Dynamics of Early Serum Tumour Markers and Neutrophil-to-Lymphocyte Ratio Predict Response to PD-1/PD-L1 Inhibitors in Advanced Non-Small-Cell Lung Cancer

Tang, Yin; Li, Linlin; Guan, Yaping; Feng, Dongfeng; Yin, Bo; Liang, Xue-feng; Yin, Jing; Jiang, Rui; Liang, Jing; Sun, Yahong; Wang, Jun

doi:10.2147/cmar.s329963

Cited by 13 publications

(21 citation statements)

References 50 publications

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“…To our knowledge, this is also the first report on the association between NLR dynamics with progression‐free survival outcomes following chemoradiotherapy for unresectable stage III NSCLC. This complements existing data from stage IV NSCLC, 14 mesothelioma, 15 gastrointestinal 10 and breast cancers. 11 Data from breast cancer patients undergoing treatment demonstrate that reduction in NLR following treatment improve both PFS and OS, with sustained elevations in NLR throughout treatment conferring worse prognosis.…”

Section: Discussionsupporting

confidence: 80%

Elevated neutrophil‐to‐lymphocyte ratio (NLR) is associated with poorer progression‐free survival in unresectable stage III NSCLC treated with consolidation durvalumab

et al. 2022

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Sustained elevation in neutrophil-to-lymphocyte ratio (NLR) after initial chemoradiotherapy (CRT) has been shown to correlate with worse prognosis in a number of solid organ malignancies. Here, we conducted a retrospective observational cohort study involving six sites across Sydney, Australia, including all patients with unresectable stage III NSCLC treated with CRT and consolidation durvalumab between January 2018 and September 2021. Patients had NLR collected prior to CRT and prior to cycle one of durvalumab. We used an NLR value of 3 to stratify patients into high and low groups. Patients with sustained NLR were defined as those with values ≥3 at both timepoints. A total of 145 patients were included in the study. The median age of patients was 66 years with median follow-up of 15.1 months. The median PFS was 17.6 months in the pre-CRT NLR high cohort and not reached (NR) in the pre-CRT NLR low cohort (HR 1.99; p = 0.01). The median OS was 35.5 months in the high pre-CRT NLR cohort compared with 42.0 months in the low pre-CRT NLR cohort (HR 2.62; 95% CI: 1.23-5.56, p < 0.01). Median PFS for sustained NLR elevation was 17.1 months versus NR (HR 1.5; p < 0.01). Pre-CRT NLR and sustained NLR remained independently prognostic for PFS on multivariate analysis (p = 0.04, p = 0.01) respectively. Pre-CRT NLR and sustained NLR is associated with worse PFS outcomes in unresectable stage III NSCLC treated with CRT and durvalumab. Pre-CRT NLR is also associated with worse OS.

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Section: Discussionsupporting

confidence: 80%

Elevated neutrophil‐to‐lymphocyte ratio (NLR) is associated with poorer progression‐free survival in unresectable stage III NSCLC treated with consolidation durvalumab

et al. 2022

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“… 35 Tang et al found that the combination score based on the dynamics of early STM and neutrophil-to-lymphocyte ratio can accurately predict the clinical efficacy of PD-1/PD-L1 inhibitors and prognosis in advanced NSCLC patients. 36 In our study, we found that FAR was independent predictors for ORR and independent prognostic factors for PFS and OS. The predictive role of STM dynamics, single or combination with FAR, further studies is needed in advanced NSCLC patients treated with first-line anti-PD-1 therapy plus platinum-based combination chemotherapy.…”

Section: Discussionsupporting

confidence: 51%

Pretreatment Fibrinogen-Albumin Ratio (FAR) Associated with Treatment Response and Survival in Advanced Non-Small Cell Lung Cancer Patients Treated with First-Line Anti-PD-1 Therapy Plus Platinum-Based Combination Chemotherapy

Yuan¹,

Huang²,

Wang³

et al. 2022

CMAR

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Purpose PD-1 inhibitors have been routinely used to treat advanced non-small cell lung cancer (NSCLC) and have significantly improved clinical outcomes. In this study, we aimed to explore the influence of pretreatment fibrinogen-albumin ratio (FAR) on treatment response and survival in advanced NSCLC patients treated with first-line anti-PD-1 therapy plus platinum-based combination chemotherapy. Patients and Methods A total of 91 patients with advanced NSCLC were included in the study. All patients received at least two cycles of systemic first-line anti-PD-1 therapy plus platinum-based combination chemotherapy. Receiver operating characteristics analysis was performed to determine the optimal cutoff values of FAR. Univariate and multivariate analyses were used to identify independent prognostic factors, and the Kaplan–Meier method was used to estimate survival curves. Results Multivariate logistic regression analysis showed that N stage (N2-3) and high FAR (≥0.175, optimal cutoff value) were independent predictors for objective response rate (P = 0.0002, P = 0.0005, respectively). Multivariate Cox regression analysis of progression-free survival and overall survival showed that high FAR (≥0.145) was independent prognostic factors (P = 0.0061, P = 0.0024, respectively). Progression-free survival and overall survival were significantly shorter in the high FAR (≥0.145) group than those in the low FAR (<0.145) group (P = 0.0024, P = 0.0024, respectively). Conclusion Pretreatment FAR was an independent predictor for treatment response and independent prognostic factors in advanced NSCLC patients treated with first-line anti-PD-1 therapy plus platinum-based combination chemotherapy.

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“…The early variations of inflammatory indices from peripheral blood are captivating dynamic biomarkers as they have consistently shown their prognostic value in several tumor types and treatment settings in addition to their easy and relatively inexpensive assessment and reproducibility in clinical practice (21,22,34). Evidence is accumulating regarding the prognostic value of their early variations, mainly involving the NLR, in advanced non-small-cell lung cancer (23,25,(29)(30)(31), small-cell lung cancer (33), esophageal squamous cell carcinoma (32), and mRCC treated with ICIs (24,28). However, the mechanisms underlying the dynamic variations of inflammatory indices from peripheral blood during treatments and whether they reflect a change in the immunological status in response to treatment, especially to ICIs, are still unclear.…”

Section: Discussionmentioning

confidence: 99%

“…IR have emerged as a quick and inexpensive assessment with reproducible prognostic value across different tumor types, stages, and treatment settings, particularly for patients with metastatic tumors treated with ICIs (21,22). However, their baseline value has been mainly investigated so far, while increasing evidence suggests a possible correlation with disease outcome related to their early variations during treatment, particularly in lung cancer patients (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). If associated with worse prognosis and failure of therapy their early variations might have clinically helpful aftermaths, like the anticipation of disease reassessments during treatments and an earlier start of the next treatment line.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of baseline and early variations of peripheral blood inflammatory ratios and their cellular components in patients with metastatic renal cell carcinoma treated with nivolumab: The Δ-Meet-URO analysis

et al. 2022

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BackgroundTreatment choice for metastatic renal cell carcinoma (mRCC) patients is still based on baseline clinical and laboratory factors.MethodsBy a pre-specified analysis of the Meet-URO 15 multicentric retrospective study enrolling 571 pretreated mRCC patients receiving nivolumab, baseline and early dynamic variations (Δ) of neutrophil, lymphocyte, and platelet absolute cell counts (ACC) and their inflammatory ratios (IR) were evaluated alongside their association with the best disease response and overall (OS) and progression-free survival (PFS). Multivariable analyses on OS and PFS between baseline and Δ ACC and IR values were investigated with receiving operating curves-based cut-offs.ResultsThe analysis included 422 mRCC patients. Neutrophil-to-lymphocyte ratio (NLR) increased over time due to consistent neutrophil increase (p < 0.001). Higher baseline platelets (p = 0.044) and lower lymphocytes (p = 0.018), increasing neutrophil Δ (p for time-group interaction <0.001), higher baseline IR values (NLR: p = 0.012, SII: p = 0.003, PLR: p = 0.003), increasing NLR and systemic immune-inflammatory index (SII) (i.e., NLR x platelets) Δ (p for interaction time-group = 0.0053 and 0.0435, respectively) were associated with disease progression. OS and PFS were significantly shorter in patients with baseline lower lymphocytes (p < 0.001 for both) and higher platelets (p = 0.004 and p < 0.001, respectively) alongside early neutrophils Δ (p = 0.046 and p = 0.033, respectively). Early neutrophils and NLR Δ were independent prognostic factors for both OS (p = 0.014 and p = 0.011, respectively) and PFS (p = 0.023 and p = 0.001, respectively), alongside baseline NLR (p < 0.001 for both) and other known prognostic variables.ConclusionsEarly neutrophils and NLR Δ may represent new dynamic prognostic factors with clinical utility for on-treatment decisions.

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Dynamics of Early Serum Tumour Markers and Neutrophil-to-Lymphocyte Ratio Predict Response to PD-1/PD-L1 Inhibitors in Advanced Non-Small-Cell Lung Cancer

Cited by 13 publications

References 50 publications

Elevated neutrophil‐to‐lymphocyte ratio (NLR) is associated with poorer progression‐free survival in unresectable stage III NSCLC treated with consolidation durvalumab

Elevated neutrophil‐to‐lymphocyte ratio (NLR) is associated with poorer progression‐free survival in unresectable stage III NSCLC treated with consolidation durvalumab

Pretreatment Fibrinogen-Albumin Ratio (FAR) Associated with Treatment Response and Survival in Advanced Non-Small Cell Lung Cancer Patients Treated with First-Line Anti-PD-1 Therapy Plus Platinum-Based Combination Chemotherapy

The prognostic value of baseline and early variations of peripheral blood inflammatory ratios and their cellular components in patients with metastatic renal cell carcinoma treated with nivolumab: The Δ-Meet-URO analysis

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