Predicting Treatment Outcomes in NSCLC

David Oubre, MD, a medical oncologist and founder of the Pontchartrain Cancer Center in Louisiana, discusses how results of the INSIGHT study (NCT03289780) shows that tests themselves for biomarkers in patients with non–small cell lung cancer (NSCLC) can predict treatment outcomes.

In the case of the INSIGHT study, researchers saw that performing blood-based host immune classifier (HIC) proteomic testing in patients with NSCLC showed that patients with HIC cold tumors, that often have poorer results when treated with monotherapy, still had poorer results regardless of their PD-L1 expression. Moreover, those with HIC hot tumors had more favorable results even if they didn’t reach their studies median overall survival (OS).

In the INSIGHT trial, results showed real world data that HIC results were independent of PD-L1 and in a subgroup of patients with PD-L1 expression at 50% or greater, with an ECOG performance status of 0 or 1, HIC stratified significantly for patients on an immune checkpoint inhibitor (ICI) monotherapy but not patients on the ICI with chemotherapy. Overall, the median OS for patients with HIC high tumors (95% CI, 15.4-undefined months) was not reached but for compared to 5 months (95% CI, 2.9-6.4) for HIC cold patients (HR=0.38; 95% CI 0.27-0.53, P < 0.0001). However, for patients on ICI monotherapy median OS was 16.8 months vs 2.8 months for those not on the monotherapy (HR = 0.36; 95% CI, 0.22- 0.58, P < 0.0001).

In an interview with Targeted Oncology^TM, Oubre explained that while this study didn’t exactly look at a patients mutation in their disease the overarching tests for biomarker driven lung cancers allows for a deeper understanding of the type of treatment the patient needs. For example, doing these tests can help determine how long a patients OS would be on monotherapy but if a biomarker is caught like ALK1 then clinicians can narrow down, which treatments will work best.

TRANSCRIPT:

0:08 | The study showed that response to immunotherapy could also be predicted by the test. What we got was the level of the host immune factor would either be hot or cold. If a patient was HIC hot, then the average survival of a patient getting immunotherapy was not reached in the study. I [believe] that 15.4 months was the minimum [in this case].

0:50 |

We knew that it was going to be at least 15.4 months, but the number wasn't reached [in patients that were considered HIC hot]. Whereas in patients who were HIC cold, the average survival was 5 months. We're talking about a difference of almost a year in patients who are HIC hot and HIC cold. It was very predictive of survival, which is the ultimate outcome in these patients.