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Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

3503 - Prognostic value of change in neutrophil-lymphocyte ratio during treatment with first-line anti-PD1 therapy in metastatic melanoma

Date

20 Oct 2018

Session

Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

Topics

Immunotherapy

Tumour Site

Melanoma

Presenters

Jennifer Soon

Citation

Annals of Oncology (2018) 29 (suppl_8): viii14-viii57. 10.1093/annonc/mdy269

Authors

J.A. Soon, E. Blackley, M. Moore, L.E. Lim, H.L. Yeoh, M. Voskoboynik, A. Haydon

Author affiliations

  • Medical Oncology, The Alfred Hospital, 3004 - Melbourne/AU
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Resources

Abstract 3503

Background

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.

Methods

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.

Results

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).

Conclusions

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

Andrew Haydon.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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