Peripheral blood inflammatory biomarkers dynamics reflect treatment response and predict prognosis in non‐small cell lung cancer patients with neoadjuvant immunotherapy

Abstract

Neoadjuvant immunotherapy has significantly changed the therapeutic approach for treating patients with surgically resectable non‐small cell lung cancer (NSCLC). Here, peripheral blood inflammation‐based biomarkers as well as previously less focused eosinophil fraction, modified Glasgow prognostic score (mGPS), and prognostic nutritional index (PNI) were systematically included to comprehensively analyze their potential in predicting neoadjuvant immunotherapy efficacy and prognosis. We enrolled 189 patients (94 in training and 95 in validation cohorts) with stage I–III B surgically resectable NSCLC treated with neoadjuvant immunotherapy from the National Cancer Center of China. Baseline and post‐treatment eosinophils fraction, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), systemic immune‐inflammation index (SII), monocyte‐to‐lymphocyte ratio (MLR), PNI, mGPS, and their changes were calculated and analyzed for correlation with neoadjuvant immunotherapy efficacy and prognosis. In patients in the major pathological response (MPR) group, the post‐treatment eosinophil fraction was significantly high, and NLR, PLR, SII, and MLR were significantly lower compared to the non‐MPR group in both the training and validation cohorts. The receiver operating characteristic curve showed that post‐treatment, eosinophil fraction and SII and their changing were two of the most important factors. Univariate and multivariate logistic regression analyses showed that post‐treatment eosinophil fraction, SII, mGPS, and ΔSII could independently predict MPR in patients treated with neoadjuvant immunotherapy. Survival analysis showed a significant correlation between high post‐treatment NLR, PLR, SII, mGPS, and their changes in ΔNLR and ΔSII elevation with poor overall survival and event‐free survival of patients. Our results suggest that inflammatory biomarkers could predict the patient's response to neoadjuvant immunotherapy and prognosis.

Clinical factors and major pathological response after neoadjuvant chemoimmunotherapy in potentially resectable lung squamous cell carcinoma

“…Previous studies have indicated that multiple factors were associated with MPR achievement after NCIO, including peripheral blood inflammatory biomarkers, 18fluorine-fluorodeoxyglucose uptake, PD-L1 expression, tumor mutational burden, and tumor regression rate (37)(38)(39)(40). Our study analyzed general clinical and laboratory characteristics and found that LY, tumor burden, N classification, radiographic response, pulmonary atelectasis, and pre-treatment PD-L1 expression level were independent factors affecting MPR rate.…”

Prognostic Significance of the Royal Marsden Hospital (RMH) Score in Patients with Cancer: A Systematic Review and Meta-Analysis

“…Rampant inflammation and malnutrition play pivotal roles in cancer patients, resulting in poor treatment outcomes [29]. Mounting evidence demonstrates the utility of peripheral blood-based parameters as surrogate markers reflecting the inflammatory state and nutritional condition of cancer patients [30,31]. The minimally invasive retrieval, low cost, and quantitative nature of complete blood count (CBC)-derived biomarkers render them particularly advantageous for clinical application.…”

Vitiligo-like Lesions as a Predictor of Response to Immunotherapy in Non-Small Cell Lung Cancer: Comprehensive Review and Case Series from a University Center

“…Besides the already mentioned potential role of lactate dehydrogenase levels, other clinical and peripheral blood inflammation-based biomarkers have also been studied in this subject. A prospective observational trial found that high absolute lymphocyte count and absence of liver metastases were associated with durable clinical benefit of ICI in NSCLC [81]. An additional study suggested that high baseline levels of transcription factor T cell factor 1 (TCF1+) CD 8 + T cell ratio and peripheral white blood cell count, lymphocyte percentage and cytokeratin 19 fragment after one cycle of ICI treatment may predict treatment response [82].…”

“…An additional study suggested that high baseline levels of transcription factor T cell factor 1 (TCF1+) CD 8 + T cell ratio and peripheral white blood cell count, lymphocyte percentage and cytokeratin 19 fragment after one cycle of ICI treatment may predict treatment response [82]. Finally, post-treatment eosinophil fraction, systemic immune-inflammation index, modified Glasgow prognostic score, and systemic immuneinflammation index variation were also mentioned as independent predictors of major pathologic response in patients with NSCLC treated with neoadjuvant ICI [81].…”