The peripheral blood neutrophil-to-lymphocyte ratio is a prognostic predictor for survival of EGFR-mutant nonsmall cell lung cancer patients treated with EGFR-TKIs

Abstract

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are the standard first-line treatment for EGFR-mutant nonsmall cell lung cancer (NSCLC) patients. However, studies have reported that not all NSCLC patients harboring kinase domain mutations in epidermal growth factor receptor (EGFR) show significant clinical benefits from EGFR-targeted tyrosine kinase inhibitors (TKIs). Therefore, it is necessary to establish feasible biomarkers to predict the prognosis of EGFR-mutant NSCLC patients treated with EGFR-TKIs. This study aimed to determine biomarkers using inflammatory parameters from complete blood counts to predict the prognosis of EGFR-mutant NSCLC patients treated with EGFR-TKIs.We retrospectively investigated 127 stage IIIB/IV NSCLC patients with activating EGFR mutations who were treated with EGFR-TKIs. We used receiver operating characteristic (ROC) curves to determine the optimal cut-off for the inflammatory markers as prognostic factors. Additionally, univariate and multivariate analyses were used to identify prognostic factors for progression-free survival (PFS) and overall survival (OS) of EGFR-mutant NSCLC patients treated with EGFR-TKIs.The receiver operating characteristic analysis indicated that the lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) cut-off values were 3.37 and 2.90, respectively. The univariate analysis showed that a high LMR (>3.37) and low NLR (≤2.90) were significantly correlated with long-term PFS and OS (LMR, P = .007; NLR, P < .001). The multivariate Cox regression analysis revealed that only low NLR was an independent prognostic factor for long-term PFS and OS (PFS, HR = 0.573, 95% CI: 0.340–0.964, P = .036; OS, HR = 0.491, 95% CI: 0.262–0.920, P = .026).The data show that a low NLR was a good prognostic factor in EGFR-mutant NSCLC patients receiving EGFR-TKIs treatment. Moreover, the NLR measurement has better prognostic value than LMR.

The value of blood biomarkers of progression and prognosis in ALK‐positive patients with non–small cell lung cancer treated with crizotinib

“…Interestingly, in recent findings, we can find the prognostic value of those biomarkers would not be affected by which kind of treatments that patients received or various cancer patients acquired. The results of our studies were in line with NSCLC treated with chemotherapy, nivolumab, and EGFR‐ tyrosine kinase inhibitors (TKIs) . Furthermore, the trend were same in breast cancer, colorectal cancer and liver cancer .…”

“…Neutrophils‐to‐lymphocytes rate (NLR) is a potential prognostic factor to evaluate efficacy of chemotherapy or immune therapy in patients with early‐stage lung cancer and epidermal growth factor receptor (EGFR) mutations . The purpose of our study was to identify the prognostic impact of pretreated (baseline) NLR, dNLR, PLR, measurements of white blood cells (WBC) and HGB in ALK‐positive patients treated with crizotinib.…”

Neutrophil Heterogeneity in Cancer: From Biology to Therapies

“…Of note, the highest response rates were observed in groups with low baseline NLR values that remained low at 6 weeks, though a good response rate was also reported in groups with an NLR superior to 3 which declined below 2.25 after the administration of targeted therapy (21). Similar observations were described in non-small cell lung carcinomas treated with gefitinib or erlotinib (22–24), advanced gastro-intestinal stromal tumors (25), advanced soft-tissue sarcoma treated with pazopanib (26), and hepatocellular carcinomas treated with sorafenib (27, 28).…”

<p>The Clinical Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Brain Metastases from Non–Small Cell Lung Cancer-Harboring EGFR Mutations</p>

“…Several previous studies reported that low NLR values were strongly correlated with better PFS and OS in EGFR mutated NSCLC patients receiving EGFR-TKIs. 16 , 29 The present study focus on specific cohort of EGFR mutated NSCLC patients with BMs. It indicates that inflammatory factors such as NLR could serve as new biologic markers in the management of this group of patients with BMs.…”