Abstract 1466P
Background
We aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and myeloid-derived suppressor cells (MDSCs) in gastric cancer patients treated with second-line ramucirumab+paclitaxel.
Methods
A total of 116 patients with advanced or metastatic gastric cancer who receive ramucirumab plus paclitaxel were prospectively enrolled. Fresh blood samples were collected before and after treatment, and flow cytometry was performed to assess the proportions of monocytic (mMDSCs) and granulocytic MDSCs (gMDSCs).
Results
Median age was 58 years and 71 (61.2%) were male. A baseline NLR ≥2.7 was associated with significantly poorer progression-free (PFS) and overall survival (OS) versus an NLR <2.7 (P = 0.024 and P = 0.0034, respectively). In multivariate analysis, an NLR ≥2.7 was independently associated with PFS (hazard ratio [HR] = 1.87; 95% confidence interval [CI]: 1.04–3.40, P = 0.04 ) and OS (HR = 1.95; 95% CI: 1.03–3.69, P = 0.04). While mMDSC counts did not significantly change following two cycles of therapy (P = 0.53), gMDSC counts decreased significantly after two treatment cycles (P = 0.025), but tended to increase in patients with progressive disease after two treatment cycles (P = 0.098). A progressive increase in gMDSC counts (≥44%) was associated with a significantly shorter PFS and OS versus a gMDSC count increase <44% (P = 0.0014 and P = 0.0032, respectively).
Conclusions
The baseline NLR may predict clinical outcomes and guide clinical decisions during ramucirumab+paclitaxel therapy for gastric cancer. Our gMDSC kinetics data warrant further clinical validation and mechanistic investigation.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
Y-K. Kang: Advisory/Consultancy: Taiho; Advisory/Consultancy: Ono; Advisory/Consultancy: Merck; Advisory/Consultancy: Daehwa; Advisory/Consultancy: BMS; Advisory/Consultancy: Astellas; Advisory/Consultancy: Zymeworks; Advisory/Consultancy: ALX Oncology; Advisory/Consultancy: Amgen; Advisory/Consultancy: Norvatis; Advisory/Consultancy: Macrogenics; Advisory/Consultancy: Surface Oncology. All other authors have declared no conflicts of interest.