Pretreatment advanced lung cancer inflammation index (<scp>ALI</scp>) for predicting early progression in nivolumab‐treated patients with advanced non–small cell lung cancer

<jats:title>Abstract</jats:title><jats:p>Programmed death‐ligand 1 (<jats:styled-content style="fixed-case">PD</jats:styled-content>‐L1) expression status is inadequate for indicating nivolumab in patients with non–small cell lung cancer (<jats:styled-content style="fixed-case">NSCLC</jats:styled-content>). Because the baseline advanced lung cancer inflammation index (<jats:styled-content style="fixed-case">ALI</jats:styled-content>) is reportedly associated with patient outcomes, we investigated whether the pretreatment <jats:styled-content style="fixed-case">ALI</jats:styled-content> is prognostic in <jats:styled-content style="fixed-case">NSCLC</jats:styled-content> patients treated with nivolumab. We retrospectively reviewed the medical records of all patients treated with nivolumab for advanced <jats:styled-content style="fixed-case">NSCLC</jats:styled-content> between December 2015 and May 2016 at three Japanese institutes. Multivariate logistic regression and Cox proportional hazards models were used to assess the impact of the pretreatment <jats:styled-content style="fixed-case">ALI</jats:styled-content> (and other inflammation‐related parameters) on progression‐free survival (<jats:styled-content style="fixed-case">PFS</jats:styled-content>) and early progression (i.e., within 8 weeks after starting nivolumab). A total of 201 patients were analyzed; their median age was 68 years (range, 27–87 years), 67% were men, and 24% had an Eastern Cooperative Oncology Group (<jats:styled-content style="fixed-case">ECOG</jats:styled-content>) performance status of 2 or higher. An <jats:styled-content style="fixed-case">ECOG</jats:styled-content> performance status ≥2, serum albumin <3.7 g/<jats:styled-content style="fixed-case">dL</jats:styled-content>, neutrophil‐to‐lymphocyte ratio ≥4, and <jats:styled-content style="fixed-case">ALI</jats:styled-content> <18 were significantly associated with poor <jats:styled-content style="fixed-case">PFS</jats:styled-content> and early progression on univariate analysis. Multivariate analyses revealed that pretreatment <jats:styled-content style="fixed-case">ALI</jats:styled-content> <18 was independently associated with inferior <jats:styled-content style="fixed-case">PFS</jats:styled-content> (median, 1.4 vs. 3.7 months, <jats:italic>P</jats:italic> < 0.001) and a higher likelihood of early progression (odds ratio, 2.76; 95% confidence interval 1.44–5.34; <jats:italic>P</jats:italic> = 0.002). The pretreatment <jats:styled-content style="fixed-case">ALI</jats:styled-content> was found to be a significant independent predictor of early progression in patients with advanced <jats:styled-content style="fixed-case">NSCLC</jats:styled-content> receiving nivolumab, and may help identify patients likely to benefit from continued nivolumab treatment in routine clinical practice.</jats:p>