Prognostic Markers of Survival among Japanese Patients with Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer Receiving First-Line Alectinib

Abstract

The prognoses of patients with non-small-cell lung cancer (NSCLC) harboring anaplastic lymphoma kinase (ALK) gene rearrangement have dramatically improved with the use of ALK tyrosine kinase inhibitors. Although immunological and nutritional markers have been investigated to predict outcomes in patients with several cancers, their usefulness in targeted therapies is scarce, and their significance has never been reported in patients receiving first-line treatment with alectinib. Meanwhile, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) has been investigated during crizotinib treatment. This multicenter retrospective study evaluated 42 consecutive Japanese patients with ALK-positive NSCLC who received first-line treatment with alectinib. Immunological and nutritional markers were evaluated at baseline and 3 weeks after alectinib introduction, and their significance in predicting progression-free survival (PFS) was explored. PFS duration was significantly associated with baseline PLR (hazard ratio (HR): 2.49, p = 0.0473), systemic immune-inflammation index (SII; HR: 2.65, p = 0.0337), prognostic nutrition index (PNI; HR: 4.15, p = 0.00185), and the 3-week values for SII (HR: 2.85, p = 0.0473) and PNI (HR: 3.04, p = 0.0125). Immunological and nutritional markers could be useful in predicting the outcomes of first-line treatment with alectinib. Since PLR and SII consist of platelet counts, platelet count could be an important constituent of these markers.

Efficacy and safety of alectinib in ALK-positive non-small cell lung cancer and blood markers for prognosis and efficacy: a retrospective cohort study

“…A study of the Chinese Academy of Medical Sciences confirmed that in ALK -positive NSCLC patients treated with crizotinib, the trend of NLR, derived NLR [dNLR = neutrophil count/(white blood cell count-neutrophil count)], PLR, and HGB can be used to assess a patient’s progress ( 15 ). A Japanese study noted that immunological and nutritional markers could be useful in predicting the outcomes of first-line treatment with alectinib ( 32 ). In our study, NLR was not only an independent prognostic factor in univariate and multivariate analysis, but also changes in NLR before and after treatment can reflect the efficacy and be used to further predict survival.…”

RETRACTED: Prognostic role of the systemic immune-inflammation in patients with non-small cell lung cancer: a meta-analysis

“…16 studies with 2378 patients(16-18, 21,22,27,30,32,34,36,37,39,41,42,44,47) showed an association between the SII and PFS in NSCLC. Heterogeneity was signi cant (I 2 = 83.1%, P < 0.001), and a random-effects model was performed.…”

“…Subsequently, 13 studies were eliminated because 9 studies did not provide survival data, full-text articles of 2 studies were not available, and 2 studies were comments. Finally, a total of 32 studies involving 12,040 patients were included 47). (Fig.…”

“…The included studies were all retrospective and published during 2017-2023, with a sample size between 34 and 3984. One of the 9 studies was conducted in non-Asian (17,22,27,30,33,35,36,42,47), and the others were conducted in China (14-16, 18-21, 23-26, 28, 29, 31, 32, 34, 37-41, 43, 44). The SII cut-off values ranged from 395.4 to 1,270.…”

Inflammation Indexes as Predictors of Recurrence in Patients With Surgically Resected Non-Small Cell Lung Cancer

“…In the case of ALK mutation in patients with non-small cell lung cancer who received appropriate first-line targeted therapy, the duration of PFS was determined to be associated with baseline PLR, and SII, as well as the SII, score three weeks after initiation of therapy. Indexes were measured before and three weeks after drug administration [18]. Ju et al found that lower SII was associated with prolonged survival in patients with different EGFR mutant lung adenocarcinomas.…”