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David Bajor



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    OA01 - Precision Medicine and Personalized Therapy for Lung Cancer (ID 1)

    • Event: NACLC 2019
    • Type: Oral Abstract Session
    • Track:
    • Presentations: 1
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      OA01.03 - Prognostic Role of NLR in Stage III NSCLC Undergoing Chemoradiation: Secondary Analysis of PROCLAIM Trial (ID 117)

      14:00 - 15:40  |  Author(s): David Bajor, David Bajor

      • Abstract
      • Slides

      Background:
      Stage III locally-advanced non-small cell cancer (NSCLC) continues to be a challenging disease with poor outcome. Only about 14% of stage IIIA and 5% IIIB lung cancer patients survive five years. However, there is no proven predictor for survival outcome in this population to guide treatment decision in order to improve outcome. In the available literature, increased systemic inflammatory response has been demonstrated to play an important role in cancer initiation, progression, and prognosis. Based on this knowledge, there has been renewed focus on identifying inflammatory biomarkers and indices that are associated with the prognosis of cancer patients, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte nadir value (LNV) during treatment. PROCLAIM trial is a randomized study comparing cisplatin- pemetrexed and cisplatin-etoposide with concurrent radiation in stage III adenocarcinoma that has been already published. This is the secondary analysis of pre-treatment NLR, nadir NLR and it’s impact on survival outcomes.


      Method:
      The study was approved by the Eli-Lilly. All patients (n=586) with stage IIIA/IIIB unresectable non-squamous non-small cell carcinoma of the lung who randomized to receive either regimen, Cisplatin-Pemetrexed or Cisplatin-Etoposide were selected from the original data base. 4 patients were found to have M1 disease and were excluded. The base line Neutrophil and lymphocyte counts were extracted along with other clinical and treatment information. In addition, nadir NLR value was calculated after extracting the nadir neutrophil and lymphocyte counts during CRT (n=550). The primary aim was to assess Overall Survival (OS) and progression free survival (PFS). Statistical analysis was performed by SASv9.4.


      Results:
      The median age was 59 years (IQR 14). The median follow up was 24 months (IQR22). 60% were male, 71% were white race and 21% were East Asian. 60% were past, and 13% were never smokers. 48% had stage IIIA disease. The median base line neutrophil and lymphocyte counts were 5.5 (IQ 2.7) and 1.9 (IQ0.91), respectively. On multivariable analysis, baseline NLR was significant for OS (p<0.0001) and also for PFS although the effect was less (p<0.006) after adjusting for age, sex, race, BMI, stage and treatment (table 1). The nadir NLR value was also significant for OS (p=0.004).


      Conclusion:
      This is a large randomized data base of locally advanced non-squamous NSCLC patients undergoing CRT showing pre-treatment NLR to be a significant predictor of OS and a trend towards PFS. In addition, the nadir NLR value has shown significant predictor for OS.

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