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EARLY CHANGES IN ALBUMIN PREDICT BENEFIT FROM IMMUNE CHECKPOINT INHIBITORS IN ADVANCED NON-SMALL CELL LUNG CANCERYizhen Guo1, Lai Wei2, Mitch A. Phelps1, and Dwight Owen31Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University2Center for Biostatistics, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute3Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research InstituteIntroduction: Hypoalbuminemia is prognostic for worse outcomes in patients with solid tumors ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cDfX7Kwk","properties":{"formattedCitation":"\\super 1\\nosupersub{}","plainCitation":"1","noteIndex":0},"citationItems":[{"id":2171,"uris":[""],"uri":[""],"itemData":{"id":2171,"type":"article-journal","abstract":"Background: There are several methods of assessing nutritional status in cancer of which serum albumin is one of the most commonly used. In recent years, the role of malnutrition as a predictor of survival in cancer has received considerable attention. As a result, it is reasonable to investigate whether serum albumin has utility as a prognostic indicator of cancer survival in cancer. This review summarizes all available epidemiological literature on the association between pretreatment serum albumin levels and survival in different types of cancer.\nMethods: A systematic search of the literature using the MEDLINE database (January 1995 through June 2010) to identify epidemiologic studies on the relationship between serum albumin and cancer survival. To be included in the review, a study must have: been published in English, reported on data collected in humans with any type of cancer, had serum albumin as one of the or only predicting factor, had survival as one of the outcome measures (primary or secondary) and had any of the following study designs (case-control, cohort, cross-sectional, case-series prospective, retrospective, nested case-control, ecologic, clinical trial, meta-analysis).\nResults: Of the 29 studies reviewed on cancers of the gastrointestinal tract, all except three found higher serum albumin levels to be associated with better survival in multivariate analysis. Of the 10 studies reviewed on lung cancer, all excepting one found higher serum albumin levels to be associated with better survival. In 6 studies reviewed on female cancers and multiple cancers each, lower levels of serum albumin were associated with poor survival. Finally, in all 8 studies reviewed on patients with other cancer sites, lower levels of serum albumin were associated with poor survival.\nConclusions: Pretreatment serum albumin levels provide useful prognostic significance in cancer. Accordingly, serum albumin level could be used in clinical trials to better define the baseline risk in cancer patients. A critical gap for demonstrating causality, however, is the absence of clinical trials demonstrating that raising albumin levels by means of intravenous infusion or by hyperalimentation decreases the excess risk of mortality in cancer.","container-title":"Nutrition Journal","DOI":"10.1186/1475-2891-9-69","ISSN":"1475-2891","issue":"1","journalAbbreviation":"Nutr J","language":"en","page":"69","source":" (Crossref)","title":"Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature","title-short":"Pretreatment serum albumin as a predictor of cancer survival","volume":"9","author":[{"family":"Gupta","given":"Digant"},{"family":"Lis","given":"Christopher G"}],"issued":{"date-parts":[["2010",12]]}}}],"schema":""} 1, but the association of albumin changes with the outcomes from immune checkpoint inhibitors (ICIs) is still unknown. Methods: This was a retrospective study of patients with untreated stage IV non-small cell lung cancer (NSCLC) who received ICI monotherapy with or without chemotherapy between 2011 and 2020. The predictive role of baseline and on-treatment albumin on overall survival (OS) was evaluated in survival analysis and Cox regression analysis. Other established biomarkers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lactate dehydrogenase (LDH), were also evaluated along with albumin. Results: A total of 210 patients were included with 109 who received ICI monotherapy and 101 who received immunochemotherapy. The median duration from baseline to on-treatment lab measurement was 21 days. Patients with normal baseline albumin (≥ 3.5 mg/dL) but low on-treatment albumin (< 3.5 mg/dL) had the shortest OS, followed by patients with consistently low albumin. Baseline albumin was significantly associated with OS in univariable analysis, but not in multivariable analysis. On-treatment albumin was significantly associated with OS in both analyses, and the association was stronger for patients who only received ICI monotherapy. In multivariable analysis, only on-treatment albumin and on-treatment NLR remained significant. Conclusions: Serum albumin within the first month of treatment was valuable in predicting treatment benefit from ICIs for patients with NSCLC. This early standard serum biomarker may be of similar value to more complex measurements, such as NLR, and therefore albumin may be useful for clinical therapy decisions within the first two cycles of therapy. Decreases in albumin during treatment potentially correspond to the worsening of disease status such as cancer-associated malnutrition or cachexia which leads to lack of response to ICIs, but the underlying mechanism of action needs to be further investigated. References ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY 1. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. Nutr J. 2010;9(1):69. ................
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