Étude rétrospective des facteurs cliniques et biologiques associés à la réponse à l’immunothérapie dans les cancers bronchiques non à petites cellules de stade avancé

Background. There is a significant growth in the patients population treated by immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) but only a small proportion would benefit from these treatments. Routinely available and reproducible biomarkers for outcome after ICI therapy are strongly needed as these may influence individual treatment selection or sequence, and thus survival. Methods. We aimed to identify clinical and biological baseline factors associated with ICIs benefit in advanced NSCLC patients and compare results with literature data. Clinical characteristics, routine blood count and biochemical parameters were investigated in two French centers (Paris and Grenoble). Results. From 2014 until 2018, 152 patients were included; median age was 63 (interquartile range, 57-70) years; 114 (75%) were male; 104 (68%) were current smokers, 90 (59%) had performance status 0-1; 106 (70%) had adenocarcinoma; 129 (85%) received second-line or more ICIs. In 91 patients with available data, 44 (48%) expressed PD-L1 in ≥ 50% of tumor cells, 25 (28%) in 1-49% of cells, and 22 (24%) were PD-L1-negative. Poor baseline LIPI, combining dNLR greater than 3 and LDH greater than upper limit of normal, was observed in 16 (10.5%). After a median follow-up of 6.5 months (interquartile range 3.2-15.4), the median OS was 18 months (95% CI 11.3-not reached). They received a median of six injections (interquartile range=3-16) of ICI. ICI was an anti-PD1 in 87 % of cases, an anti-PDL1 in 5 % and a combination in 8% of cases. The incidence rate of any grade treatment-related adverse events was 37.5%. No clinical or biological factors were correlated with immunotherapy clinical benefit in NSCLC. Conclusion. Our real-life study finds results comparable to the literature in terms of survival and response but doesn’t permit to identify a marker associated with ICI’s response.Bien que l’essor de l’immunothérapie ait révolutionné la prise en charge des patients atteints d’un cancer bronchique non à petites cellules (CBNPC), seule une faible proportion d'entre eux répondent au traitement. Des marqueurs disponibles en routine et associés à la réponse aux inhibiteurs de point de contrôle immunitaires (ICI) sont nécessaires car ils pourraient définir un meilleur positionnement de l’immunothérapie dans l’arsenal thérapeutique. Notre objectif était d'identifier des facteurs cliniques et biologiques associés à la réponse aux ICI. Les caractéristiques cliniques, la numération sanguine et les paramètres biochimiques ont été étudiés dans deux centres français (Paris et Grenoble).De 2014 à 2018, 152 patients ont été inclus. L’âge médian était de 63 ans, 75% (n=114) étaient des hommes, 68% (n=104) étaient des fumeurs actifs ou sevrés depuis