Pretreatment clinical and hematological predictors of efficacy and immune-related adverse events in patients with advanced non-small cell lung cancer receiving first-line chemotherapy combined with immune checkpoint inhibitors

BACKGROUND: The combination of immune checkpoint inhibitors (ICI) and platinum-based chemotherapy has rapidly become the standard first-line treatment for advanced or metastatic non-small cell lung cancer (NSCLC). However, identifying reliable predictive factors of treatment response remains a significant clinical challenge. This study comprehensively analyzed pretreatment predictive factors in patients with advanced lung cancer who received first-line ICI–chemotherapy combination therapy. METHODS: We retrospectively analyzed clinical data from 100 patients with advanced NSCLC who received first-line ICI–chemotherapy. Univariate and multivariate Cox proportional hazards regression analyses were used to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). Univariate logistic regression analysis was used to identify factors affecting the incidence of immune-related adverse events (irAEs). RESULTS: Multivariate analysis for PFS identified Eastern Cooperative Oncology Group performance status (ECOG-PS), number of metastases, lactate dehydrogenase level, cytokeratin 19 fragment antigen level, and programmed death-ligand 1 expression as independent predictors of PFS. Multivariate analysis for OS identified ECOG-PS, number of metastases, and neutrophil-to-lymphocyte ratio as significant independent predictors of OS. Patients with liver metastases showed a significantly lower incidence of irAEs than patients without liver metastases (8.3% vs. 29.7%, P = 0.013). The occurrence of irAEs was associated with longer PFS and OS. CONCLUSION: This study identified pretreatment clinical and hematological factors that could predict the efficacy of ICI–chemotherapy. Furthermore, the absence of liver metastases was associated with a higher incidence of irAEs. These results underscore the critical need for individualized treatments and potential adjustment of strategies for high-risk groups to achieve a long-term durable response and better survival.