817P - Prognostic impact of change in neutrophil to lymphocyte ratio (NLR) in response to targeted therapy for metastatic renal cell carcinoma (mRCC)

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Renal Cell Cancer
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Biological Therapy
Presenter Arnoud Templeton
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors A.J. Templeton1, J. Knox1, N. Mitchell2, R. Broom2, T. Choueiri3, D.F. McDermott4, A. Fay5, B.I. Rini6, A. Alvarez7, G.A. Bjarnason8, M. Smoragiewicz9, C.K. Kollmannsberger9, R. Kanesvaran10, S. North11, N. Alimohamed1, T. Hermanns12, C. Wells13, E. Amir1, D. Heng13
  • 1Medical Oncology, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 2Medical Oncology, Auckland City Hospital, Aukland/NZ
  • 3Medical Oncology, Dana Farber Cancer Institute, Boston/US
  • 4Division Of Hematology/oncology, Beth Israel Deaconess Medical Center, Boston/US
  • 5Medical Oncology, Dana-Faber Cancer Institute, Boston/US
  • 6Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic Taussig Cancer Institute, Cleveland/US
  • 7Medical Oncology, Cleveland Clinic, Cleveland/US
  • 8Medical Oncology, Sunnybrook Odette Cancer Center, CA-M4N 3M5 - Toronto/CA
  • 9Medical Oncology, British Columbia Cancer Agency, V5Z 4E6 - Vancouver/CA
  • 10Medical Oncology, National Cancer Center, SG-169610 - Singapore/SG
  • 11Oncology, Cross Cancer Institute, Edmonton/CA
  • 12Surgical Oncology, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 13Medical Oncology, Tom Baker Cancer Centre, Calgary/CA



NLR is a marker of host inflammation and adds independent prognostic information to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model (Templeton et al. ASCO GU 2014). Here we evaluate the impact of change in NLR after exposure to targeted therapy.


We included patients with mRCC treated with targeted therapy for which NLR data were available at start of first-line treatment, and 6 and 12 weeks thereafter (± 2 weeks). Change from below to above (or vice versa) NLR cut-offs between 2.5 and 5.0 by week 6 and 12 were studied. Median overall survival (OS) and progression free survival (PFS) was estimated using the Kaplan Meier method, the impact of conversion on OS and PFS was evaluated by Cox regression analyses. The impact of NLR conversion on objective response rates (ORR) was evaluated by binary logistic regression.


Data comprising 1199 pts from 9 Consortium sites were evaluated. Median age was 62 years; 23%, 52%, 25% were in the favorable, intermediate and poor prognostic groups, respectively. Sunitinib was first line treatment in 74%. Median baseline NLR was 3.5. Compared with pts without change in NLR, a fall was associated with longer OS, PFS and higher ORR for all cut-offs tested. A rise in NLR showed opposite effects for the 3 endpoints. Data for change in NLR by week 6 using a cut-off of 3.0 are shown in the table. Similar results were observed for changes by week 12.

NLR week 0 -> NLR week 6 (cut-off 3.5) H -> L H -> H L -> H L -> L
N 320 276 58 545
median (mo) 19.4 8.1 14.3 28.9
HR*; P 0.54; <0.001 2.20; <0.001
median (mo) 8.6 3.9 6.6 11.7
HR*; P 0.56; <0.001 2.20; <0.001
N (%) 91 (32) 29 (12) 6 (11) 176 (35)
OR*; P 3.48; <0.001 0.16; 0.002

* adjusted for IMDC score. H, high (i.e. NLR > 3.5); L, low (i.e. NLR ≤ 3.5). HR, hazard ratio; mo, months; OR, odds ratio; ORR, objective response rate; OS, overall survival; PFS, progression free survival.


NLR is a readily available and inexpensive biomarker. Changes in NLR as early as 6 weeks after exposure to targeted therapy appear to have both prognostic and predictive value. Prospective validation of change in NLR is warranted.


All authors have declared no conflicts of interest.