Cited by 39Cancer Immunotherapy and BiomarkersRadiomics and Machine Learning in Medical ImagingInflammatory Biomarkers in Disease Prognosis

Real-world data to build explainable trustworthy artificial intelligence models for prediction of immunotherapy efficacy in NSCLC patients

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Prelaj, Arsela, Galli, Edoardo Gregorio, Miskovic, Vanja, Pesenti, Mattia, Viscardi, Giuseppe, Pedica, Benedetta, Mazzeo, Laura, Bottiglieri, Achille +28 more·2023·Frontiers in Oncology

Abstract

Introduction: Artificial Intelligence (AI) methods are being increasingly investigated as a means to generate predictive models applicable in the clinical practice. In this study, we developed a model to predict the efficacy of immunotherapy (IO) in patients with advanced non-small cell lung cancer (NSCLC) using eXplainable AI (XAI) Machine Learning (ML) methods. Methods: We prospectively collected real-world data from patients with an advanced NSCLC condition receiving immune-checkpoint inhibitors (ICIs) either as a single agent or in combination with chemotherapy. With regards to six different outcomes - Disease Control Rate (DCR), Objective Response Rate (ORR), 6 and 24-month Overall Survival (OS6 and OS24), 3-months Progression-Free Survival (PFS3) and Time to Treatment Failure (TTF3) - we evaluated five different classification ML models: CatBoost (CB), Logistic Regression (LR), Neural Network (NN), Random Forest (RF) and Support Vector Machine (SVM). We used the Shapley Additive Explanation (SHAP) values to explain model predictions. Results: Of 480 patients included in the study 407 received immunotherapy and 73 chemo- and immunotherapy. From all the ML models, CB performed the best for OS6 and TTF3, (accuracy 0.83 and 0.81, respectively). CB and LR reached accuracy of 0.75 and 0.73 for the outcome DCR. SHAP for CB demonstrated that the feature that strongly influences models’ prediction for all three outcomes was Neutrophil to Lymphocyte Ratio (NLR). Performance Status (ECOG-PS) was an important feature for the outcomes OS6 and TTF3, while PD-L1, Line of IO and chemo-immunotherapy appeared to be more important in predicting DCR. Conclusions: In this study we developed a ML algorithm based on real-world data, explained by SHAP techniques, and able to accurately predict the efficacy of immunotherapy in sets of NSCLC patients.

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Authors
Prelaj, A., Galli, E. G., Miskovic, V., Pesenti, M., Viscardi, G., Pedica, B., Mazzeo, L., Bottiglieri, A., Provenzano, L., Spagnoletti, A., Marinacci, R., De Toma, A., Proto, C., Ferrara, R., Brambilla, M., Occhipinti, M., Manglaviti, S., Galli, G., Signorelli, D., Giani, C., Beninato, T., Pircher, C. C., Rametta, A., Kosta, S., Zanitti, M., Di Mauro, M. R., Rinaldi, A., Di Gregorio, S., Antonia, M., Garassino, M. C., de Braud, F. G. M., Restelli, M., Lo Russo, G., Ganzinelli, M., Trovò, F., & Pedrocchi, A. L. G.
Affiliations
  • Fondazione Politecnico di Milano (IT)
  • University of Campania "Luigi Vanvitelli" (IT)
  • University of Milan (IT)
  • Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
  • Policlinico San Matteo Fondazione (IT)
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • Aalborg University (DK)
  • University of Chicago (US)
Corresponding author
Prelaj, Arsela
Venue
Frontiers in Oncology
Published
2023-01-23
Volume
12
Pages
1078822-1078822
ISSN
2234-943X (ISSN-L)
OpenAlex
W4317718004
Cited by
39
References
35
Citations by year
2026: 11 · 2025: 19 · 2024: 6 · 2023: 3
FWCI
4.76
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Oncology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, cc-by)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, cc-by)
  • Virtual Community of Pathological Anatomy (University of Castilla La Mancha) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
  • Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
Keywords
non-small cell lung cancer, immunotherapy response prediction, immune checkpoint inhibitors, explainable AI, SHAP, CatBoost, real-world data, neutrophil-to-lymphocyte ratio, PD-L1 expression, overall survival, disease control rate, chemoimmunotherapy

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