Guru Sonpavde, MD, Director of the bladder cancer program at Dana-Farber Cancer Institute and is on the faculty of Harvard Medical School at Harvard University. In this video, he speaks about the ASCO GU 2022 Abstract – Early changes in peripheral blood neutrophil-lymphocyte ratio (NLR) predicts outcomes with immune checkpoint inhibitors (ICIs) for metastatic urothelial carcinoma (mUC).
Â
Origins:
ICIs have made strides in the treatment of mUC. However, determining the objective effectiveness of ICIs via radiographic imaging might take months and can be muddled by pseudoprogression. Immune cells infiltrating the tumor microenvironment appear to be reflected in peripheral blood cells. We wanted to study dynamic early changes in NLR as a biomarker of benefit in patients (pts) with mUC, given the known predictive influence of baseline peripheral blood NLR.
Â
Methodologies:
Â
From 2015 to 2020, deidentified data from mUC patients treated with ICIs at Dana Farber Cancer Institute were analyzed retrospectively. At baseline and 3-4 weeks after starting the ICI, demographic data (age, gender), setting (untreated vs. post-platinum), locations of metastasis, performance status (PS), platelet count, and NLR were collected. We looked at the relationship between NLR at baseline and 3-4 weeks after initiating the ICI and tumor regression (ART) and overall survival (OS). Backward selection was used to find the connection of NLR alterations with ART and OS, respectively, using a multivariable logistic regression model and a Cox proportional-hazards model.
Outcomes:
There were a total of 144 points available. The median age was 76, and 100 (69.3%) of the participants were men. Overall, 54.8 percent (n=79) of the patients had ART, with a median OS of 15.2 (12.2-23.5) months. The remaining 37.5 percent (n=54) were platinum naive and got post-platinum ICI therapy. In the multivariable models (Table), an increase in NLR of 1.0 from baseline at 3-4 weeks was linked with a decreased risk of ART (OR= 0.80; 95 percent CI = 0.70-0.90; p = 0.0004) and a worse OS (HR = 1.08; 95 percent CI = 1.05-1.11; p 0.0001). The presence of hepatic metastasis was linked to a decreased risk of ART (OR = 0.30; 95% CI = 0.13-0.70; p = 0.006) and OS (HR 2.73; 95% CI 1.71- 4.36; p0.0001).
Observations:
In patients with mUC, changes in NLR in the first four weeks after starting ICI were linked to tumor regression and survival. Changes in NLR may aid in the early detection of benefits as well as the identification of patients who may be on the verge of disease progression. To facilitate the early discrimination of benefit from ICIs in pts with mUC, more validation is required.