Systemic inflammation response can be characterized by changes of peripheral blood cell amounts. Several blood cell-based scores have been found to have prognostic value in some tumors treated with ICI. Neutrophil-platelet score (NPS) is a systemic inflammation-based score characterizing 3 prognostic groups: good (0), neutrophils < =7500 and platelets < =400000; intermediate (1), neutrophils >7500 or platelets >400000; poor (2), neutrophils >7500 and platelets >400000). It has never been evaluated as prognostic biomarker in NSCLC patients treated with ICI.
This is a multicenter retrospective study with the aim to evaluate prognostic value of NPS in patients with pretreated advanced NSCLC treated with PD-1 ICI between March 2015 and April 2018. Clinical data were contributed by 7 medical centers in Spain. Primary endpoint was association of NPS with overall survival (OS).
168 patients were included. Median age 65 years (39-85). 134(79,8%) were male and 121(72%) were PS > =1. Predominant histologies were adenocarcinoma (50%) and squamous-cell carcinoma (42,9%). 92,3% received nivolumab and 7,7% pembrolizumab. 2,3% had EGFR mutations, and 0,6% ALK rearrangement. PD-L1 IHC was available in 25% (<1%: 36,6%; 1-49%: 39%; > =50%: 24,4%). Median number of prior lines was 1 (1-5). Median number of cycles 11 (1-68). Median follow-up time 6,3m. Response rate (RR) was 30,4% and disease control rate (DCR) 52%. Median PFS and OS were 5,6 months (m) (3,9-7,3) and 11,4 m (9,4-13,5). According to NPS, median OS for good, intermediate, and poor prognostic groups was 11,9m (9,4-14,4), 6,8m (3,3-10,2), and 3m (1,4-4,6), respectively (p = 0,003). Higher NPS was associated with poor OS: NPS1 HR 1,73 (95%CI,1,13-2,65),p=0,01; NPS2 HR 2,89 (95%CI,1,31-6,39), p = 0,009). No significant association between NPS and PFS was found. NPS was associated with DCR, NPS2 had more patients with progression disease as best response to ICI than NPS1 and 0 (86 vs 57 vs 42%, p = 0,039).
NPS predicted OS and DCR in pretreated advanced NSCLC patients who received treatment with PD-1 ICI nivolumab or pembrolizumab. These results need to be validated in prospective studies.
Clinical trial identification
Legal entity responsible for the study
Xabier Mielgo Rubio.
Has not received any funding.
All authors have declared no conflicts of interest.