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

Abstract

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.

Elevated Neutrophil-to-Lymphocyte Ratio Is Associated With Poor Outcomes for Melanoma Patients Treated With PD-1 Inhibitor or Chemotherapy in a Chinese Population

“…In another cohort containing 101 patients with unresectable stage III or IV melanoma treated with anti-PD-1 antibodies, the results showed that along with known prognostic factors, such as lactate dehydrogenase (LDH), PS score, and symptomatic brain metastasis, NLR was an independent prognostic factor for patient outcomes and was closely related to worse survival (39). Similarly, in a recent publication of 224 patients with stage IV melanoma treated with anti-PD-1 immunotherapy (nivolumab or pembrolizumab) as the initial treatment, the baseline NLR was closely related to ECOG PS and the number of metastatic sites, and elevated NLR was associated with lower ECOG PS and more metastatic sites (40). Survival analysis showed that an elevated baseline NLR was independently and significantly associated with an increased risk of death and disease progression in patients with either mucosal melanoma or non-mucosal melanoma, regardless of the mutation status of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) gene.…”

Blood-based Markers in the Prognostic Prediction of Esophagogastric Junction Cancer

“…From Figure 1A, among research involving CBC, the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are two of the most popular criteria in predicting prognosis of EJC. As shown in Table 1, increased NLR is one of the most frequently observed markers in EJC [15][16][17][18]. With cutoff values varying from 1.84 -4.00, the NLR might act as a potential marker in predicting the survival rate of patients with EJC [19][20][21][22][23][24][25][26], especially for patients who have undergone surgery.…”

No Impact of NRAS Mutation on Features of Primary and Metastatic Melanoma or on Outcomes of Checkpoint Inhibitor Immunotherapy: An Italian Melanoma Intergroup (IMI) Study

“…Finally, NRAS mutations were found at the limits of statistical significance (p = 0.05) ( Table 7). Regarding overall survival (OS), we recorded a median OS of 28 months (95% CI, 23-35) with 32 months (95% CI, 23-49) in the mut/wt group and 27 months (95% CI, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] in the wt/wt group (p = ns). In patients treated with ipilimumab monotherapy as the first-line therapy, the OS was 26 (95% CI, 14-48) and 15 (95% CI, 11-35) months (p = ns), whereas in patients treated with anti-PD-1, the OS was 32 months (95% CI, 22-NA) and 27 months (95% CI, 18-42) in the mut/wt and wt/wt groups, respectively (p = ns) ( Figure 2).…”