Neutrophil to lymphocyte ratio (NLR) as a predictor of outcomes in patients with urothelial carcinoma (UC) treated with immune checkpoint inhibitors (ICI)
Ahmed
Soualhi1*,
Rosalind
Kieran2*,
Charlotte
L.
Moss3,
Deborah
Enting2,
Simon
Hughes2,
Sarah
Rudman2,
Simon
Chowdhury2,
Shamim
Khan4,
Rajesh
Nair4,
Sachin
Malde4,
Ramesh
Thurairaja4,
Mieke
Van Hemelrijck3 and
Debra
Josephs2
-
1
King's College London, United Kingdom
-
2
Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom
-
3
Department of Translational Oncology and Urology Research, Faculty of Life Sciences & Medicine, King's College London, United Kingdom
-
4
Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom
Background
The ICI pembrolizumab is approved for treatment of locally advanced or metastatic UC. There remains a need for additional biomarkers to guide patient selection. This study aimed to identify baseline clinical characteristics associated with outcome in patients with UC treated with pembrolizumab at a single UK Cancer Centre.
Methods
Patients with locally advanced or metastatic UC treated with pembrolizumab between January and September 2018 were identified. Data on the following factors before treatment were collected: NLR, ECOG performance status (PS), haemoglobin, and presence of liver metastases. Multivariate logistic and Cox proportional hazards regression was used to evaluate the association with clinical outcomes: best response, progression free survival (PFS), and overall survival (OS). All models were adjusted for age, sex, and line of treatment.
Results
33 patients were evaluated with a median age of 68y (range 50-85y). 12 patients (36%) were female. 36% received pembrolizumab first line, and 64% second line. Median number of cycles received was 3 (range 1-10). Baseline NLR<5 and 5 was seen in 16 and 17 patients, respectively. Among those with NLR<5, 9/16 (56%) experienced clinical benefit (partial response or stable disease), compared to only 2/12 (17%) in those with NLR5. Moreover, NLR5 was associated with shorter PFS (HR = 11.2, 95% CI 3.2 – 40) and OS (HR = 6.3, 95% CI 1.6 – 25.1). For patients with NLR<5, median PFS and OS were not reached, compared to 61 days and 96 days for those with NLR5 respectively. No differences in clinical outcomes were detected according to PS, haemoglobin or presence of liver metastases.
Conclusion
Baseline NLR ≥5 was found to be a predictor of shorter PFS and OS with pembrolizumab in UC. NLR is an easily applicable clinical predictive factor that may help guide therapy, after prospective validation of these findings in a larger patient cohort.
Keywords:
Immune checkpoint inhibitor,
Neutrophyl lymphocyte ratio,
Pembrolizumab,
Urothelial,
Bladder,
Cancer,
biomarker
Conference:
Bladder Cancer Translational Research Meeting, London, United Kingdom, 29 Mar - 29 Mar, 2019.
Presentation Type:
Poster
Topic:
Optimisation of diagnostic pathways
Citation:
Soualhi
A,
Kieran
R,
Moss
CL,
Enting
D,
Hughes
S,
Rudman
S,
Chowdhury
S,
Khan
S,
Nair
R,
Malde
S,
Thurairaja
R,
Van Hemelrijck
M and
Josephs
D
(2019). Neutrophil to lymphocyte ratio (NLR) as a predictor of outcomes in patients with urothelial carcinoma (UC) treated with immune checkpoint inhibitors (ICI).
Front. Oncol.
Conference Abstract:
Bladder Cancer Translational Research Meeting.
doi: 10.3389/conf.fonc.2019.01.00009
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Received:
01 Mar 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Mr. Ahmed Soualhi, King's College London, London, WC2R 2LS, United Kingdom, ahmed.soualhi@kcl.ac.uk
Dr. Rosalind Kieran, Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, roskieran@hotmail.com