Abstract
PurposeBiomarkers are needed to guide treatment decisions in recurrent ovarian cancer, as a high proportion of patients do not benefit from treatments. Data on immune subsets in patients receiving chemotherapy are scarce. We investigated the impact of T cells, B cells, neutrophils and the neutrophil-lymphocyte ratio (NLR) in ovarian cancer patients receiving palliative chemotherapy.MethodsBlood samples were collected prospectively at baseline in recurrent ovarian cancer (N = 72) receiving chemotherapy. T cells, B cells, neutrophils, and NLR were analyzed. Primary and secondary endpoints were overall survival (OS) and treatment response, respectively. Cut-offs for T and B cells were predefined.ResultsIn patients with low vs. high T and B cells counts, OS was 6.1 months vs 12.0 months (P = 0.017) and 6.1 months vs 12.0 months (P = 0.011, respectively. Low T and B cells analyzed as continuous variables were also associated with unfavorable OS, P = 0.011 and P = 0.007, respectively. Neutrophils had no significant prognostic impact. Median NLR was 4.1. High vs. low NLR was associated with poor survival, 7.4 months vs. 15.9 months (P = 0.012). In multivariate analysis including platinum sensitivity, number of prior lines of chemotherapy, and performance status, high NLR remained an independent poor prognostic factor HR: 2.17 (95% CI 1.21–3.88) (P = 0.009). High NLR was also significantly associated with lack of response, OR 0.15 (95% CI: 0.04–0.51) (P = 0.002).ConclusionIn recurrent ovarian cancer patients undergoing palliative chemotherapy, low T and B lymphocyte counts had an unfavorable prognostic impact. High NLR was associated with lack of response and a poor prognosis, and the parameter may be used in patient counselling and treatment decisions.
Highlights
Recurrent ovarian cancer represents a therapeutic challenge
Baseline CA-125 level, histology, number of previous lines of chemotherapy, present chemotherapy, and performance status were evenly distributed between patients according to immune cell subset level, with the exception that more patients with low baseline B and T cells, respectively, had received more lines of chemotherapy (Table 1)
A total of 21 patients (29%) achieved a treatment response according to the GCIG criteria [33]
Summary
Recurrent ovarian cancer represents a therapeutic challenge. Advances in the area of PARP-inhibitors have improved the outcome for some patients [1], but chemotherapy options for platinum-resistant disease or third line treatment are of minimal or no benefit [2, 3]. Checkpoint immunotherapy has been promising in other malignancies, but it has only shown a modest effect as single agent in ovarian cancer [4]. Despite poor efficacy and risk of toxicity from chemotherapy in the recurrent metastatic setting, most patients request further treatment. In these situations, a subjective clinician assessment of a patient’s physical state is the only tool to foresee if a patient will benefit from further chemotherapy. No biomarkers to support the decision exist and are certainly warranted
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