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The prognostic value of the derived neutrophil-to-lymphocyte ratio (dNLR) in patients treated with immune checkpoint inhibitors

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

The (derived) neutrophil-to-lymphocyte ratio (dNLR) is a potential predictive biomarker in the era of checkpoint inhibitors (CPI). An elevated dNLR is associated with worse outcomes across several malignancies. However, there is no clearly defined cut-off in the clinical setting.

Aim

To compare outcomes in patients prescribed CPI with a baseline dNLR0 > 3 and dNLR0 ≤ 3. The dNLR6 was measured 6 weeks later to determine its impact on patient overall survival (OS).

Methods

Prospectively maintained pharmacy databases in a regional cancer centre were interrogated for patients who were prescribed CPI in the advanced setting between January 2017 and May 2020.

Results

There were 121 patients with advanced cancer and a median age of 68 (range 30 to 88) years. Forty-four percent (n = 53) received prior systemic therapy. Patients with an initial dNLR0 > 3 when compared with a dNLR0 ≤ 3 had significantly shorter median progression-free survival (PFS), 3 vs. 14 months (p = 0.001) and median OS, 6.4 vs. 30.2 months (p = 0.001). Patients with an initial dNLR0 > 3 and increased dNLR at 6 weeks (dNLR6) had significantly reduced median PFS (3.5 vs. 14.7 months, p = 0.03) and OS (5.7 vs. 16.3, p = 0.03) when compared with those whose dNLR decreased. In the dNLR0 ≤ 3 cohort, any increased dNLR when compared with decreased dNLR after 6 weeks of CPI had significantly reduced PFS (8.4 months vs. NR, p = 0.01) and OS (24.2 months vs. NR, p = 0.02).

Conclusions

Lower pre-CPI treatment dNLR is associated with improved OS. A decrease in dNLR during treatment confers improved OS.

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Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Participating cancer patients and the UHW pharmacy department.

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Authors and Affiliations

  1. Department of Medical Oncology, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland

    William J. Mullally, John Greene, Emmet J. Jordan, Anne M. Horgan, Miriam O’Connor & Paula M. Calvert

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  1. William J. Mullally
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  2. John Greene
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  3. Emmet J. Jordan
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  4. Anne M. Horgan
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  5. Miriam O’Connor
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  6. Paula M. Calvert
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Contributions

All authors contributed equally to this manuscript, read, and approved the final manuscript.

Corresponding author

Correspondence to William J. Mullally.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Mullally, W.J., Greene, J., Jordan, E.J. et al. The prognostic value of the derived neutrophil-to-lymphocyte ratio (dNLR) in patients treated with immune checkpoint inhibitors. Ir J Med Sci 192, 83–87 (2023). https://doi.org/10.1007/s11845-022-02982-3

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  • DOI: https://doi.org/10.1007/s11845-022-02982-3

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