Akademik Veri Yönetim Sistemi
Journal of Oncological Science, cilt.11, sa.2, ss.126-133, 2025 (Scopus)
Objective: Although immune checkpoint inhibitors have transformed routine oncology practice in the treatment of advanced non-small cell lung cancer (NSCLC), the identification of reliable predictive biomarkers, particularly in the second-line setting, remains an unmet clinical need. In this context, where programmed death-ligand 1 (PD-L1) expression alone is often inadequate, the Royal Marsden Hospital (RMH) score, which integrates objective laboratory and imaging data, has emerged as a potential prognostic tool for various cancer types. This study aims to evaluate the predictive value of the RMH score in patients with advanced NSCLC receiving second-line nivolumab and to investigate its role in stratifying patients based on treatment efficacy and survival outcomes. Material and Methods: This retrospective study explores the association between the RMH score, assessed prior to immunotherapy initiation, and survival outcomes in metastatic NSCLC patients. Fifty patients who received second-line nivolumab between 2010 and 2023 were included. The RMH score was categorized into low-risk (0-1) and high-risk (2-3) groups based on baseline serum albumin levels, lactate dehydrogenase levels, and metastatic burden. Patients with conditions affecting these biomarkers were excluded. All assessments were conducted before the initiation of nivolumab. Results: The RMH score was a significant predictor of survival in metastatic NSCLC patients receiving second-line nivolumab. High-risk patients had a median overall survival (OS) of 4 months, while those in the low-risk group had a median OS of 15 months [hazard ratio (HR)=3.1, p=0.003]; and a median progression-free survival (PFS) of 3 months versus a median PFS of 8 months in the low-risk group (HR=2.4, p=0.008). In multivariate analysis, the RMH score remained the significantly independent predictor of OS, while PD-L1 expression showed no significant impact. Conclusion: Our study highlights the RMH score, based on radiological and laboratory parameters, as a predictive marker for survival in metastatic NSCLC patients treated with second-line nivolumab.