are de facto the most commonly used targeted therapies for upfront treatment of metastatic renal cell carcinoma (mRCC). After the first era in which targeted agents were compared with placebo and interferon-α, a new phase has started in recent years characterized by head-to-head trials comparing targeted agents in superiority or non-inferiority trials. Recently, the results a head-to-head phase III trial comparing axitinib to sorafenib as upfront therapy in patients affected by mRCC have been reported. We discuss several critical aspects of this study and the results of our metaanalysis on the activity of axitinib over sorafenib in a larger population with the intent to confirm the superiority of axitinib. Despite this, the definition of primary endpoint remains a central factor in determining the final results of a trial.