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Publications

Journal Article Ahead of print

PubMed: 42520592 DOI: 10.1016/j.ejca.2026.116955

Validation of the lung immune prognostic index in extensive-stage small cell lung cancer: Post hoc analysis of the caspian and IMpower133 phase 3 trials.

Eur J Cancer 245:116955

Authors: Edouard Auclin, Matthieu Roulleaux Dugage, Teresa Gorría, Juan Carlos Laguna, Diana Anguita, Angela Montes, Michele Rota, Miquel Ferriol-Galmes, Charles Vauchier, Pernelle Lavaud, Benjamin Besse, Laura Mezquita

Affiliations

  • Medical Oncology Department, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris Cité, Inserm U970, PARCC, Paris F-75015, France.
  • Clinical Research Division, Institut Gustave Roussy, Villejuif, France.
  • Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain; MECA (Environment & Cancer) Group, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Spain; Department of Medicine, University of Barcelona, Spain.
  • Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain; MECA (Environment & Cancer) Group, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Spain.
  • MECA (Environment & Cancer) Group, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Spain.
  • Medical Oncology Department, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
  • Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain; MECA (Environment & Cancer) Group, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Spain; Department of Medicine, University of Barcelona, Spain.

Abstract

BACKGROUND

The Lung Immune Prognostic Index (LIPI) is an inflammation-based biomarker associated with outcomes to immunotherapy across several tumor types. Its prognostic value in extensive-stage small-cell lung cancer (ES-SCLC), however, remains insufficiently validated. We aimed to validate the prognostic impact of LIPI in ES-SCLC using data from two phase III trials.

METHODS

Patients enrolled in the CASPIAN (NCT03043872) and IMpower133 (NCT02763579) trials were included. LIPI groups were defined as good (dNLR<3 and LDH<ULN), intermediate (dNLR≥3 or LDH≥ULN) and poor (dNLR≥3 and LDH≥ULN). Overall survival (OS) and progression-free survival (PFS) were assessed across LIPI categories and treatment arms.

RESULTS

LIPI was available for 1140 patients (Good: 34%, Intermediate: 49%, Poor: 17%), including 708 treated with chemotherapy-immunotherapy and 432 with chemotherapy alone. Poor LIPI was associated with unfavorable characteristics, including lower albumin levels and higher rate of liver metastases. Median OS was 14.6 months (95%CI: 12.4-15.9) for LIPI Good, 10.9 (10.1-11.5) for Intermediate, and 8.4 (7.1-9.3) for Poor (p < 0.0001). In multivariate models adjusted on gender, age, ECOG, treatment arm and metastatic sites, LIPI remained an independent prognostic factor for OS (HR Poor vs. Good: 1.76, 95%CI: 1.45-2.15, p < 0.001) and PFS (HR: 1.59, 95%CI: 1.33-1.90, p < 0.001). Although patients with poor LIPI derived limited benefit from immunotherapy, no significant treatment-LIPI interaction was observed.

CONCLUSION

This large post hoc analysis confirms LIPI as a robust and clinically applicable prognostic biomarker in ES-SCLC. Patients with poor LIPI have substantially worse outcomes and limited benefit from immunotherapy, highlighting the need for novel therapeutic strategies in this subgroup.

MeSH

Cells, Lung, Neoplasms, Drug Therapy, Biomarkers, Immunotherapy, Lung Neoplasms, Small Cell Lung Carcinoma, Therapeutics, Chemotherapy