Abstract 764P
Background
Systemic inflammation has been shown to promote tumorigenesis, tumour progression and confers poorer survival. An elevated neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammation, has been linked to inferior patient outcomes in various solid malignancies. Real-world data on the relationship between NLR with survival outcomes in melanoma patients who are receiving immune-checkpoint inhibitors (ICI) remains scarce. We aim to investigate the role of NLR as a prognostic biomarker in metastatic melanoma patients treated with ICI (either pembrolizumab or nivolumab).
Methods
We retrospectively reviewed the records of 118 metastatic melanoma patients treated with either pembrolizumab or nivolumab between August 2014 to January 2020 at our institution. NLR values were grouped into two categories: ≤5 and >5. Median overall survival (OS) and progression free survival (PFS) were obtained. Univariate analyses were performed using Cox regression model. Multivariate analyses were performed while controlling for age, gender, prior therapy, BRAF mutation status, ECOG performance status and presence of liver and brain metastases.
Results
The mean age was 68±12. Majority (66.9%) were female, had only one line of treatment (72.9%) and were BRAF wild type (66.9%). Most did not have brain metastases (80.5%) and liver metastases (86.4%). Most were ECOG 0 or 1 (69.5%). The median OS for patients in the NLR>5 and NLR≤5 group was 12.2 months and undefined (more than 50% of patients were still alive at end of study) respectively. The median PFS for patients in the NLR>5 and NLR≤5 group was 6.0 months and 28.1 months respectively. On univariate analysis, patients with baseline NLR >5 had significantly worse OS (HR 3.07; 95% CI 1.61-5.82; P=0.001) and PFS (HR 1.91; 95% CI 1.06-3.45; P=0.031) than patients with NLR≤5. On multivariate analyses, the prognostic value of NLR significantly improved for both OS (HR 5.69; 95% CI 2.31-14.04; P≤0.0001) and PFS (HR 2.77; 95% CI 1.32-5.80; P=0.007).
Conclusions
Our study suggests that pretreatment NLR>5 is associated with worse survival outcomes. NLR is a cheap and readily-available biomarker which could be used to prognosticate metastatic melanoma patients who are receiving ICI.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.