Elevated NLR is associated with worse outcomes in several malignancies, including mRCC. However, its role in the current immunotherapy era is unknown. We investigated the utility of NLR at baseline and during therapy in mRCC patients treated with PD-1/PD-L1 immunotherapy (IO).
116 patients from Dana-Farber Cancer Institute (Boston, MA) receiving IO-based therapies were included. NLR was examined at baseline and 6 (±2) weeks later. Landmark analysis at 6 weeks was conducted to explore the prognostic value of relative NLR change on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) using Cox or logistic regression models, adjusted for line of therapy, number of IMDC risk factors, histology and baseline NLR.
Median follow up was 16.3 months (range: 1.4-64.2). Median duration on therapy was 7 months (
Early decline and NLR at 6-weeks are associated with significantly improved outcomes in mRCC patients treated with IO, whereas an increase is associated with worse outcomes. The prognostic value of the readily-available NLR warrants larger, prospective validation.Table:
|Continuous Ln(NLR) Baseline**||116||0.58 (0.23-1.42)||0.232||1.36 (0.78-2.37)||0.269||1.74 (0.82-3.69)||0.147|
|Continuous Ln(NLR) 6-weeks**||113||0.28 (0.11-0.69)||0.006||2.39 (1.38-4.15)||0.002||3.24 (1.83-5.74)|
Clinical trial identification
Legal entity responsible for the study
Dana-Farber/Harvard Cancer Center
J. Bellmunt: Research support from Novartis and Sanofi; consulting support from OncoGenex, AstraZeneca, Merck, Bristol Myers-Squibb, Genentech, Inovio, Champions Oncology, Seattle Genetics and Pierre Fabre. E.M. Van Allen: Stock and Other Ownership Interests: Syapse; Consulting or Advisory Role: Novartis, Roche, Syapse, Takeda, Third Rock Ventures; Research Funding: Bristol-Myers Squibb T.K. Choueiri: Consulting: Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Novartis, Pfizer; Research Funding: AstraZeneca, Bristol-Myers Squibb, Exelixis, GlaxoSmithKline, Merck, Novartis, Peloton Therapeutics, Pfizer, Roche/Genentech, TRACON Pharma. All other authors have declared no conflicts of interest.