Ali AYTAÇ, Bilgin DEMİR, Kübra CANASLAN, Halil İbrahim ELLEZ, Yasemin AYDINALP CAMADAN
Journal of Current Hematology & Oncology Research - 2026;4(3):86-92
Aims : The Advanced Lung Cancer Inflammation Index (ALI)-calculated from body-mass index (BMI), serum albumin, and neutrophil-to-lymphocyte ratio (NLR)-is an accessible composite biomarker of systemic inflammation and nutritional status. Its prognostic value in second-line immune checkpoint inhibitor (ICI) therapy in an ICI-naive population remains undefined. Methods : This multicenter retrospective cohort study included 249 metastatic non-small cell lung cancer (NSCLC) patients treated with second-line single-agent nivolumab without prior immunotherapy exposure. ALI was categorized using a receiver operating characteristic (ROC)-derived cut-off of 27.27. Treatment response was assessed by RECIST 1.1. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression models. Results : High baseline ALI (>=27.27) was associated with significantly longer median PFS (10.05 vs. 6.01 months; p=0.012) and OS (13.89 vs. 6.27 months; p<0.001). In multivariable analyses, high ALI remained independently associated with improved PFS (HR 0.688; p=0.011) and OS (HR 0.585; p=0.002). The overall objective response rate (ORR) was 35.3% and disease control rate (DCR) was 43.0%; both were numerically higher in the high-ALI group but did not reach statistical significance, and no significant differences were observed in ORRs. Conclusion : Baseline ALI is an independent prognostic biomarker for PFS and OS in ICI-naive metastatic NSCLC patients receiving second-line nivolumab, representing a cost-effective tool for pre-treatment risk stratification. Prospective validation is warranted.
