With the advent of immunotherapy, the overall survival (OS) of patients (pts) with advanced melanoma has seen significant improvement. Multiple studies have demonstrated a negative correlation between elevated baseline serum neutrophil-lymphocyte ratio (NLR) and OS in melanoma and other solid tumours. This retrospective analysis aimed to identify a relationship between change in NLR during treatment and OS.
83 consecutive pts with metastatic melanoma who received first-line anti-PD1 immunotherapy (mono or combination therapy) were identified at a single institution between May 2015 and August 2017. NLR was measured at baseline and following 4-6 weeks (4-6W) of therapy, with the result at each time point correlated with OS. An elevated NLR was defined as > 4.
Median follow-up was 17 months. Median OS of pts with baseline NLR <4 was not reached (NR) compared with 17.1 months with NLR >4 (HR 0.29, 95% CI 0.13-0.65, p = 0.003). Pts whose NLR started and remained high after 4-6W of treatment performed significantly worse than pts whose NLR fell to < 4 at 4-6W (median OS 6.5 months vs NR, HR 0.18, p = 0.028). Survival in the latter group was comparable to those with a baseline NLR <4. NLR was more prognostic at 4-6W (HR 0.17, 95% CI 0.07-0.41, p = 0.000091) than at baseline (HR 0.29, 95% CI 0.18-0.65, p = 0.003). On Cox regression multivariate analysis including age, sex, M stage, lactate dehydrogenase level, presence of brain and/or liver metastases and NLR at the two time points, NLR >4 at 4-6W was the strongest prognostic factor (HR 0.14, 95% CI 0.06-0.37, p = 0.00005).
NLR is a simple and inexpensive prognostic biomarker in metastatic melanoma. NLR >4 at baseline is associated with a significantly poorer OS. In this cohort, NLR at 4-6W was the strongest predictor of outcome. Persistent elevation of NLR >4 at 4-6W after initiation of treatment was associated with a significantly poorer prognosis than those with a change in NLR to < 4 at this time point. Further analysis of a larger cohort may strengthen this association and potentially allow early identification of poor-risk pts and an opportunity to escalate treatment.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.