In recent years, neutrophil lymphocyte ratio has been extensively studied as a prognostic marker in patients with solid tumors on the basis that it reflects the inflammatory response to cancer. This study was undertaken to evaluate whether there is any association between clinical benefit rate and progression of disease, using neutrophil lymphocyte ratio as a marker during immunotherapy in advanced solid cancer treatment.
Sixty adult patients diagnosed with metastatic solid tumors planned to receive ICI were prospectively surveyed. Response evaluation was performed with PET-CT scans after every 4 cycles of ICI or earlier if indicated using RECIST 1.1 criteria. Baseline NLR was correlated with Objective Response Rates (ORR) calculated as the percentage of patients achieving either a complete response (CR) or partial response (PR) and Clinical Benefit Rate (CBR) calculated as the percentage of patients achieving a CR, PR or stable disease (SD) for at least 6 months.
The mean overall duration of treatment of patients with immunotherapy was 119 days. When a baseline NLR value of 5 was used as the cut-off, patients with NLR < 5 (n = 30; 50%) had a significantly longer PFS of 184 days versus 84 days (p< 0.0001). On correlation analysis of baseline NLR with treatment duration, it was found that the Pearson correlation coefficient was -0.369. This shows that baseline NLR was inversely and significantly related to treatment duration, (p value=0.004). The baseline NLR had a sensitivity and specificity of 65% and 54% respectively in predicting progression. Low NLR had significant correlation with achieving a SD or a PR, that is achieving a CBR (p = 0.001). Amongst the 37 patients with negative ORR, 60% patients had high NLR. 85% of the patients with positive ORR had low NLR (p value=0.009). Out of the 39 patients receiving clinical benefit from the immunotherapy, 26 patients had low NLR (66.67%) (p value<0.0001).
An NLR of less than or equal to 4.5 was found to be useful in predicting CBR. The baseline NLR was inversely and significantly related to treatment duration and hence the progression of disease. Therefore NLR has the potential to be readily available as a prognostic indicator for patients receiving ICI.
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