TITLE:
Prognostic and Predictive Value of Pretreatment Derived Neutrophil-to-Lymphocyte Ratio in Non-Small-Cell Lung Cancer Patients Treated with an Immune Checkpoint Inhibitor
AUTHORS:
John Kucharczyk, Caitlin Sullivan, Jonathan Lu, Andrew Kolomensky, Edward Peters, Marc R. Matrana
KEYWORDS:
Clinical Marker, PD-1 Inhibitor, Immunotherapy, Nivolumab, Pembrolizumab
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.9 No.1,
January
25,
2018
ABSTRACT: Background: Immune checkpoint inhibitors produce prolonged
responses in select non-small cell lung cancer (NSCLC) patients, however the
identification of patients most likely to benefit is difficult. Pretreatment derived neutrophil-to-lymphocyte
ratio (dNLR) is an easily calculated marker available in routine clinical care
that has shown prognostic value in many cancer treatment settings, but its
association with survival in NSCLC patients treated with immune-checkpoint
inhibitors is less understood. Patients and Methods: We retrospectively reviewed 72 NSCLC patients receiving either nivolumab or pembrolizumab between
3/1/15 and 3/1/17 with a median follow-up time
of 5.1 months. Patients were compared using Cox proportional hazards models to
detect an association between pretreatment dNLR 3 vs ≥3
on overall survival (OS), progression-free survival (PFS) and overall response
rate. Results: Median age was 65 (range: 41 - 86),
65% were male, 40% received ≥ 2 prior
systemic therapies and 14% had an Eastern Cooperative Oncology Group
Performance Status (ECOG PS) ≥ 2. Pretreatment dNLR ≥ 3 was
independently associated with shortened OS (median 3.6 vs 8.5 months; HR: 5.4;
95% CI: 2.0 - 14.6; p = 0.001) and PFS (median 2.1 vs 3.4; HR: 2.3; 95% CI: 1.1 - 4.8; p
= 0.027). Conclusion: Pretreatment
dNLR ≥ 3 was independently associated with inferior survival in NSCLC treated
with immune checkpoint inhibitors in routine
practice. Prospective verification of this marker is warranted as it could serve as an inexpensive and widely-available marker for identifying NSCLC
patients most likely to benefit from PD-1 inhibitors.