Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer
Introduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2021.734735/full |
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| author | Mark Stares Mark Stares Amanda Swan Kirsten Cumming Tze-En Ding James Leach Cory Stratton Findlay Thomson Colin Barrie Kirsty MacLennan Sorcha Campbell Tamasin Evans Aisha Tufail Stephen Harrow Melanie MacKean Iain Phillips Iain Phillips |
| author_facet | Mark Stares Mark Stares Amanda Swan Kirsten Cumming Tze-En Ding James Leach Cory Stratton Findlay Thomson Colin Barrie Kirsty MacLennan Sorcha Campbell Tamasin Evans Aisha Tufail Stephen Harrow Melanie MacKean Iain Phillips Iain Phillips |
| author_sort | Mark Stares |
| collection | DOAJ |
| description | Introduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers. We evaluated the prognostic significance of albumin in patients receiving first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC.Methods: All patients treated with first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC at a regional Scottish cancer centre were identified. Serum albumin at pre-treatment, after 12-weeks of treatment, and at the time of progressive disease were recorded. The relationship between albumin (≥ 35g/L v <35g/L) and overall survival (OS) was examined.Results: Data were available for 389 patients of both targeted therapy cohort (n = 159) and immunotherapy-based therapy cohort (n = 230). Pre-treatment albumin was predictive of OS in each cohort at HR1.82 (95%CI 1.23–2.7) (p =0.003) and HR2.55 (95%CI 1.78–3.65) (p < 0.001), respectively. Pre-treatment albumin <35 g/L was associated with a significantly higher relative risk of death within 12 weeks in each cohort at RR9.58 (95%CI 2.20–41.72, p = 0.003) and RR3.60 (95%CI 1.74–6.57, p < 0.001), respectively. The 12-week albumin was predictive of OS in each cohort at HR1.88 (95%CI 1.86–4.46) (p < 0.001) and HR2.67 (95%CI 1.74–4.08) (p < 0.001), respectively. 46 out of 133 (35%) evaluable patients treated with targeted therapy and 43 out of 169 (25%) treated with immunotherapy-based therapy crossed over albumin prognostic groups between pre-treatment and 12-week. The prognostic value of 12-week albumin was independent of pre-treatment albumin status. A majority of patients had albumin <35g/L at the time of progressive disease when it was also predictive of survival following progressive disease at HR2.48 (95%CI 1.61–3.82) (p < 0.001) and HR2.87 (95%CI 1.91–4.31) (p < 0.001) respectively).Conclusions: Albumin is a reliable prognostic factor in patients with metastatic NSCLC, predicting survival independent of the class of drug treatment at various time points during the patient journey. Tracking albumin concentrations during systemic therapy may indicate disease activity or treatment response over time. |
| first_indexed | 2024-12-17T01:22:38Z |
| format | Article |
| id | doaj.art-207d54c6c7194b8f83f5f44fc9aad494 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-12-17T01:22:38Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj.art-207d54c6c7194b8f83f5f44fc9aad4942022-12-21T22:08:46ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2021-10-01810.3389/fnut.2021.734735734735Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung CancerMark Stares0Mark Stares1Amanda Swan2Kirsten Cumming3Tze-En Ding4James Leach5Cory Stratton6Findlay Thomson7Colin Barrie8Kirsty MacLennan9Sorcha Campbell10Tamasin Evans11Aisha Tufail12Stephen Harrow13Melanie MacKean14Iain Phillips15Iain Phillips16Edinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Research UK Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Research UK Centre, Edinburgh, United KingdomEdinburgh Cancer Research UK Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Centre, Edinburgh, United KingdomEdinburgh Cancer Research UK Centre, Edinburgh, United KingdomIntroduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers. We evaluated the prognostic significance of albumin in patients receiving first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC.Methods: All patients treated with first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC at a regional Scottish cancer centre were identified. Serum albumin at pre-treatment, after 12-weeks of treatment, and at the time of progressive disease were recorded. The relationship between albumin (≥ 35g/L v <35g/L) and overall survival (OS) was examined.Results: Data were available for 389 patients of both targeted therapy cohort (n = 159) and immunotherapy-based therapy cohort (n = 230). Pre-treatment albumin was predictive of OS in each cohort at HR1.82 (95%CI 1.23–2.7) (p =0.003) and HR2.55 (95%CI 1.78–3.65) (p < 0.001), respectively. Pre-treatment albumin <35 g/L was associated with a significantly higher relative risk of death within 12 weeks in each cohort at RR9.58 (95%CI 2.20–41.72, p = 0.003) and RR3.60 (95%CI 1.74–6.57, p < 0.001), respectively. The 12-week albumin was predictive of OS in each cohort at HR1.88 (95%CI 1.86–4.46) (p < 0.001) and HR2.67 (95%CI 1.74–4.08) (p < 0.001), respectively. 46 out of 133 (35%) evaluable patients treated with targeted therapy and 43 out of 169 (25%) treated with immunotherapy-based therapy crossed over albumin prognostic groups between pre-treatment and 12-week. The prognostic value of 12-week albumin was independent of pre-treatment albumin status. A majority of patients had albumin <35g/L at the time of progressive disease when it was also predictive of survival following progressive disease at HR2.48 (95%CI 1.61–3.82) (p < 0.001) and HR2.87 (95%CI 1.91–4.31) (p < 0.001) respectively).Conclusions: Albumin is a reliable prognostic factor in patients with metastatic NSCLC, predicting survival independent of the class of drug treatment at various time points during the patient journey. Tracking albumin concentrations during systemic therapy may indicate disease activity or treatment response over time.https://www.frontiersin.org/articles/10.3389/fnut.2021.734735/fullalbumin (ALB)non-small cell lung (NSCLC)prognostic biomarkersystemic anticancer therapytargeted therapiesimmunotherapies |
| spellingShingle | Mark Stares Mark Stares Amanda Swan Kirsten Cumming Tze-En Ding James Leach Cory Stratton Findlay Thomson Colin Barrie Kirsty MacLennan Sorcha Campbell Tamasin Evans Aisha Tufail Stephen Harrow Melanie MacKean Iain Phillips Iain Phillips Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer Frontiers in Nutrition albumin (ALB) non-small cell lung (NSCLC) prognostic biomarker systemic anticancer therapy targeted therapies immunotherapies |
| title | Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer |
| title_full | Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer |
| title_fullStr | Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer |
| title_full_unstemmed | Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer |
| title_short | Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer |
| title_sort | hypoalbuminaemia as a prognostic biomarker of first line treatment resistance in metastatic non small cell lung cancer |
| topic | albumin (ALB) non-small cell lung (NSCLC) prognostic biomarker systemic anticancer therapy targeted therapies immunotherapies |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2021.734735/full |
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