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

Authors :
De Giglio A
Leonetti A
Comito F
Filippini DM
Mollica V
Rihawi K
Peroni M
Mazzaschi G
Ricciotti I
Carosi F
Marchetti A
Rosellini M
Gagliano A
Favorito V
Nobili E
Gelsomino F
Melotti B
Marchese PV
Sperandi F
Di Federico A
Buti S
Perrone F
Massari F
Pantaleo MA
Tiseo M
Ardizzoni A
Source :
Cancer immunology, immunotherapy : CII [Cancer Immunol Immunother] 2024 Oct 03; Vol. 73 (12), pp. 246. Date of Electronic Publication: 2024 Oct 03.
Publication Year :
2024

Abstract

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.<br />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.<br />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 (nā€‰=ā€‰255) (AUC 0.72, 95% CI 0.64-0.80).<br />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.<br /> (© 2024. The Author(s).)

Details

Language :
English
ISSN :
1432-0851
Volume :
73
Issue :
12
Database :
MEDLINE
Journal :
Cancer immunology, immunotherapy : CII
Publication Type :
Academic Journal
Accession number :
39358642
Full Text :
https://doi.org/10.1007/s00262-024-03836-w