Pretreatment Prognostic Nutritional Index Is A Prognostic Marker For Extensive-Stage Small Cell Lung Cancer Patients Treated With Anlotinib

Background: Anlotinib is a multi-targeted tyrosine kinase inhibitor that inhibits tumor angiogenesis which has shown activity in several malignancies and approved for the treatment of small cell lung cancer (SCLC) in China. However, there are no markers can predict the clinical outcomes of anlotinib. We aimed to evaluate the efficacy of anlotinib in extensive stage SCLC (ES-SCLC) patients who failed at least two regimens treatment and to explore potential factors related to its survival benefit.Methods: Patients with ES- SCLC treated with anlotinib monotherapy were screened between March 2017 and May 2019, prognostic nutritional index (PNI) before treatment were collected. Progression free survival (PFS) and overall survival (OS) were calculated and compared using the Kaplan-Meier method and the log-rank test. The prognostic values of each variable were evaluated with univariate and multivariate Cox proportional hazard regression (PHR) analyses.Results: A total of 41 patients with ES-SCLC were received anlotinib treatment, the median age was 57 (range, 33-76). Median OS was significantly longer in the PNI high arm compared with the low arm [8.4 months (95% CI, 5.1-9.6 months) vs. 4.7 months (95% CI, 2.1-6.3 months); hazard ratio (HR) 0.42 (95% CI, 0.21-0.85); P=0.01]. The median PFS of two arms were 4.1 months (95% CI, 2.1-8.2 months) and 2.6 months (95% CI, 0.7-3.9 months), respectively (HR =0.53, 95% CI, 0.27-1.02, P=0.05). Multivariate analysis confirmed that PNI (P<0.01) and LDH (P<0.01) were significant independent biomarkers for OS.Conclusions: The present study demonstrated that pretreatment PNI can be used as a novel and convenient biomarker to predict the prognosis in ES-SCLC patients treated with anlotinib.