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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