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Neutrophil to Lymphocyte Ratio (NLR) kinetics as predictors of outcomes in metastatic renal cell carcinoma (mRCC) and non-small cell lung cancer (NSCLC) patients treated with nivolumab (N).

Date

30 Sep 2019

Session

Poster Display session 3

Presenters

Audrey Simonaggio

Citation

Annals of Oncology (2019) 30 (suppl_5): v475-v532. 10.1093/annonc/mdz253

Authors

A. Simonaggio1, R. Elaidi2, L. Fournier3, E. Fabre4, V. Ferrari5, D. Borchiellini6, C. Thibault7, P. Barthelemy8, J. Thouvenin9, E. Tartour10, S. Oudard11, Y. Vano12

Author affiliations

  • 1 Oncology, Hopital European George Pompidou, 75015 - Paris/FR
  • 2 Service D'oncologie Médicale Hôpital Européen Georges Pompidou, ARTIC - Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, 75015 - Paris/FR
  • 3 Radiology, Hopital European George Pompidou, 75015 - Paris/FR
  • 4 Medical Thoracic Oncology Department, Hopital European George Pompidou, 75015 - Paris/FR
  • 5 Oncology, CENTRE ANTOINE LACASSAGNE, nice/FR
  • 6 Medical Oncology, Centre Anticancer Antoine Lacassagne, 6100 - Nice/FR
  • 7 Medical Oncology, Hopital European George Pompidou, 75015 - Paris/FR
  • 8 Medical Oncology Department, C.H.U. Strasbourg-Nouvel Hopital Civil, 67000 - Strasbourg/FR
  • 9 Alsace, CHU Hautepierre, 67200 - Strasbourg/FR
  • 10 Immunology, Hopital European George Pompidou, 75015 - Paris/FR
  • 11 Immunothérapie Et Traitement Antiangiogénique En Pathologie cancérologique, Hopital European George Pompidou, 75015 - Paris/FR
  • 12 Service D'oncologie Médicale, Hôpital Européen Georges Pompidou, 75015 - Paris/FR
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Background

An elevated pre-treatment Neutrophil to Lymphocytes Ratio (NLR) is associated with poor prognosis in various malignancies. As optimal cut-off is highly variable and few data have been reported in patients treated with anti-PD-1, we investigated the association between NLR kinetics with outcomes in patients receiving anti-PD-1.

Methods

We performed a retrospective study including successive patients with mRCC and NSCLC treated with anti PD-1 N monotherapy in second-line setting or later, between March 2013 and December 2018. NLR were prospectively collected before study entry and before every nivolumab administration. Main clinical and biological characteristics were recorded including IMDC prognostic groups for mRCC cohort. We analysed associations between baseline NLR, NLR kinetics (any increase or decrease) and survival outcomes, including PFS, OS and objective response rate (ORR).

Results

161 patients (86 mRCC and 75 NSCLC) were included in our study. With a median follow-up of 25 months, median PFS and OS were respectively 4.6 and 24.7 months for mRCC cohort and 4.4 and 16.8 months for NSCLC cohort. Between the first and the fourth N administration, 55 and 45% of the overall cohort had a decreased or an increased NLR. Survival outcomes according to NLR variations between the first and the fourth N administration are summarized in the Table. In multivariate analysis, NLR increase was associated with worse PFS (HR = 2.6; p = 0.000004) and OS (HR = 2.3; p = 0.001) for the overall cohort but also for the two cohorts when analysed separately. Association between NLR kinetics and response rate, IMDC groups and adverse events in the mRCC will be presented at the meeting.Table:

1255P Survival outcomes

All patients
NLR increaseNLR decreasep
PFS (months, 95% IC)3.7 (2.9-4.4)11 (9-15.3)<0.0001
OS (months, 95% CI)18 (10.6-28.2)28.5 (27;4-NR)0.01

Conclusions

We report the largest multi-cohort analysis of NLR kinetic in N treated patients supporting that early NLR increase is associated with worse survival outcomes in two distinct cohort of mRCC and NSCLC patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

D. Borchiellini: Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Pfizer; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Roche; Advisory / Consultancy: MSD; Advisory / Consultancy: Janssen Cilag; Advisory / Consultancy: Sanofi; Advisory / Consultancy: Astellas. C. Thibault: Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: AstraZeneca; Advisory / Consultancy: bms; Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Sanofi; Advisory / Consultancy, Travel / Accommodation / Expenses: Janssen; Advisory / Consultancy: Astellas; Advisory / Consultancy, Travel / Accommodation / Expenses: Pfizer. P. Barthelemy: Advisory / Consultancy: Pfizer; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Novartis. Y. Vano: Advisory / Consultancy, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Pfizer; Travel / Accommodation / Expenses: MSD; Advisory / Consultancy: Novartis; Advisory / Consultancy, Travel / Accommodation / Expenses: Bristol-Myers Squibb; Advisory / Consultancy: Merck; Travel / Accommodation / Expenses: Janssen Cilag; Advisory / Consultancy: Sanofi; Advisory / Consultancy: Astellas. All other authors have declared no conflicts of interest.

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