Telomere Status of Advanced Non-Small-Cell Lung Cancer Offers a Novel Promising Prognostic and Predictive Biomarker.

Telomere length appears to correlate with survival in early non-small-cell lung cancer (NSCLC), but the prognostic impact of telomere status in advanced NSCLC remains undetermined. Our purpose was to evaluate telomere parameters as prognostic and predictive biomarkers in advanced NSCLC. In 79 biopsies obtained before treatment, we analyzed the telomere length and expression of and shelterin complex genes (, , , , , and ), using quantitative PCR. Non-responders to first-line chemotherapy were characterized by shorter telomeres and low expression ( = 0.0035 and = 0.0069), and tended to show higher levels ( = 0.058). In multivariate analysis, short telomeres were associated with reduced event-free (EFS, = 0.0023) and overall survival (OS, = 0.00041). and overexpression correlated with poor EFS ( = 0.0069 and = 0.00041) and OS ( = 0.0051 and = 0.007). Low and expression-levels were linked to reduced EFS ( = 0.00032 and = 0.0069) and OS ( = 0.000051 and = 0.02). Short telomeres were also associated with decreased survival after nivolumab therapy ( = 0.097). Evaluation of telomere status in advanced NSCLC emerges as a useful biomarker that allows for the selection of patient groups with different clinical evolutions, to establish personalized treatment.