A composite biomarker of neutrophil-lymphocyte ratio and hemoglobin level correlates with clinical response to PD-1 and PD-L1 inhibitors in advanced non-small cell lung cancers.

摘要: BACKGROUND Immune checkpoint inhibitors (ICIs) have been incorporated into various clinical oncology guidelines for systemic treatment of advanced non-small cell lung cancers (aNSCLC). However, less than 50% (and 20%) the patients responded to therapy as a first (or second) line therapy. PD-L1 immunohistochemistry (IHC) is an extensively studied biomarker response ICI, but results from this test equivocal predictive power. In order identify other biomarkers that support decision-making around whether treat with ICIs or not, we performed retrospective study aNSCLC who underwent ICI-based in Mount Sinai Health System between 2014 and 2019. METHODS We analyzed data standard laboratory tests part routine workup during treatment, including complete blood counts (CBC) comprehensive metabolic panel (CMP), correlate survival. RESULTS Of 11,138 NSCLC identified, 249 had treated ICIs. found associations high neutrophil-to-lymphocyte ratio (NLR ≥ 5) poor survival ICI-treated NSCLC. further observed sustained NLR after initiation more profound impact on baseline NLR, regardless status. Hazard ratios when comparing NLR ≥ 5 vs. NLR < 5 are 1.7 (p = 0.02), 3.4 (p = 4.2 × 10- 8), 3.9 (p = 1.4 × 10- 6) at baseline, 2-8 weeks, 8-14 weeks start, respectively. Mild anemia, defined hemoglobin (HGB) 12 g/dL was correlated independently NLR. Finally, developed composite HGB biomarker. Patients pretreatment HGB < 12 g/dL median overall (OS) 8.0 months (95% CI 4.5-11.5) compared rest cohort OS not reached 15.9-NE, p = 1.8 × 10- 5), hazard 2.6 1.7-4.1, p = 3.5 × 10- 5). CONCLUSIONS novel based CBC tests, which may provide meaningful utility guide decision. The suggest anemia elevate before ICI improve patient outcomes use alternative non-chemotherapy containing regimens.