Indices of peripheral leukocytes predict longer overall survival in breast cancer patients on eribulin in Japan

Abstract

Background It was reported that eribulin regulates the tumor microenvironment, including the immune system, by inducing vascular remodeling. Lymphocyte counts are a critical index of immune response in patients. The non-Asian, global EMBRACE study has suggested that baseline absolute lymphocyte count (ALC) may be a predictor of the survival benefit of eribulin in breast cancer patients. We examined whether the baseline ALC is a potential predictor of overall survival (OS) in Japanese patients with HER2-negative advanced breast cancer treated with eribulin. Methods This was a post hoc analysis of data from a post-marketing observational study of eribulin in Japan. The OS by baseline ALC was estimated using the Kaplan–Meier method, with the cut-off value of 1500/μL for ALC. The OS by baseline neutrophil-to-lymphocyte ratio (NLR), a general prognostic index in breast cancer patients, was also estimated, with the cut-off value of 3. Results The median OS was longer in patients with an ALC of ≥ 1500/μL than in those with an ALC of < 1500/μL (19.4 vs. 14.3 months; hazard ratio [HR]: 0.628; 95% confidence interval [CI]: 0.492, 0.801). Patients with an NLR of ≥ 3 showed shorter OS than those with an NLR of < 3 (13.2 vs. 18.8 months; HR: 1.552; 95% CI 1.254, 1.921), and NLR also separated OS in patients with an ALC of < 1500/μL. Conclusions Consistent with the findings of a previous study involving a non-Asian, Western population, our study suggested that baseline ALC may be a predictive factor for the survival benefit of eribulin in Japanese patients.

Association of Neutrophil-to-Lymphocyte Ratio and Absolute Lymphocyte Count With Clinical Outcomes in Advanced Breast Cancer in the MONARCH 2 Trial

“…These data suggest pretreatment NLR may be a useful prognostic marker in the setting of HR+, HER2− advanced or metastatic breast cancer treated with abemaciclib but was not predictive of treatment response, as the benefit of abemaciclib was observed irrespective of baseline NLR. The current findings are broadly aligned with several recent meta-analyses that indicate baseline NLR correlates with disease-free survival and OS in a variety of breast cancer subtypes 41-43 , 47 , 48 and may be a general prognostic factor for PFS and OS in patients with metastatic breast cancer treated with eribulin, 29 , 30 , 32 with high NLR consistently associated with poorer prognosis.…”

Monitoring trends in the absolute lymphocyte count and the neutrophil-to-lymphocyte ratio in patients with breast cancer receiving eribulin

“…Other studies have reported that a high baseline ALC was associated with improved OS despite the use of different ALC cut-offs (e.g. 1000/µl, 1500/µl or the median ALC value) [ 4 – 6 , 8 ]. In the current study, a baseline ALC > 1000/µl was an independent predictor of OS, a finding consistent with previous studies [ 9 , 27 – 29 ].…”

“…These actions contribute to an improvement in OS in patients with A/MBC [ 18 ]. Several studies have shown that a high ALC or a low baseline NLR is associated with better survival outcomes in patients with A/MBC treated with eribulin [ 4 , 5 , 7 , 8 ], but not for patients receiving traditional treatments [ 3 , 19 ].…”

“…Almost all of available studies have focussed mainly on the ALC or NLR values at the baseline, i.e., before the initiation of a treatment, to identify patients who might benefit from monitoring these measures [ 3 – 5 , 7 , 8 , 19 ]. Some researchers suggest that the associated factors could change dynamically during treatment with several therapies.…”

Therapeutic efficacy of a four-year treatment with eribulin in a patient with uterine leiomyosarcoma: A case report

“…They identified a low baseline NLR (<3.0) as an independent predictive marker of durable clinical benefits and better PFS in patients with STS treated with eribulin ( Sato et al, 2021 ). NLR and absolute lymphocyte count are attracting attention as predictors of the effect of eribulin on metastatic breast cancer ( Miyagawa et al, 2018 , Miyoshi et al, 2020 , Takahashi et al, 2021 ). A combination of NLR and PLR has been reported to be able to predict survival in patients with STS ( Shimada et al, 2021 ).…”