Author of

• 25924

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  P1.04 - Immunooncology (Not CME Accredited Session) (ID 936)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26453

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    P1.04-19 - Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Survival After Immunotherapy in Non-Small Cell Lung Cancer (ID 13650)

    16:45 - 18:00  |  Author(s): Diana Saravia
    • Abstract
    • Slides

    Background
    

    Effective use of immune checkpoint inhibitors in non-small cell lung cancer (NSCLC) may be improved by identifying biomarkers that are easily measured and predictive of clinical outcomes. Peripheral complete blood counts are commonly obtained and can be indicative of systemic inflammatory response, which has been associated with poor prognosis in multiple cancer types. Here, we investigated the ability of peripheral cell counts to predict patient survival after treatment with immunotherapy for NSCLC.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Complete blood counts were retrospectively collected for 274 patients and analyzed for absolute neutrophil count (ANC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Values were obtained immediately prior to treatment initiation. Overall survival (OS) and progression-free survival (PFS) was assessed using Kaplan-Meier analyses with log-rank test and Cox regression analysis.

    4c3880bb027f159e801041b1021e88e8 Result
    

    OS was significantly associated with ANC (HR 1.63, p<0.0001) and NLR>5 (HR 1.62, p<0.0001), as was PFS (HR 1.48, p=0.0008 and HR 1.48, p=0.0012, respectively). PLR>400 was not associated with OS but did have a significant association with PFS (HR 1.39, p=0.0388). Baseline elevation of both NLR and PLR identified a particularly high-risk population, with worse OS (HR 1.69, p=0.0020) and PFS (HR 1.58, p=0.0069) when compared to the patient group with low baseline NLR and PLR (Figure 1). High NLR and PLR as a combined marker remained an independent predictor of OS in multivariate analysis after adjusting for multiple clinical variables (HR 1.91, p=0.008).

    

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Increased baseline ANC, NLR, and PLR were associated with worse overall and progression-free survival, and the combination of both high NLR and PLR denoted a subgroup with especially poor outcomes. These findings will need to be validated in larger prospective studies to further assess their clinical utility.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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• 25938

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  P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 26886

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    P2.01-82 - Neutrophil-to-Lymphocyte Ratio Complements the Prognostic Ability of PD-L1 in Non-Small Cell Lung Cancer Treated with PD-1/PD-L1 Inhibitors (ID 14091)

    16:45 - 18:00  |  Presenting Author(s): Diana Saravia
    • Abstract
    • Slides

    Background
    

    PD-L1 expression is an imperfect predictor of outcomes for patients (pts) with advanced non-small cell lung cancer (aNSCLC) treated with PD-1/PD-L1 inhibitors (PD-1/L1i). This was demonstrated in the recent ARCTIC trial in which PD-L1 expression did not significantly correlate with outcomes. In the quest for additional markers, a high neutrophil-to-lymphocyte ratio (NLR) has been associated with poor outcomes and may reflect a higher myeloid-to-lymphoid balance. Here we show improved prognostic ability for response to PD-1/L1i when baseline NLR is added to PD-L1 expression.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We used a retrospective cohort of 146 aNSCLC pts from the authors’ institutions in the United States and Japan who received single-agent PD-1/L1i. We categorized patients into three groups; favorable: PD-L1 ≥ 1% and NLR < 5, intermediate: PD-L1 ≥ 1% or NLR < 5, and poor: PD-L1 < 1% and NLR ≥ 5. We correlated the outcome of each group with overall survival (OS) and progression free survival (PFS).

    4c3880bb027f159e801041b1021e88e8 Result
    

    Median follow-up was 11.1 months (M) (95% Confidence Interval [CI]: 9.1-13.1). 47 pts had PD-L1 <1% and 99 pts ≥1%, 81 pts had NLR <5 and 65 pts ≥5. There were 52, 76, and 18 pts in the favorable, intermediate, and poor groups, respectively. Median OS for the favorable group was not reached and it was 14.7 M (CI: 10.5-19.0) and 3.5 M (CI: 0-13.1), respectively for the intermediate and poor groups. Median PFS was 9.9 M (CI: 3.7-16), 3.2 M (CI: 2.1-4.3), and 1.1 M (CI: 0.8-1.4), respectively. The poor group (PD-L1 < 1% and NLR ≥ 5) was significantly associated with progressive disease (Odds ratio [OR]: 5.0, p=0.01) in comparison to the PD-L1 < 1% group (OR: 2.6, p=0.013).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Prognostic ability of PD-L1 expression is enhanced when combined with baseline NLR for aNSCLC pts treated with single-agent PD-1/L1i. This study raises the hypothesis that high NLR and low PD-L1 expression could serve to identify those pts less likely to benefit from these therapies.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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