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. 2020 Mar;146(3):777-785.
doi: 10.1007/s00432-019-03104-w. Epub 2019 Dec 11.

The efficacy of immune checkpoint inhibitors in advanced non-small-cell lung cancer with liver metastases

Rui Kitadai  1 , Yusuke Okuma  2   3 , Taiki Hakozaki  1 , Yukio Hosomi  1
Affiliations

The efficacy of immune checkpoint inhibitors in advanced non-small-cell lung cancer with liver metastases

Rui Kitadai et al. J Cancer Res Clin Oncol. 2020 Mar.

Abstract

Objectives: Although liver metastasis has been known to be associated with poor prognosis, only a few studies have shown an association between liver metastasis and treatment outcomes with immune checkpoint inhibitors (ICI). Furthermore, factors associated with prognosis have remained unclear. The present study therefore evaluates the efficacy of nivolumab, pembrolizumab, and atezolizumab among patients with non-small cell lung cancer (NSCLC) who had liver metastasis and identifies factors correlated with prognosis.

Materials and methods: A total of 215 patients with advanced and recurrent NSCLC who received ICI therapy at a single center were retrospectively reviewed. A total of 41 patients (19.1%) had liver metastasis upon initiation of ICI therapy. Overall, 125, 64, and 26 patients were treated with nivolumab, pembrolizumab, and atezolizumab, respectively.

Results: Among the included patients, those with liver metastasis had shorter overall survival (OS) [hazard ratio (HR), 2.04; 95% CI 1.33-3.13] and progression-free survival (PFS) (HR, 1.89; 95% CI 1.29-1.71) compared to those without the same. Patients with liver metastasis had a response rate (RR) of 22.5%. Among patients with liver metastasis, inferior OS was associated with low albumin, poor Eastern Cooperative Oncology Group performance status, driver mutation, and number of liver metastasis (≥ 5). Moreover, patients with liver metastasis who had good Royal Marsden Hospital (0-1) and Gustave Roussy Immune (0-1) scores showed significantly longer OS and PFS.

Conclusion: Despite the poor outcomes with ICI treatment in patients with advanced and recurrent NSCLC who had liver metastasis, some characteristics among patients with liver metastasis may be associated with prognosis.

Keywords: Atezolizumab; Liver metastasis; Nivolumab; Non-small-cell lung cancer; Overall survival; Pembrolizumab.

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Conflict of interest statement

YO has received honoraria from AstraZeneca Japan, Boehringer-Ingelheim Japan, Chugai Pharmaceutical Co. Ltd., Eli Lily Co. Ltd., MSD K. K., and Ono Pharmaceutical Co. The other authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for overall survival (a) and progression free survival (b) according to liver metastasis status
Fig. 2
Fig. 2
Kaplan–Meier curves for overall survival (a) and progression free survival (b) according to RMH Score among patients with liver metastasis
Fig. 3
Fig. 3
Kaplan–Meier curves for overall survival (a) and progression free survival (b) according to GRIm-score among patients with liver metastasis
See this image and copyright information in PMC

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