The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict efficacy of platinum-based chemotherapy in patients with metastatic triple negative breast cancer

Abstract

Platinum salts are active against metastatic triple negative breast cancer (mTNBC), and biomarkers to predict their effectiveness are urgently needed. In recent years, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have emerged as prognostic biomarkers in many malignancies, but their predictive role in platinum-treated mTNBC patients remains unexplored. We performed a retrospective, single centre study to evaluate the association between baseline NLR or PLR and progression free survival (PFS) of mTNBC patients treated with platinum-based chemotherapy. As a control population, we analysed data from patients with hormone receptor-positive HER2-negative (HR+ HER2−) metastatic breast cancer. Among 57 mTNBC patients treated with the carboplatin-paclitaxel or carboplatin-gemcitabine combination, high NLR and PLR were associated with significantly lower PFS at both univariate and multivariable analysis. Conversely, we did not find a significant association between NLR or PLR and the PFS of 148 patients in the control population. Our findings suggest that the NLR and PLR are predictive of benefit from platinum-containing chemotherapy specifically in mTNBC patients. If validated in larger prospective studies, these easy-to-measure parameters could be combined with emerging predictive biomarkers, such as BRCA 1/2 mutations, to improve the selection of mTNBC patients more likely to benefit from platinum-based chemotherapy.

Peripheral Blood Markers Identify Risk of Immune-Related Toxicity in Advanced Non-Small Cell Lung Cancer Treated with Immune-Checkpoint Inhibitors

“…Nevertheless, our data derive from a relatively large series of consecutively treated patients, reflecting a real-world scenario and including a control group of patients treated without ICIs, to evaluate the potential prognostic role of NLR in aNSCLC. The results found in the control group are overall consistent with recently published data [11], although they differ from what has been previously observed in other malignancies, in which prognostic role of NLR has been observed among patients treated with chemotherapy [33][34][35][36]. Using a different cutoff of 3.7, Berardi and colleagues demonstrated NLR to be an independent prognostic factor for both PFS and OS in patients with non-small cell lung cancer treated with first-line therapies, including chemotherapy and targeted therapies [37].…”

Prognostic value of platelet to lymphocyte ratio in predicting survival of patients with metastatic castration‐resistant prostate cancer receiving abiraterone acetate: An evidence‐based case report and review of literature

“…A high PLR indicates chronic inflammation in cancer patients, which is known to play a major role in carcinogenesis and tumor progression . The use of peripheral blood count as an indicator of localized or systemic inflammatory event is a well‐established concept . High platelet levels can be associated with systemic inflammation or spreading of cancer cells via platelet clots .…”

“…Platelets have also been implicated in tumor aggressiveness due to their ability to promote neoangiogenesis, increase MMP‐9 secretion, and promote the expression of endothelial adhesion molecules that facilitate tumor cell attachment to metastatic sites . Low lymphocyte levels can indicate impaired activation of adaptive immunity or poor nutritional status . Unlike platelets, lymphocytes are known to hinder malignant cancer progression, as shown in several studies where high lymphocyte levels increase the survival of patients with multiple cancers .…”

“…18 High platelet levels can be associated with systemic inflammation or spreading of cancer cells via platelet clots. 18 Platelets have also been implicated in tumor aggressiveness due to their ability to promote neoangiogenesis, increase MMP-9 secretion, and promote the expression of endothelial adhesion molecules that facilitate tumor cell attachment to metastatic sites. 19,20 Low lymphocyte levels can indicate impaired activation of adaptive immunity or poor nutritional status.…”

“…19,20 Low lymphocyte levels can indicate impaired activation of adaptive immunity or poor nutritional status. 18 Unlike platelets, lymphocytes are known to hinder malignant cancer progression, as shown in several studies where high lymphocyte levels increase the survival of patients with multiple cancers. 21 Therefore, high platelet and/ or low lymphocyte levels, as indicated by increased PLR, can contribute to poor prognosis in cancer patients.…”