Clinical implications of neutrophil-to-lymphocyte ratio and MDSC kinetics in gastric cancer patients treated with ramucirumab plus paclitaxel

Abstract

Objective We aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and myeloid-derived suppressor cells (MDSCs) in gastric cancer patients treated with second-line ramucirumab plus paclitaxel. Methods A total of 116 patients with advanced or metastatic gastric cancer who receive ramucirumab plus paclitaxel were prospectively enrolled. Fresh blood samples were collected before and after treatment, and flow cytometry was performed to assess the proportions of monocytic (mMDSCs) and granulocytic MDSCs (gMDSCs). Results Median age was 58 years and 71 (61.2%) patients were male. A baseline NLR≥2.94 was associated with significantly poorer progression-free survival (PFS) and overall survival (OS) vs . an NLR<2.94 (P=0.011 and P=0.002, respectively). In multivariate analysis, an NLR≥2.94 was independently associated with poorer PFS [hazard ratio (HR)=1.58; 95% confidence interval (95% CI): 1.01−2.49, P=0.046] and OS (HR=1.77; 95% CI: 1.04−3.04, P=0.036). While mMDSC counts did not significantly change following two cycles of therapy (P=0.530), gMDSC counts decreased significantly after two treatment cycles (P=0.025) but tended to increase in patients with progressive disease after two treatment cycles (P=0.098). A progressive increase in gMDSC counts (≥44%) was associated with a significantly shorter PFS and OS vs . a gMDSC count increase <44% (P=0.001 and P=0.003, respectively). Conclusions The baseline NLR may help guide clinical decisions during ramucirumab plus paclitaxel therapy for gastric cancer. Our gMDSC kinetics data warrant further clinical validation and mechanistic investigation.

Real-World Effectiveness and Safety of Ramucirumab as a Second-Line Treatment for Patients with Unresectable Advanced or Metastatic Gastric/Gastroesophageal Junction Adenocarcinoma in Japan and South Korea: A Systematic Literature Review

“…The 23 included studies published between 2016 and 2021, 4 (17.4%) from South Korea [ 20 , 25 , 34 , 41 ] and 19 (82.6%) from Japan [ 18 , 19 , 21 – 24 , 26 – 33 , 35 – 40 ]. Of the 23 studies, 8 (34.8%) were controlled studies [ 21 , 23 , 24 , 26 , 30 – 32 , 34 , 38 ], and 15 (65.2%) were non-controlled studies.…”

“…Of the 23 studies, 8 (34.8%) were controlled studies [ 21 , 23 , 24 , 26 , 30 – 32 , 34 , 38 ], and 15 (65.2%) were non-controlled studies. With one prospective study [ 25 ], all studies (95.7%) were retrospective. Additionally, 6 studies (26.1%) were conducted in multiple centers [ 18 , 20 , 21 , 30 , 32 , 34 ], 12 (52.2%) were conducted in a single center [ 19 , 22 – 24 , 26 – 29 , 31 , 33 , 35 – 37 ], and the location of the remaining 5 (21.7%) was unknown [ 25 , 38 – 41 ].…”

“…With one prospective study [ 25 ], all studies (95.7%) were retrospective. Additionally, 6 studies (26.1%) were conducted in multiple centers [ 18 , 20 , 21 , 30 , 32 , 34 ], 12 (52.2%) were conducted in a single center [ 19 , 22 – 24 , 26 – 29 , 31 , 33 , 35 – 37 ], and the location of the remaining 5 (21.7%) was unknown [ 25 , 38 – 41 ]. Of these included studies, 11 (47.8%) were available in full text [ 18 – 27 , 34 , 35 ], and the other 12 (52.2%) were presented as conference abstracts (Table 1 ).…”