Change in neutrophil-to-lymphocyte ratio (NLR) in response to immune checkpoint blockade for metastatic renal cell carcinoma

Lalani, Aly-Khan A.; Xie, Wanling; Martini, Dylan J.; Steinharter, John A.; Norton, Craig; Krajewski, Katherine M.; Duquette, Audrey; Bossé, Dominick; Bellmunt, Joaquim; Allen, Eliezer M. Van; McGregor, Bradley A.; Creighton, Chad J.; Harshman, Lauren C.; Choueiri, Toni K.

doi:10.1186/s40425-018-0315-0

Cited by 214 publications

(182 citation statements)

References 30 publications

(31 reference statements)

Supporting

Mentioning

163

Contrasting

Unclassified

Order By: Relevance

“…A recent study in patients treated with immune checkpoint blockade for renal cell carcinoma, however, demonstrated quite similarly that an increase ≥25% in the NLR was strongly associated with worse PFS and OS. 32 In the current study, differences in the TTF between patient groups stratified by changes in the NLR were not nearly as pronounced as the differences seen in OS. Although the difference in the median TTF (12.8 vs 5.9 months) was quite substantial, the landmark analysis demonstrated only a trend toward statistical significance Cancer January 1, 2020 (P = .05), and the curves appeared to converge around the 3-year time point (Fig.…”

Section: Discussioncontrasting

confidence: 40%

“…Other than our previous study in patients treated with ipilimumab, we are not aware of groups that have analyzed changes in the NLR in relation to treatment for melanoma. A recent study in patients treated with immune checkpoint blockade for renal cell carcinoma, however, demonstrated quite similarly that an increase ≥25% in the NLR was strongly associated with worse PFS and OS …”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

High neutrophil‐to‐lymphocyte ratio (NLR) is associated with treatment failure and death in patients who have melanoma treated with PD‐1 inhibitor monotherapy

Bartlett

Flynn

Panageas

et al. 2019

Cancer

View full text Add to dashboard Cite

Background An elevated neutrophil‐to‐lymphocyte ratio (NLR) is associated with poor survival in patients with cancer, including those who receive immunotherapies. The authors sought to investigate NLR as a biomarker of treatment outcomes in patients with melanoma who were treated with PD‐1 inhibition. Methods Patients undergoing initial treatment with PD‐1 inhibitor monotherapy for stage IV melanoma at a single center from 2012 to 2015 were included. Clinical characteristics and the NLR at baseline and before subsequent treatment cycles were collected. The time to treatment failure (TTF) and overall survival (OS) were evaluated using Kaplan‐Meier and landmark analyses. Results Among 224 study patients, 63 (28%) had a baseline NLR ≥5. The baseline NLR was significantly associated with Eastern Cooperative Oncology Group performance status and the number of involved metastatic sites. With a median follow‐up of 39 months in survivors, a baseline NLR ≥5 was independently associated with shorter OS (hazard ratio, 2.0; 95% CI, 1.3‐2.9) and TTF (hazard ratio, 1.7; 95% CI, 1.2‐2.4). An NLR increase ≥30% during the first 2 cycles of treatment was associated with worse OS (median, 47 vs 13.5 months; P < .001) and a trend toward shorter TTF (12.8 vs 5.9 months; P = .05). A combined baseline NLR ≥5 and an NLR increase ≥30% identified a small cohort with markedly shortened OS (median, 5.8 months) and TTF (median, 1.8 months). Conclusions Elevated baseline NLR and an increased NLR early during treatment are prognostic for TTF and OS in patients who have melanoma treated with PD‐1 inhibitor monotherapy. Combined, these biomarkers can widely risk‐stratify patients for treatment failure and survival.

show abstract

Section: Discussioncontrasting

confidence: 40%

Section: Discussionmentioning

confidence: 96%

High neutrophil‐to‐lymphocyte ratio (NLR) is associated with treatment failure and death in patients who have melanoma treated with PD‐1 inhibitor monotherapy

Bartlett

Flynn

Panageas

et al. 2019

Cancer

View full text Add to dashboard Cite

show abstract

“…[22][23][24][25] Although previous studies have investigated the role of NLR and PLR on clinical outcomes in patients who received IO, to our knowledge, this is the first study to incorporate MLR in an analysis of patients with a wide variety of malignancies who received IO. The results of this retrospective analysis support previous data on the association between these biomarkers and clinical outcomes in patients who received IO.…”

Section: Discussionmentioning

confidence: 99%

The prognostic and predictive impact of inflammatory biomarkers in patients who have advanced‐stage cancer treated with immunotherapy

Bilen

Martini

Liu

et al. 2018

Cancer

Self Cite

122

View full text Add to dashboard Cite

BACKGROUND: Optimal prognostic and predictive biomarkers for patients with advanced-stage cancer patients who received immunotherapy (IO) are lacking. Inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the platelet-to-lymphocyte ratio (PLR), are readily available. The authors investigated the association between these markers and clinical outcomes of patients with advanced-stage cancer who received IO. METHODS: A retrospective review was conducted of 90 patients with advanced cancer who received treatment on phase 1 clinical trials of IO-based treatment regimens. NLR, MLR, and PLR values were log-transformed and treated as continuous variables for each patient. Overall survival (OS), progression-free survival (PFS), and clinical benefit were used to measure clinical outcomes. For univariate associations and multivariable analyses, Cox proportional-hazards models or logistic regression models were used. RESULTS: The median patient age was 63 years, and most were men (59%). The most common histologies were melanoma (33%) and gastrointestinal cancers (22%). High baseline NLR, MLR, and PLR values were associated significantly with worse OS and PFS (P < .05) and a lower chance of benefit (NLR and PLR; P < .05). Increased NLR, MLR, and PLR values 6 weeks after baseline were associated with shorter OS and PFS (P ≤ .052). CONCLUSIONS: Baseline and early changes in NLR, MLR, and PLR values were strongly associated with clinical outcomes in patients who received IO-based treatment regimens on phase 1 trials. Confirmation in a homogenous patient population treated on late-stage trials or outside of trial settings is warranted. These values may warrant consideration for inclusion when risk stratifying patients enrolled onto phase 1 clinical trials of IO agents. Cancer 2019;125:127-134.

show abstract

“…Recently, several studies 10-12 have reported that inflammatory status is important for survival in NSCLC patients, and the most promising one is neutrophil-lymphocyte ratio (NLR). NLR is a marker of systemic inflammation and suggested to be associated with clinical benefits in various cancer patients.…”

Section: Introductionmentioning

confidence: 99%

A reliable and feasible way to predict the benefits of Nivolumab in patients with non-small cell lung cancer: a pooled analysis of 14 retrospective studies

Cao

et al. 2018

OncoImmunology

View full text Add to dashboard Cite

Objective: Nivolumab has been used for treating non-small cell lung cancer (NSCLC) worldwide. Whether neutrophil-lymphocyte ratio (NLR) can predict the prognosis of NSCLC treated with Nivolumab is still under debate. This meta-analysis was to assess the significance of NLR as a predictive factor in NSCLC patients receiving Nivolumab.Methods: Databases including PubMed, Embase, and the Cochrane library were searched to identify eligible studies evaluating the role of NLR in predicting prognosis of NSCLC treated with Nivolumab until March 2018 without language restrictions. The meta-analysis was performed using hazard ratio (HR) of progression free survival (PFS) and overall survival (OS) in NSCLC patients with various NLR.Results: A total of 14 retrospective studies consisting of 1225 NSCLC patients were included. The combined results showed that relatively higher baseline NLR was associated with poor PFS (HR = 1.44; 95% confidence interval (CI):1.18–1.77; p < 0.05) and OS (HR = 1.75; 95% CI: 1.33–2.30; p < 0.05) after treatment of Nivolumab. Subgroup analysis suggested that NLR ≥ 5 was more reliable for PFS (HR = 1.73; 95%CI: 1.14, 2.62; p < 0.05) and OS (HR = 1.76; 95%CI: 1.47, 2.10; p < 0.05). In addition, post-treatment NLR also had predictive roles for PFS (HR = 3.17; 95%CI: 1.48, 6.82; p < 0.05) and OS (HR = 2.26; 95%CI: 1.05, 4.86; p < 0.05).Conclusion: Our findings suggest that NLR can be used as a prognostic biomarker for NSCLC treating with Nivolumab, and the recommended cutoff value of NLR is 5.

show abstract

Change in neutrophil-to-lymphocyte ratio (NLR) in response to immune checkpoint blockade for metastatic renal cell carcinoma

Cited by 214 publications

References 30 publications

High neutrophil‐to‐lymphocyte ratio (NLR) is associated with treatment failure and death in patients who have melanoma treated with PD‐1 inhibitor monotherapy

High neutrophil‐to‐lymphocyte ratio (NLR) is associated with treatment failure and death in patients who have melanoma treated with PD‐1 inhibitor monotherapy

The prognostic and predictive impact of inflammatory biomarkers in patients who have advanced‐stage cancer treated with immunotherapy

A reliable and feasible way to predict the benefits of Nivolumab in patients with non-small cell lung cancer: a pooled analysis of 14 retrospective studies

Contact Info

Product

Resources

About