190P - Are neutrophil-to-lymphocyte ratio (NLR) and neutrophil count percentage (NCP) predictors of nivolumab outcome and toxicity in NSCLC?

Advanced NSCLC

190P - Are neutrophil-to-lymphocyte ratio (NLR) and neutrophil count percentage (NCP) predictors of nivolumab outcome and toxicity in NSCLC?

Authors

Jacobo Rogado (ES)
Vilma Pacheco Barcia (ES)
Patricia Toquero (ES)
Beatriz Vera (ES)
Rebecca Mondejar (ES)
Nuria Romero Laorden (ES)
Ana Isabel Ballesteros Garcia (ES)
Olga Donnay (ES)
Ramon Colomer Bosch (ES)
José Miguel Sánchez-Torres (ES)

Presenter

Jacobo Rogado (ES)

Abstract

Abstract

Background

There is limited data of the effect of inflammatory markers on Nivolumab efficacy. We assessed the association between NLR and NCP in NSCLC and the efficacy of Nivolumab. In order to establish whether the effect was either predictive or prognostic, we studied NLR and NCP in two independent cohorts, one treated with Nivolumab and one treated with chemotherapy. Finally, we also analyzed the relationship of NLR and NCP with immune-related adverse events (irAEs).

Methods

Data from 40 NSCLC patients treated with Nivolumab between January 2015 and May 2017 were retrospectively collected. Population was dichotomized according to NLR of 5 and NCP of 80%. The association between NLR or NCP and progression free survival (PFS) and overall survival (OS) was analyzed by univariate and multivariate models. A cohort of 54 chemotherapy-treated NSCLC patients was also analyzed. The association between development of irAEs and NLR or NCP was estudiad by chi square test and Odds Ratio.

Results

Multivariate analysis demonstrated that patients treated with Nivolumab and baseline NLR < 5 have a favourable PFS (6 vs 2 months, HR 8.3, p < 0.001) and OS (26 vs 10.5 months, HR 4.40, p < 0.000001) than cases with NLR ≥ 5. Patients treated with nivolumab and NCP < 80% have also a favourable PFS (6 vs 1.5 months, HR 0.10, p < 0.001) and OS (21.5 vs 9.5 months, HR 0.21, p < 0.05) than cases with NCP ≥ 80%. Patients who received chemotherapy and NLR < 5 have significative better PFS and OS too (15.5 vs 6.5 months, HR 5.9, p < 0.00001) and OS (24 vs 17 months, HR 6.7, p < 0.0001), but this was not observed with NCP < 80%, since no significant diferences showed in the multivariate analysis (PFS 4 vs 2.5 months, p = 0.8; OS 14 vs 9.5 months, p = 0.54). In our analysis, NLR and NCP were not associated with the development of irAEs.

Conclusions

Neutrophil count percentage is a predictive biomarker of Nivolumab clinical course in NSCLC. NCP < 80% was associated with improved PFS and OS. In contrast, neutrophil-to-lymphocyte ratio had a prognostic but not a predictive value. Our results may relevant in the future when patients with NSCLC initiate nivolumab therapy.