81P - Predictive value of inflammatory ratios on the outcome of advanced melanoma patients treated with anti-PD1 monotherapy: A multicentric analysis

Background

Despite immune-checkpoint inhibitors (ICIs) transforming outcomes of melanoma patients, a vast number remain unresponsive to treatment. Baseline-derived host-related inflammatory ratios such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) are easily accessible biomarkers that can depict the balance between myeloid-derived protumour inflammation and lymphocyte-derived antitumour response. Our analysis aims to assess the predictive value of baseline inflammatory ratios on the outcome of melanoma patients treated with mono-ICIs.

Methods

We conducted a multicentric retrospective analysis that included 112 advanced melanoma patients treated with mono-ICI (Pembrolizumab or Nivolumab) at three Centers in Serbia and Bosnia & Herzegovina. Data were extracted from the European Melanoma Registry (EuMelaReg). ROC curves with Youdens J-statistic were used to determine optimal cut-off-values (NLR: 3.35, PLR: 165.5, MLR: 165.5). The p-values regarding Progression-free survival (PFS and overall survival (OS) were calculated using log-rank (p<0.05; CI 95%).

Results

Each of the inflammatory ratios separately showed poorer prognosis in high-value subgroup in terms of shorter PFS (NLR: 3.55 vs 14.01- p<0.0001; PLR: 3.85 vs 11.48- p=0.0011; MLR: 5.16 vs 11.48- p=0.0171) and OS (NLR: 5.69 vs 23.59- p<0.0001; PLR: 6.12 vs 23.59- p<0.0001; MLR: 8.42 vs 21.78- p=0.0007). In group analysis, patients with all three ratios elevated were compared with patients with at least one low ratio. Shorter PFS (2.86 vs 10.56; p<0.0001) and OS (6.78 vs 21.45; p<0.0001) were also observed in the all-high subgroup. Patients with high-value ratios were younger (p=0.0162). No difference was observed in terms of gender (p=0.99), BRAF mutation status (p=0.53), the occurrence of immune-related adverse events (p=0.34) or LDH levels (p=0.16).

Conclusions

Inflammatory ratios are promising and accessible biomarkers that solely, or combined could be incorporated into clinical practice delineating patients who will benefit the most from mono-ICI and those who would need additional agents or a different therapeutic approach.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.