{
  "abstract": "Background and Importance Very elderly patients (≥80 years) with non-small-cell lung cancer (NSCLC) often present distinct clinical profiles, where inflammation and nutritional status may influence treatment outcomes. Identifying prognostic indicators in this frail population remains an unmet clinical need.Aim and Objectives To assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and lactate dehydrogenase (LDH) levels in very elderly NSCLC patients receiving immune checkpoint inhibitors (ICIs), and its association with overall survival (OS) and progression-free survival (PFS) in a real-world clinical setting. These three variables are collectively referred to as the ‘Inflammatory and Prognostic Score 3’ (IPS3).Material and Methods A retrospective observational included NSCLC patients aged ≥80 years treated with ICIs between 2018 and 2024. Demographic, clinical, histopathological and baseline biochemical data were collected. Patients were stratified using the IPS3, a composite index combining neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH) and prognostic nutritional index (PNI), classifying patients into three groups: favourable (score 0), intermediate (score 1) and poor (score 2-3). OS and PFS were estimated using Kaplan-Meier curves and compared using the log-rank test (p<0.05 considered significant).Results Thirty-two patients (mean age 82.6 years, 81.3% male) were included. Adenocarcinoma was the most common histology (56.3%). PD-L1 ≥50% was observed in 34% of patients, and 12.5% had CNS metastases. Treatments included pembrolizumab (71.9%), nivolumab (21.9%) and durvalumab (6.3%); 71.9% received monotherapy. Based on the IPS3, 15.6% were classified as favourable, 25.0% intermediate, and 56.3% as poor. Median OS was 8.0 months (95% CI 4.5-11.5) and PFS 7.0 months (95% IC 3.3-10.7). Median OS by prognostic group was 14.0, 6.0 and 6.0 months and PFS was 12.7, 2.0 and 4.0 months, respectively. Although not statistically significant (OS p=0.259, PFS p=0.465), a trend toward poorer survival with higher scores was observed. Grade ≥3 immune-related toxicity occurred in 9.4% of patients.Conclusion and Relevance The IPS3 composite score showed a consistent trend in predicting survival outcomes in very elderly NSCLC patients treated with ICIs. Despite limited statistical power, these parameters may support improved prognostic stratification in this vulnerable population.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Complejo Asistencial Universitario De Salamanca, Farmacia, Salamanca, Spain"
      ],
      "name": "A Albarran Gomez"
    },
    {
      "affiliations": [
        "Complejo Asistencial Universitario De Salamanca, Farmacia, Salamanca, Spain"
      ],
      "name": "R Gomez Navas"
    },
    {
      "affiliations": [
        "Complejo Asistencial Universitario De Salamanca, Farmacia, Salamanca, Spain"
      ],
      "name": "L Lorenzo Vidal"
    },
    {
      "affiliations": [
        "Complejo Asistencial Universitario De Salamanca, Oncologia, Salamanca, Spain"
      ],
      "name": "A Olivares Hernandez"
    },
    {
      "affiliations": [
        "Complejo Asistencial Universitario De Salamanca, Farmacia, Salamanca, Spain"
      ],
      "name": "S Jimenez Cabrera"
    },
    {
      "affiliations": [
        "Complejo Asistencial Universitario De Salamanca, Farmacia, Salamanca, Spain"
      ],
      "name": "MJ Otero Lopez"
    }
  ],
  "title": "4CPS-200 Inflammatory and nutritional prognostic score as a marker of outcomes in very elderly patients with non-small-cell lung cancer treated with immunotherapy",
  "uid": "e4fb3fba-b867-5ba9-bfca-d00e01f59ebe"
}