22P - Low neutrophil-to-lymphocyte ratio (NLR) may predict efficacy of pembrolizumab in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC)

Date 20 November 2015
Event ESMO Symposium on Immuno-Oncology 2015
Session Welcome reception and general Poster viewing
Topics Immunotherapy
Head and Neck Cancers
Presenter Hsiang-Fong Kao
Citation Annals of Oncology (2015) 26 (suppl_8): 5-14. 10.1093/annonc/mdv514
Authors H. Kao1, C. Hsu1, H. Huang1, J. Cheng2, R. Hong1
  • 1Oncology, National Taiwan University Hospital, 10002 - Taipei/TW
  • 2Oncology Clinical Research, Merck Sharpe and Dohme, 19454 - North Wales/US



NLR was considered as a marker of inflammation and immunosenescence. The predictive role of NLR for the treatment of immune checkpoint inhibitor was not studied before. KEYNOTE-028 is a phase Ib trial of pembrolizumab for recurrent or metastatic, PD-L1+ solid tumors, including NPC. The predictive role of NLR for the clinical response of pembrolizumab in NPC patients was explored.


Eight NPC patients at our hospital were enrolled to KEYNOTE-028 trial and were treated with pembrolizumab, 10 mg/kg every 2 week for up to 2 years or until confirmed progression or unacceptable toxicity. Treatment response were evaluated every 8 weeks by computed tomography (RECIST 1.1). The hemogram of enrolled NPC patients in our institute were analyzed. The hemogram were examined and reported by a certificated laboratory.


All eight enrolled patients were male. At the first evaluation, four patients had confirmed partial response, one patient had stable disease, and 3 patients had progressive disease (PD). In the PR + SD group, three patients were off trial due to toxicities, and one patient had progressive disease later. The total white blood cell count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, platelet count, and lactate dehydrogenase (LDH) in both groups were listed in table 1. The total WBC count, neutrophil count, and NLR were significantly lower in patients with PR or SD at first evaluation.

PR + PD (n = 5) (mean, range) PD (n = 3) (mean, range) p value (Mann-Whitney U test)
Age 52.6 (47-65) 40 (33-44) 0.024
Total white blood cell count (/uL) 5374 (3770-7320) 11786.7 (9590-14280) 0.025
Neutrophil count (/uL) 3464.1 (2269.5-5131.3) 9912.5 (7269.2 -12495.0) 0.025
Lymphocyte count (/uL) 1174.4 (921.0-1598.9) 892.9 (457-1428.9) 0.297
Neutrophil to lymphocyte ratio 2.98 (2.18-4.58) 15.00 (5.08-27.34) 0.025
Platelet count (K/uL) 326 (172-463) 263.3 (136-468) 0.655
LDH (U/L) 175 (105-267) 248 (203-291) 0.101


Our preliminary finding enlightened the possible predictive role of NLR on pembrolizumab for cancer treatment. The underlying mechanism should also be explored.

Clinical trial identification



J. Cheng: Employee of Merck Sharp and Dohme. All authors have declared no conflicts of interest.