337P - Neutrophil-to-Lymphocyte ratio as a predictive factor for hyperprogressive disease in NSCLC patients treated with immune checkpoint inhibitor

Background

Hyperprogressive disease (HPD) has been reported as one of unfavorable responses during treatment with immunecheck point inhibitors for advanced non-small cell lung cancer (NSCLC) patients. However its mechanism remains unclear and the phenomenon itself remains controversial.

Methods

Medical records from consecutive NSCLC patients treated by monotherapy with anti-PD-1/PD-L1 antibodies at Hyogo College of Medicine Hospital between Jun 2016 and May 2018 were analyzed retrospectively. HPD criteria was defined as 1) time to treatment failure < 1 month and 2) tumor growth kinetics rate > 2. To explore the predictive factor for HPD, we examined the association between clinical parameters and responses.

Results

Ninety-four patients were treated with nivolumab. The median patient age was 70 (range 4188) years and 72 patients (73%) were male. Patients number of ECOG PS 0/1/2/3/4 were 15(16%)/59(60%)/18(19%)/2 (3%)/0 respectively. Fifty-two patients (55%) were diagnosed with adenocarcinoma, 38 (40%) were squamous cell carcinoma, and 4 (5%) were other types. We examined Neutrophil-to-lymphocyte ratio (NLR) at base line and relative change in the course of treatment, and the NLR of 48 (56%) patients were ≥ 3.0 and the other 46 (44%) were < 3.0. Among 94 patients, the best all over response were complete response 3 (3.2%), partial response 27 (28.7%), stable disease 35 (37.2%), progressive disease 25 (26.6%); non-HPD 21 (22.3%), HPD 4 (4.3%), and not evaluated 3 (3.2%). All of the 4 HPD patients were male with ECOG PS 1/2/2/3, and treated in 2nd-line therapy for adenocarcinoma. NLR for HPD patients at baseline were 1.62, 4.84, 9.31, 14.75 (median=2.80, range 0.62-19.9) and ΔNLR (relative change of NLR in the course) were 1.51, 3.44, 3.29, 4.26 (median=1.10, range 0.27-4.26).

Conclusions

Our study suggests that HPD exists in a fraction of patients treated immune checkpoint inhibitor and could be associated with high neutrophil-to-lymphocyte ratio. We will update and publish the data containing patients treated with other anti-PD-1/PD-L1 antibodies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

T. Minami: Honoraria (institution): Taiho. T. Yokoi: Honoraria (institution): Ono; Honoraria (institution): Chugai; Honoraria (institution): MSD; Honoraria (institution): Bristol-Myeres; Honoraria (institution): AstraZeneca; Honoraria (institution): Taiho. K. Kuribayashi: Honoraria (institution): Ono; Honoraria (institution): Bristol-Myers Squibb. T. Kijima: Honoraria (institution), Speaker Bureau / Expert testimony, Research grant / Funding (self): Ono; Honoraria (institution), Speaker Bureau / Expert testimony, Research grant / Funding (institution): Bristol-Myeres; Honoraria (institution), Speaker Bureau / Expert testimony, Research grant / Funding (institution): Chugai; Honoraria (institution), Speaker Bureau / Expert testimony, Research grant / Funding (institution): MSD; Honoraria (institution), Speaker Bureau / Expert testimony, Research grant / Funding (institution): Taiho. All other authors have declared no conflicts of interest.