67P - Inflammation status and sarcopenia synergistically impact outcomes in cancer patients (pt) treated with ImmunOtherapy (IO) within the framework of a Molecular Pre-screening program (MP) and a spEcial Medication (ME) program

Background

Inflammation is a key factor in the pathogenesis of sarcopenia, a negative prognostic factor in cancer. Higher neutrophil-to-lymphocyte ratio (NLR) is significantly associated with poorer overall survival (OS) across multiple tumor types and can serve as cost-effective surrogate biomarker of a preexisting inflammatory status. We aimed to assess the combined prognostic value of sarcopenia and NLR in IO-treated pt.

Methods

Retrospective analysis of pt with metastatic solid tumors treated with IO within the MP and the ME (off-label/expanded access use) programs at the Catalan Institute of Oncology between Jan’11-Dec’19. Included pt had clinic-analytical data and computed tomography scans performed as standard practice within a month before first IO dose. To analyze sarcopenia, skeletal mass index (SMI) was calculated using Slice-O-Matic software at L3 landmark and sarcopenia was dichotomized according to the median baseline SMI (high versus low). High NLR (>=3) versus low NLR (<3) was calculated in baseline IO-blood test. Kaplan-Meier was used to estimate median OS and log-rank test was used to compare survival curves.

Results

We included 90 pt: the majority were male (66%), <75 years (76%), ECOG <2 (89%), <2 sites of metastases (61%) and had received <3 lines of treatment (93%). Most common tumors were lung (37%) genitourinary (29%), skin (27%) and others (8%, including gynecological, gastrointestinal, sarcomas and SCCHN). Sarcopenia was detected in half of pt of whom 67% had high NLR. OS was 23.5 months (m) in high SMI/low NLR, 12.3m in high SMI/high NLR, 11.8m in low SMI/low NLR and 3 m in low SMI/high NLR groups (p=0.0003). Noteworthy, OS rate at 12 m was 75% (CI 95%; 60-94) in high SMI/low NLR group, whilst in low SMI/high NLR group was 27% (CI 95%; 15-48) (p=0.0001).

Conclusions

The combination of both widely accessible prognostic biomarkers may help in MP and ME programs decision-making, by identifying the subgroup of low SMI/high NLR patients with worse prognosis to better select candidates. Strategies for reducing systemic inflammation and improving skeletal muscle mass are warranted to increase benefits of IO.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.