WCLC 2025 - Posters & ePosters-P1.11.28 Nomogram and Effectiveness of Bone-Modifying Agents in Advanced Driver-Negative NSCLC: A Retrospective Real-World Study

P1.11.28 Nomogram and Effectiveness of Bone-Modifying Agents in Advanced Driver-Negative NSCLC: A Retrospective Real-World Study

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This retrospective multicenter study analyzed 421 patients with advanced unresectable driver-negative non-small cell lung cancer (NSCLC) treated with first-line immunotherapy between 2017 and 2024. The study aimed to identify prognostic factors, develop survival-predicting nomograms for patients with bone metastasis (BM), and evaluate the effectiveness of bone-modifying agents (BMAs)—denosumab and bisphosphonates.<br /><br />Among the patients, 213 developed BM, which was associated with significantly poorer progression-free survival (PFS) and overall survival (OS) compared to those without BM (PFS: 8.63 vs. 22.87 months; OS: 16.83 vs. 58.83 months). Both BM and liver metastasis independently predicted worse outcomes. A prognostic nomogram was constructed for BM patients, demonstrating good predictive accuracy for 6-, 12-, and 18-month PFS and OS, with area under the curve (AUC) values ranging approximately from 0.67 to 0.85 across timepoints in training and validation cohorts.<br /><br />Among the 213 BM patients, 92 received denosumab and 121 received bisphosphonates, with well-balanced baseline characteristics. Denosumab treatment resulted in significantly longer median PFS (12.60 vs. 8.00 months; HR 1.74) and OS (25.73 vs. 14.03 months; HR 3.08) compared to bisphosphonates. These survival benefits were consistent across most subgroups. There were no significant differences in objective response rate or disease control rate between agents. Skeletal-related events (SREs) occurred in 7.98% of BM patients, with similar incidence and time to event between the two treatment groups.<br /><br />In summary, the study identified key prognostic factors in advanced driver-negative NSCLC treated with immunotherapy, validated a useful survival nomogram for patients with bone metastases, and demonstrated that denosumab may offer superior survival benefits over bisphosphonates without increased risk of skeletal events. These findings provide valuable guidance for treatment decision-making in this patient population.

Asset Subtitle

Lingyun Zhang

Meta Tag

Speaker Lingyun Zhang

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

non-small cell lung cancer

NSCLC

bone metastasis

immunotherapy

bone-modifying agents

denosumab

bisphosphonates

progression-free survival

overall survival

prognostic nomogram