98P - Low prognostic nutritional index is independently associated with poorer survival in patients receiving immune checkpoint inhibitors

Background

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, although less than half of patients respond to ICIs, denoting the need for biomarkers. Blood-based biomarkers like prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lactate dehydrogenase (LDH) are readily available and inexpensive candidate biomarkers, however, data on their use is limited. Herein, we evaluated the association between survival and these markers in ICI-treated patients.

Methods

The data of advanced cancer patients treated with ICIs between 09/2014 and 06/2019 were retrospectively evaluated. Baseline demographics, ECOG performance status (PS), anthropometric measures, baseline LDH, PNI, NLR, and PLR levels were recorded together with survival data. The medians were used as the cut-offs for PNI, NLR, and PLR. The association between these factors and overall survival (OS) was analyzed by univariate and multivariate analyses.

Results

A total of 150 patients were included. The median age was 61 (18-86) and more than 2/3 of the patients were males. Most of the patients (89.3%) had an ECOG PS of 0 or 1. Melanomas and renal cell carcinomas (RCC) comprised more than half of the patients (59.4%) and nivolumab was the most frequently used ICI (65.3%). After a median follow-up of 8.5 months, 94 patients died. The median OS of the cohort was 11.07±1.95 months. In univariate analyses, poorer baseline ECOG PS (0-1 vs. >1, p=0.003), more than a two-fold increase in LDH levels (p<0.001), lower PNI (<45 vs >45, p<0.001), and higher NLR (<3.6 vs >3.6, p=0.016) were associated with decreased OS, while PLR (<200 vs >200, p=0.105) and body mass index (<25 vs >25, p=0.473) did not show a significant association. Among these factors, low PNI (HR: 2.065, 95% CI: 1.349-3.160, p=0.001), high LDH (HR: 2.515, 95% CI: 1.425-4.440, p=0.001) and poor ECOG PS (HR: 2.164, 95% CI: 1.217-3.848, p=0.009) remained significant in multivariate analyses.

Conclusions

Survival with ICIs was impaired in patients with low PNI, high LDH levels, and poor ECOG PS. Additional therapeutic strategies should be implemented in these patients to improve outcomes.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.