1122P - Neutrophil/lymphocyte ratio and systemic inflammatory index as prognostic biomarkers in metastatic melanoma patients under immune checkpoint inhibitors: Could any of them be used?

Background

Immune checkpoint inhibitors (ICI) targeting cytotoxic T-lymphocyte-associated protein 4 and programmed cell death protein 1 are now the standard of care for patients with advanced melanoma, with an improvement in overall survival (OS) and quality of life. Elevated neutrophil to lymphocyte ratio (NLR) and systemic inflammatory index (SII) have been reported associated with poor survival in cancer patients, including those with ICI. The aim of this study was to determine the clinical significance of pre-treatment NLR and SII as prognostic indicator in metastatic melanoma patients treated with ICI.

Methods

Retrospective, multicentric study of metastatic melanoma patients who received ICI between 2016-2022 in two hospitals in Portugal. The SII [platelets x neutrophil/lymphocyte ratio] and NLR were calculated before the beginning of ICI. SII was considered high if > 572 and NLR was considered high if >5. Data was collected from clinical records. Statistical analysis was performed with SPSSv26. Progression free survival (PFS) and OS were assessed using Kaplan-Meier plots and log-rank testing.

Results

Eighty-nine patients were enrolled, 57 were male, mean age 68 years old. Seventy-six patients had cutaneous, 10 mucosal and 3 uveal melanoma. The type of ICI was nivolumab in 36 patients, ipilimumab/nivolumab in 34 and pembrolizumab in 19. With a median follow-up of 19 months, the median PFS and OS was 11 and 15 months, respectively. NLR was high in 12 patients. The median PFS was 3 months in NLR high vs 25 months in NLR low patients and OS was 13 months in NLR high vs 32 months. However, these differences were not statistically significant. A total of 53 patients were presented with SII high. In this group, the median PFS was 10 months vs 22 months in SII low patients (p=0.017) and the median OS was 17 months vs 32 months (p=0.032).

Conclusions

The present study suggests that elevated SII may be associated with a worse PFS and OS in metastatic melanoma patients, however, this association was not demonstrated for NLR. Thus, SII could be a prognostic value on advanced/metastatic melanoma in patients under ICI and could be an important tool in the management of these patients.

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.