Highlights
- •High–tumour infiltrating lymphocyte (TIL) density was associated with immunotherapy benefit in non–small cell lung cancer (NSCLC) patients.
- •No correlation with outcome was observed in chemotherapy-treated patients with NSCLC.
- •TILs may be useful in selecting patients for immunotherapy.
Abstract
Background
The established role of morphological evaluation of tumour-infiltrating lymphocytes
(TILs) with immune checkpoint inhibitors (ICIs) in non–small cell lung cancer (NSCLC)
is unknown. We aimed to determine TIL association with the outcome for ICIs and for
chemotherapy in advanced NSCLC.
Methods
This is a multicenter retrospective study of a nivolumab cohort of 221 patients treated
between November 2012 and February 2017 and a chemotherapy cohort of 189 patients
treated between June 2009 and October 2016. Patients with available tissue for stromal
TIL evaluation were analysed. The presence of a high TIL count (high-TIL) was defined
as ≥10% density. The primary end-point was overall survival (OS).
Results
Among the nivolumab cohort, 64% were male, with median age of 63 years, 82.3% were
smokers, 77% had performance status ≤1 and 63% had adenocarcinoma histology. High-TIL
was observed in 22% patients and associated with OS (hazard ratio [HR] 0.48; 95% confidence
interval [95% CI]: 0.28–0.81) and progression-free survival [PFS] (HR = 0.40; 95%
CI: 0.25–0.64). Median PFS was 13.0 months (95% CI: 5.0–not reached) with high-TIL
versus 2.2 months (95% CI: 1.7–3.0) with the presence of a low TIL count (low-TIL).
Median OS for high-TIL was not reached (95% CI: 12.2–not reached) versus 8.4 months
(95% CI: 5.0–11.6) in the low-TIL group. High-TIL was associated with the overall
response rate (ORR) and disease control rate (DCR) (both, P < .0001). Among the chemotherapy cohort, 69% were male, 89% were smokers, 86% had
performance status ≤1 and 90% had adenocarcinoma histology. High-TIL was seen in 37%.
Median PFS and OS were 5.7 months (95% CI: 4.9–6.7) and 11.7 months (95% CI: 9.3–13.0),
respectively, with no association with TILs.
Conclusions
High-TIL was associated with favourable outcomes in a real-world immunotherapy cohort
of patients with NSCLC, but not with chemotherapy, suggesting that TILs may be useful
in selecting patients for immunotherapy.
Keywords
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Article info
Publication history
Published online: January 27, 2021
Accepted:
October 8,
2020
Received in revised form:
October 1,
2020
Received:
June 12,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
