Abstract
BackgroundThe absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) and neutrophil to lymphocyte ratio (NLR) are known markers of inflammation. We evaluated whether ANC, ALC, AMC and NLR, both before and after treatment with nivolumab, are indicative markers of overall survival (OS) and evaluated change in NLR as a predictive marker of response in non -small cell lung cancer (NSCLC) patients treated with nivolumab.MethodsA total of 109 patients with advanced NSCLC treated with nivolumab were included. ANC, ALC, AMC and NLR were examined at initiation of nivolumab therapy and after two cycles. The prognostic role of ANC, ALC, AMC and NLR with OS and changes in NLR ratio were examined with Kaplan-Meier curves and proportional hazard model.ResultPost-treatment NLR ≥5 after two cycles of nivolumab was associated with poor OS (median OS in NLR = <5 vs NLR = ≥5 was 29.1 (16.2–40.9) vs 24.2(16.1–36.2) months respectively, p<0.001). In addition NLR increased in non-responders after two cycles of nivolumab by 6.6±21.8 as compared to responders (p = 0.027).ConclusionsPost-treatment ANC, ALC and NLR are independent prognostic factors in NSCLC patients treated with nivolumab. Changes in NLR can be an early biomarker for response in NSCLC patients treated with nivolumab.
Highlights
Lung cancer is the most common cause of cancer related death in the United States and worldwide [1, 2]
A total of 109 patients with advanced non -small cell lung cancer (NSCLC) treated with nivolumab were included
Post-treatment absolute neutrophil count (ANC), absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) are independent prognostic factors in NSCLC patients treated with nivolumab
Summary
Lung cancer is the most common cause of cancer related death in the United States and worldwide [1, 2]. An estimated 80–85% of patients with lung cancer have non-small-cell lung cancer (NSCLC). Two PD-1(programmed death -1) inhibitors, nivolumab and pembrolizumab and one PD-L1 (programmed death ligand -1) inhibitor, atezolizumab have been approved by the Food and Drug Administration (FDA) for treating patients with advanced NSCLC who have progressed after chemotherapy. [3, 4] This observation was most prominent in patients with advanced squamous cell lung cancer treated with nivolumab. We evaluated whether ANC, ALC, AMC and NLR, both before and after treatment with nivolumab, are indicative markers of overall survival (OS) and evaluated change in NLR as a predictive marker of response in non -small cell lung cancer (NSCLC) patients treated with nivolumab
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