# Prediction of survival and outcomes with depth of response at 6 months in metastatic non-small-cell lung cancer patients treated with chemotherapy and immunotherapy combination: SPORE trial

## TL;DR

This study shows that the depth of tumor response after 6 months of treatment can predict survival in lung cancer patients receiving immunotherapy and chemotherapy.

## Contribution

The study identifies depth of radiological response at 6 months as a novel predictor of overall survival in metastatic NSCLC patients.

## Key findings

- Patients with deeper tumor shrinkage at 6 months had significantly lower risk of death compared to those with moderate shrinkage.
- Depth of response according to RECIST 1.1 criteria at 6 months predicts overall survival in mNSCLC patients.
- Median overall survival was 35 months for the entire cohort, with group 1 showing the best outcomes.

## Abstract

Metastatic non-small-cell lung carcinoma (mNSCLC) first-line therapy is based on the combination of chemotherapy with immune checkpoint inhibitors (ICIs). Early assessment of long-term outcomes may be crucial to guide clinician’s decisions. Whether radiological depth of response (DpR) could be a surrogate of survival remains unsolved.

This study aims to evaluate the correlation between the DpR at 6 months and survival in patients presenting an mNSCLC treated with ICI chemotherapy in a first-line metastatic setting.

This retrospective multicenter study included mNSCLC patients treated with ICI chemotherapy, still on first-line therapy at 6 months, with measurable disease. Patients were classified into four groups according to radiological assessment at 6 months of the beginning of first-line therapy using RECIST criteria 1.1: group 1: −100% to −60%, group 2: −59% to −30%, group 3: 0% to −29% and group 4: 0% and more. We evaluate the impact of DpR on survival with the Cox model using group 3 (0% to −29%) as the reference.

The analysis included 175 patients: (median age: 61 years, adenocarcinoma: 82.3%; brain metastasis: 25.7%, PD-L1 ≥ 1%: 56.0%. Patients were in groups 1, 2, 3 and 4 in 21.1%, 31.5%, 29.7% and 17.7% of cases, respectively. Median overall survival and progression-free survival were 35.0 months [95% confidence interval (CI), 31.0-NA], and 17.1 months (95% CI, 14.0-23.9 months), respectively. Patients in group 1 and 2 had a significantly lower risk of death compared with group 3 [Hazard ratio (HR) = 0.31, 95% CI, 0.14-0.68, P = 0.003, and HR = 0.53, 95% CI, 0.30-0.92, P = 0.025, respectively].

Depth of response at 6 months according to RECIST 1.1 criteria for patients with mNSCLC still on first-line therapy is a predictor of overall survival.

•Early prediction of long-term efficacy of ICI chemotherapy combinations in metastatic NSCLC remains a challenge.•Impact of early radiological depth of response on the efficacy of chemo-immunotherapy in metastatic NSCLC is poorly studied.•Depth of RECIST 1.1 response at 6 months for mNSCLC patients still on first-line therapy appears to be a predictor of OS.

Early prediction of long-term efficacy of ICI chemotherapy combinations in metastatic NSCLC remains a challenge.

Impact of early radiological depth of response on the efficacy of chemo-immunotherapy in metastatic NSCLC is poorly studied.

Depth of RECIST 1.1 response at 6 months for mNSCLC patients still on first-line therapy appears to be a predictor of OS.