Real‐world outcomes of 18,186 metastatic solid tumor outpatients: Baseline blood cell counts correlate with survival after immune checkpoint inhibitor therapy

Abstract

BackgroundPatient survival in advanced/metastatic melanoma, non‐small cell lung cancer (NSCLC), and renal cell carcinoma (RCC) has improved with immune checkpoint inhibitors (ICI). Biomarkers' role in prognosis and treatment has been limited by conflicting trial results.MethodsThis retrospective, observational study analyzed baseline demographic, clinical, laboratory, and treatment data versus outcomes of The US Oncology Network adult outpatients. Patients with advanced/metastatic melanoma, NSCLC, or RCC treated between January 1, 2015 and November 30, 2020 were given ICI monotherapy or combination therapy with ipilimumab, pembrolizumab, nivolumab, or atezolizumab. Treatment outcomes (overall survival [OS], time to treatment discontinuation, time to next treatment) were followed longitudinally until May 31, 2021, last patient record, or date of death. Baseline blood cell counts, including absolute monocyte count (AMC), absolute lymphocyte count (ALC), monocyte‐to‐lymphocyte ratio (MLR), absolute neutrophil count (ANC), and eosinophil count, were subdivided into quintiles for univariate and multivariable Cox regression analyses.ResultsData from 18,186 patients with advanced/metastatic melanoma (n = 3314), NSCLC (n = 12,416), and RCC (n = 2456) were analyzed. Better OS correlated with increased baseline serum albumin concentration, increased eosinophil and lymphocyte counts, and Western United States physician practice location. Decreased OS correlated with increased AMC, MLR, ANC, age, and worse Eastern Cooperative Oncology Group performance status.ConclusionsTo our knowledge, this study is the largest to date to associate baseline survival indicators and outcomes in outpatients with advanced/metastatic melanoma, NSCLC, or RCC and receiving ICIs. Results may inform disease‐specific prognostic models and help providers identify patients most likely to benefit from ICI therapy.

Eosinophilic granulocytes as a potential prognostic marker for cancer progression and therapeutic response in malignant melanoma

“…Several studies have shown an improved prognosis with TATE or evidence of eosinophil degranulation in various types of solid tumors ( 35 , 45 – 47 ). In a large national cohort of metastatic solid tumor could show better OS correlated with increased eosinophil count ( 16 ). Moreira et al.…”

Retreatment with Immune Checkpoint Inhibitors in the New Scenario of Immunotherapy in Non-Small Cell Lung Cancer

“…A multicenter, retrospective study analyzed the correlation between baseline patient characteristics and OS in 18,186 patients treated with ICIs alone or combined with chemotherapy or target therapy, including 12,416 patients with NSLCL [54]. OS was signifi-cantly longer in patients with high levels of basal albuminemia and elevated eosinophil and lymphocyte counts (p < 0.0001).…”