The impact of SARS-CoV-2 infection on the survival in NSCLC patients undergoing immunotherapy

Öz

Purpose: The impact of immune checkpoint inhibitor (ICI) utilisation on prognosis and the prognostic value of inflammatory markers (neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation score (SII), prognostic nutrition index (PNI)) in patients with advanced non-small cell lung cancer (NSCLC) were evaluated in the context of the ongoing pandemic. The cut-off values of the prognostic markers were obtained from clinical studies in the literature. Materials and methods: A non-probability sequential sampling technique ensured the study included 104 patients who had received ICI at any stage. Laboratory tests taken at the outset of ICI treatment were recorded, and NLR, PLR, PNI and SII were calculated and 2-year median overall survival (mOS) was then evaluated. Results: The median age of the cohort was 63.99 years, with 98% of patients being male. Infection with SARS-CoV-2 virus was documented in 29 patients (27.9%). The survival results were similar in both groups when the cut-off values were applied for inflamatuar markers. The two-year mOS was 22 months (44.1%). The two-year survival rate of patients who developed a SARS-CoV-2 infection following the administration of an ICI at any stage of treatment was inferior to that of ICI recipients who did not develop the infection (14.3 months vs. 53.6 months; p=0.001). In contrast with previous studies, 57.1% of patients with a PD-L1 level of 0 survived for two years, while only 10% with levels of 1-49 did so (p=0.010). Conclusion: This study revealed a significantly lower two-year survival rate in patients with a positive diagnosis for SARS-CoV-2 during ICI use compared to those without a positive diagnosis (14.3 months; 53.6 months; p=0.001). In the course of our research, we were unsuccessful in identifying a prognostic marker that could be useful in predicting survival in NSCLC patients using ICI in the context of the pandemic. This investigation yielded findings that differed from the conclusions of previous studies. It demonstrated that, contrary to the prevailing view, the two-year survival rate was higher in patients exhibiting PD-L1 '0' than in those with PD-L1:1-49 (57.1%; 10%, p=0.010).

Anahtar Kelimeler

• NSCLC
• COVID-19
• immunotherapy

İmmünoterapi uygulanan NSCLC hastalarında SARS-CoV-2 enfeksiyonunun sağkalım üzerine etkisi

Öz

Amaç: İleri evre küçük hücreli dışı akciğer kanserli (NSCLC) hastalarda immün kontrol noktası inhibitörü (ICI) kullanımının prognoz üzerindeki etkisi ve inflamatuar belirteçlerin (nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR), sistemik immün inflamasyon skoru (SII), prognostik beslenme indeksi (PNI)) prognostik değeri devam eden pandemi bağlamında değerlendirildi. Gereç ve yöntem: Olasılıksız sıralı örnekleme tekniği ile belirlenen tedavinin herhangi bir basamağında ICI almış 104 hastanın çalışmaya dahil edildi. ICI tedavisinin başlangıcında alınan laboratuvar testleri kaydedilerek; NLR, PLR, PNI ve SII hesaplandı. Ardından 2 yıllık medyan genel sağkalım (mOS) değerlendirildi. Prognostik belirteçlerin cut-off değerleri literatürde yer alan klinik çalışmalardan elde edildi. Bulgular: Ortalama tanı yaşı 63,99 yıl olup hastaların %98'i erkekti. SARS-CoV-2 virüsü ile enfekte olan 29 hasta (%27,9) vardı. Enflamatuar belirteçler için kesme değerler uygulandığında sağkalım sonuçları her iki grupta da benzerdi. İki yıllık mOS 22 aydı (%44,1). Tedavinin herhangi bir aşamasında ICI uygulanmasını takiben SARS-CoV-2 enfeksiyonu gelişen hastaların iki yıllık sağkalım oranı, enfeksiyon gelişmeyen ICI alıcılarınınkinden daha düşüktü (14,3 ay; 53,6 ay; p=0,001). Önceki çalışmaların aksine, PD-L1 düzeyi 0 olan hastaların %57,1'i iki yıl boyunca hayatta kalırken, 1-49 düzeyine sahip hastaların yalnızca %10'u hayatta kalmıştır (p=0,010). Sonuç: Bu çalışma, ICI kullanımı sırasında SARS-CoV-2 için pozitif tanı alan hastalarda, pozitif tanı almayanlara kıyasla iki yıllık sağkalım oranının anlamlı derecede düşük olduğunu ortaya koymuştur (14,3 ay; 53,6 ay; p=0,001). Araştırmamızda, pandemi döneminde ICI kullanan NSCLC hastalarında sağkalımı tahmin etmede yararlı olabilecek bir prognostik belirteç tanımlayamadık. Bu araştırma, önceki çalışmaların sonuçlarından farklı olarak, iki yıllık sağkalım oranının PD-L1:'0' olan hastalarda PD-L1:1-49 gösterenlere göre daha yüksek olduğunu göstermiştir (%57,1; %10, p=0,010).

Anahtar Kelimeler

• NSCLC
• COVID-19
• immünoterapi

Kaynakça

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