Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study

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Abstract
The present study aimed to assess whether the baseline pan‑immune‑inflammation value (PIV), a readily available blood‑based marker, is linked to benefits from nivolumab treatment (response and survival) in patients with metastatic non‑small cell lung cancer (mNSCLC) receiving second‑line or later therapy. The data of 303 patients diagnosed with mNSCLC who received nivolumab at Kartal Dr Lütfi Kırdar City Hospital (Istanbul, Türkiye) between January 2022 and December 2023 were retrospectively reviewed. After excluding 33 ineligible cases, 270 patients were included in the final analysis. PIV was calculated from pre‑treatment peripheral blood counts. The median overall survival (OS) and progression‑free survival (PFS) times were assessed from the start of nivolumab treatment. Programmed death‑ligand 1 expression data were unavailable in this real‑world cohort, reflecting routine clinical practice. The median age was 63 years, and 84.1% of patients were male. The median OS and PFS times were 16 and 7 months, respectively. The patient responses were as follows: Progressive disease in 41.1%, partial response in 30.4%, stable disease in 22.2% and complete response in 6.3% of patients. Receiver operating characteristic analysis identified an optimal PIV cut‑off of 604.5 for predicting nivolumab response. Patients with low PIV values had significantly longer median OS (25 vs. 11 months) and PFS (9 vs. 5 months) times, and a lower rate of nivolumab resistance (38.7 vs. 61.3%; P<0.001). Baseline PIV was confirmed as a significant predictor of nivolumab response (specificity, 62.9%; sensitivity, 61.3%; P<0.001). Upon multivariate logistic regression analysis, high PIV, blood group B antigen, Eastern Cooperative Oncology Group performance status 2 and lack of response to prior chemotherapy were identified as independent predictors of nivolumab resistance. In this real‑world cohort, results were consistent with the known activity of nivolumab in previously treated mNSCLC. Baseline PIV was associated with treatment outcomes and may serve as a convenient, blood‑based marker to inform immunotherapy decision‑making. Further prospective validation is needed before routine clinical use.

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