Neutrophil-lymphocyte ratio as a prognostic marker in a resource constraint setting for metastatic malignancies treated with immune checkpoint inhibitors

Abstract

Abstract Background There exists a need for a prognostic marker apart from PDL1 expression for patients being treated with immunotherapy. Neutrophil lymphocyte ratio (NLR) has been shown to correlate with outcomes in certain malignancies treated with immune checkpoint inhibitors (ICI). Methods A retrospective analysis was carried out of a total of 70 patients who received ICI for metastatic renal cell carcinoma (mRCC) and metastatic non-small cell lung cancer (mNSCLC) from 2016-2019. Peripheral blood NLR of 5 at baseline was used as cut off to divide patients into two groups. Objective response rate (ORR) and overall survival (OS) were calculated in the two groups. Results 37 patients of mRCC and 33 patients of mNSCLC were treated with ICI. Among the 37 with mRCC , 24 patients (64.9%) had a NLR less than 5. Those with NLR 5 group (p = 0.01).There was also a marked significant difference in the survival between the two groups with median OS not reached in NLR 5 group( HR = 0.12 , 95% CI : 0.04-0.40, p = 0.00). Three patients with NLR 5. Those with NLR 5 (HR = 0.59). Conclusion Patients with low NLR had a significantly better response rate and overall survival. In a resource and cost constraint setting, a simple inexpensive test such as NLR would not only be prognostic, but can help in choosing treatment strategies in scenarios where PDL-1 expression does not carry any implication such as in 2nd line mRCC and 2nd line mNSCLC. Also with the advent of combination regimens in 1st line setting (chemo+ ICI in mNSCLC and oral TKI+ICI in mRCC), large scale studies need to be done on whether those with low NLR can benefit with only single agent ICI which would have an impact in not only lowering the cost burden in a developing country such as India but also maintain a better quality of life. Legal entity responsible for the study Nitin Yashas Murthy. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.