Abstract
PurposeTo investigate whether eosinophils and other white blood cell subtypes could be used as response and prognostic markers to anti-Programmed cell Death-1 or anti-PD-Ligand-1 treatments in non-small cell lung cancer patients.MethodsWe retrospectively analyzed data from the NSCLC patients consecutively treated at our hospital with a PD-1/PD-L1 inhibitor in monotherapy for advanced disease. A total of 191 patients were evaluated at three time-points to investigate any relation between tumor response and WBC counts.ResultsBaseline WBC and subtypes did not differ according to the type of response seen under treatment. A higher relative eosinophil count (REC) correlated with more objective responses (p = 0.019 at t1 and p = 0.014 at t2; OR for progression = 0.54 and 0.53, respectively) independently of the smoking status, PD-L1 status, and immune-related toxicity (IRT). Higher REC was also associated with a longer duration of treatment (p = 0.0096). Baseline absolute neutrophil count was prognostic (p = 0.049). At t1 relative lymphocytes, absolute and relative neutrophils, and neutrophil-to-lymphocyte ratio were prognostic (p = 0.044, p = 0.014, p = 0.0033, and p = 0.029, respectively).ConclusionOur results show that in NSCLC patients anti-PD-1/PD-L1 therapy induces an early increase only in blood eosinophils, more prominent in responding patients and independent of the smoking status, PD-L1 status, and IRT. Eosinophils are also associated with a longer duration of treatment. Furthermore, our data support a prognostic role of neutrophils, lymphocytes, and their ratio for NSCLC patients with advanced disease treated with PD(L)-1 blockade.
Highlights
The use of immune checkpoint inhibitors (ICI) for nonsmall-cell lung cancer (NSCLC) is increasing
We previously reported a retrospective study investigating peripheral blood eosinophil counts as a parameter in the evaluation of response in NSCLC patients receiving Programmed cell Death (PD)-1 blockers [10]
More than half of the patients presented with a chronic obstructive airway disease at the time of PD(L)-1 blocker initiation but only 10.5% used inhaled corticoids and none used oral corticoids during the study period
Summary
The use of immune checkpoint inhibitors (ICI) for nonsmall-cell lung cancer (NSCLC) is increasing. Validated indications include advanced and locally advanced disease [1]. One of the challenges regarding ICI lies in the evaluation of objective response to these drugs. Response evaluation relies on radiological criteria based on. Lung (2021) 199:549–557 potential predictive value of different subtypes of WBC and investigated the prognostic value of baseline WBC subtypes
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