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Lung Cancer Research Studies · Journal article
Cancer Research and Treatment · August 10, 2026
Encouraging direction, but not yet definitive.
In a prospective multicenter cohort of 441 advanced NSCLC patients on first-line pembrolizumab-based therapy, early on-treatment Prognostic Nutritional Index (PNI) independently predicted progression-free survival and response durability, while baseline PNI added prognostic value for overall survival. The combination of baseline and cycle 2 PNI measurements stratifies patients into risk groups with distinct outcomes, particularly the low/low category showing poorest response maintenance at 6 and 12 months.
Prospective multicenter cohort analysis with paired baseline and on-treatment measurements. Advanced NSCLC patients receiving first-line pembrolizumab-based therapy; 441 had both baseline and cycle 2 PNI measurements available for analysis.. Intervention: Prognostic Nutritional Index (PNI) calculated from serum albumin and lymphocyte count at baseline and before cycle 2 of pembrolizumab-based therapy. n = 441. Multicenter (specific centers and countries not stated in abstract).
Among responders, low early on-treatment PNI associated with lower odds of 6-month response maintenance (adjusted OR 0.40; 95% CI 0.17–0.97) Low early on-treatment PNI independently associated with shorter PFS (HR 1.50; 95% CI 1.11–2.04); low baseline PNI not significant (HR 1.27; 95% CI 0.94–1.71) Both low baseline PNI (HR 1.53; 95% CI 1.07–2.19) and low early on-treatment PNI (HR 1.47; 95% CI 1.02–2.12) associated with shorter OS
No report of confidence intervals or p-values for baseline or on-treatment objective response rate or treatment-related mortality comparisons. Low baseline PNI associated with lower objective response and higher treatment-related mortality
Clinicians may consider serial PNI measurement (baseline and before cycle 2) to identify high-risk patients for shorter PFS and OS despite response, particularly those with persistent low PNI. However, PNI is a prognostic marker only; the source does not address whether nutritional intervention modifies outcomes.
Prospective multicenter trial of 441 patients shows early on-treatment PNI refines prognosis in advanced NSCLC on immunotherapy with statistically significant associations for PFS and OS, but uses a surrogate nutritional biomarker rather than direct clinical intervention.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians may consider serial PNI measurement (baseline and before cycle 2) to identify high-risk patients for shorter PFS and OS despite response, particularly those with persistent low PNI. However, PNI is a prognostic marker only; the source does not address whether nutritional intervention modifies outcomes.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
PurposeWe assessed whether baseline and early on-treatment measurements of host fitness using the Prognostic Nutritional Index (PNI) provide complementary prognostic information in advanced non-small cell lung cancer (NSCLC). Materials and MethodsWithin the prospective, multicenter OPTIMUS trial, 497 patients with advanced NSCLC receiving first-line pembrolizumab-based therapy were analyzed.PNI was calculated from serum albumin and lymphocyte count at baseline and before cycle 2 (early on-treatment).Using a cutoff of 50.5, 441 patients with paired measurements were classified by baseline/early ontreatment PNI status as high/high, high/low, low/high, or low/low. ResultsLow baseline PNI was associated with lower objective response and higher treatment-related mortality.Among responders, low early on-treatment PNI was associated with lower odds of 6month response maintenance (adjusted OR, 0.40; 95% CI, 0.17-0.97).Response-maintenance rates were lowest in the low/low group at both 6 and 12 months.In multivariable analyses including both PNI time points, low early on-treatment PNI was associated with shorter PFS (HR, 1.50; 95% CI, 1.11-2.04),whereas low baseline PNI was not (HR, 1.27; 95% CI, 0.94-1.71).Both low baseline PNI (HR, 1.53; 95% CI, 1.07-2.19)and low early on-treatment PNI (HR, 1.47; 95% CI, 1.02-2.12)were associated with shorter OS.The higher mortality risk in the low/low group was generally consistent across PD-L1 expression and treatment regimen subgroups. ConclusionPNI assessment at baseline and before cycle 2 provides complementary prognostic information, with early on-treatment PNI particularly related to PFS and response durability (ClinicalTrials.govIdentifier: NCT04909164).
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.