Abstract 4469: Impact of peripheral blood neutrophil lymphocyte ratio on response and survival in various malignancies treated with immunotherapy
Authors: Murthy Nitin Yashas , Rauthan Amit , Patil Poonam , Somashekhar S.p , Zaveri Shabber S. , Lahkar Kakoli , Gupta Kushal , Nigade Gaurav , Ashwath Rajshri , Vundemodalu Prathyush , Raghunathan Aditi 
Published: September 2020

Abstract
Introduction: Immune check point inhibitors(ICI) have revolutionized the treatment of metastatic malignancies. There is a need for a bio-marker apart from PDL-1 especially in a 2nd line setting in malignancies like metastatic renal cell carcinoma (mRCC), metastatic non small cell lung cancer (mNSCLC). Peripheral blood neutrophil lymphocyte ratio (NLR) is emerging as a prognostic marker.
Materials & methods: Ambi-directional retro-prospective study of 100 patients who received ICI between 2016-2019. Peripheral blood NLR of 5 at baseline was used to stratify them into 2 groups. Objective response rate (ORR) and overall survival (OS) was compared between the 2 groups. NLR was also monitored at the 4th cycle.
Results: Among the 100 patients, 40 had mRCC, 35 had mNSCLC, 18 had recurrent/metastatic head and neck squamous cell carcinoma (mHNSCC) and 7 had MMR-deficient/MSI high tumors. In patients with mRCC, those with NLR&lt;5 (n=26) had significantly better ORR of 73%, median OS not reached (HR:0.12) as compared to 14.28 % in those with NLR&gt; 5 (n=14) with median OS of only 5 months.4 patients with NLR &lt;5 (15.38%) achieved complete response (CR) and continue to be in CR for 41,39, 30 &21 months respectively. Of 35 mNSCLC patients treated with ICI,18 received it in 2nd line setting. Among these 18 patients, ORR of 37.5% with median OS of 14 months was found in NLR&lt;5 (n=8) as compared to ORR of 20% with median OS of only 6 months in NLR&gt;5 (n=10). In the first line setting of NSCLC, ORR was 69.2 % in NLR &lt;5 (n=13) as compared to 50% in NLR&gt;5(n=4) with median OS not reached in both groups. In mHNSCC(n=18), patients with NLR &lt;5 (n=8) had a ORR of 37.5%,median OS of 10 months (maximum ongoing follow up of 22 and 20 months) as compared to ORR of 30% with median OS of 4 months in those with NLR&gt;5. Among MMR-d/MSI-H tumours (n=7), 3 patients had NLR&gt;5. There was no impact of baseline NLR on response or survival as 6 of 7 patients achieved a partial response with ongoing prolonged survival. There was no significant change in the NLR at 4th cycle across all malignancies in both the groups (p&gt;0.05). However a subset of those with NLR&gt;5 at baseline (5 out of 14 in NSCLC, 2 out of the 10 in mHNC, and all 3 patients of MMR-d/MSI-H tumours) - had reduction in the NLR to &lt;5 after 3 cycles of treatment with ICI and demonstrated an objective response and prolonged survival of 12 months or more as compared to those who did not have significant reduction.
Discussion: Patients with low baseline NLR were found to have superior response and survival in various malignancies treated with ICI. A significant reduction in NLR after initiation of treatment with ICI may influence prognosis. Large scale studies need to be done to see if NLR can be used as a marker to guide treatment such as combining ICI with another agent in those with high NLR rather than using it as a single agent. As NLR is cost effective, it maybe of great value for prognostication in resource constrained settings.
Citation Format: Nitin Yashas Murthy, Amit Rauthan, Poonam Patil, S.p Somashekhar, Shabber S. Zaveri, Kakoli Lahkar, Kushal Gupta, Gaurav Nigade, Rajshri Ashwath, Prathyush Vundemodalu, Aditi Raghunathan. Impact of peripheral blood neutrophil lymphocyte ratio on response and survival in various malignancies treated with immunotherapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4469.