NSCLC: peri-immunotherapy lymphopenia worsens outcomes

  • Cho Y & al.
  • Int J Radiat Oncol Biol Phys
  • 30 Aug 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Peri-immunotherapy lymphopenia was associated with significantly worse outcomes in patients with advanced NSCLC, and was more common in those who also received radiotherapy (RT).
  • Stereotactic body radiotherapy/radiosurgery (SBRT/SRS) reduced the risk of RT-associated lymphopenia.

Why this matters

  • There is rising interest in combining immunotherapy with RT.

Study design

  • 268 patients with advanced NSCLC received immunotherapy.
  • Median follow-up, 6.4 months.
  • Funding: Ministry of Science, Korea.

Key results

  • Overall, 54.5% developed lymphopenia before or during immunotherapy.
  • 41.1% of those who received RT (n=146) before or during immunotherapy developed RT-associated lymphopenia.
  • Peri-immunotherapy lymphopenia was more common in patients who received RT before (53.4% vs 32.8%; P=.001) or during (32.2% vs 15.6%; P=.002) immunotherapy.
  • Peri-immunotherapy lymphopenia was significantly associated with poor PFS (aHR, 2.35; P<.001 and os p=".028)," survival was worse among patients who developed lymphopenia within months from immunotherapy initiation.>
  • RT was associated with a significant increase in peri-immunotherapy lymphopenia risk (aOR, 1.91; P=.025).
  • Multiple courses of RT (aOR, 3.78; P<.001 multiple irradiated sites p=".018)," and high rt doses increased lymphopenia risk after rt.>
  • SBRT/SRS were associated with a reduced risk of RT-associated lymphopenia (aOR, 0.21; P=.002).

Limitations

  • Single-center, retrospective study.