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M. Iazzi



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    P3.02c - Poster Session with Presenters Present (ID 472)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.02c-076 - Correlation of Neutrophil to Lymphocyte Ratio (NLR) with Clinical Benefit from Checkpoint Inhibitors in Advanced Lung Cancer (ID 5965)

      14:30 - 14:30  |  Author(s): M. Iazzi

      • Abstract

      Background:
      Immune checkpoint inhibitors (ICI) have become standard therapy after platinum failure in advanced non-small cell lung cancer. ICI response patterns differ from chemotherapy with the potential for delayed regression and pseudo-progression in patients benefiting from treatment. Additional markers beyond PDL-1 expression are needed to assist in patient selection, response evaluation and treatment decision-making.

      Methods:
      The relationship between clinical outcome (response, treatment duration, survival) and hematologic parameters (absolute neutrophil count [ANC], neutrophil to lymphocyte ratio [NLR]) was explored in a cohort of patients treated with ICIs at a major cancer centre from 05/2013 to 05/2016. Clinical benefit was defined as achievement of complete or partial response (CR, PR) or stable disease (SD) at 8 weeks. Hematologic parameters at baseline (T0) and on treatment (T1=2 or 3 weeks, T2=8 weeks) were included.

      Results:
      Of 101 Non-SCLC patients treated with ICIs, 84 (83%) had documented response assessment. All received PD-1 axis inhibitors, (71 anti-PD-1, 12 anti-PDL-1, 1 anti-PDL-1 plus -CTLA-4); tumour PDL-1 expression was +/-/unknown in 32/12/40; median follow-up was 5.1 months (range 0.4 – 36.8) from treatment start. Clinical benefit was seen in 62% (20 PR, 32 SD). Baseline NLR≤4 was associated with greater clinical benefit (75% vs 51%, p=0.025) and median survival (21.7 vs 6.9 months) compared with NLR>4; (HR=0.45, 95% CI: 0.22-0.90, p=0.03). This appears independent of tumour PDL-1 expression. Lower on-treatment (T1, T2) ANC values (trend analysis p=0.0037) and NLR≤4 (T2) were also associated with PR/SD (Table 1). Longer treatment duration was associated with on-treatment NLR≤4 (T1 6.2 vs 3.4 months, p=0.037; T2 6.2 vs 2.7 months, p=0.0075) and lower ANC (T1 p=0.014, T2 p=0.012). Figure 1



      Conclusion:
      Pretreatment NLR≤4 may be a potential predictor of clinical response in patients receiving ICIs, as well as lower on-treatment ANC and NLR.