REPORTING FROM THE NCCN ANNUAL CONFERENCE
ORLANDO (FRONTLINE MEDICAL NEWS) – Information readily available on complete blood count can help predict response to immunotherapy and outcomes in patients with advanced non–small cell lung cancer, according to findings from a review of 157 cases.
Specifically, absolute monocyte count of 0.63 or greater and absolute neutrophil count/absolute lymphocyte count of 5.9 or greater at baseline were significantly associated with poor progression-free survival (hazard ratios, 1.50 and 1.61, respectively) and overall survival (HRs, 1.71 and 1.87, respectively) in patients treated with anti–programmed death-1 (PD-1) antibodies, Aixa E. Soyano, MD, reported in a poster at the annual conference of the National Comprehensive Cancer Network.
Additionally, absolute neutrophil count of at least 7.5 and myeloid to lymphoid ratio of at least 11.3 at baseline were associated with poor overall survival (HRs, 1.86 and 2.31, respectively), according to Dr. Soyano of the Mayo Clinic, Jacksonville, Fla.
“The potential predictive value of these readily available biomarkers might help with risk stratification and treatment strategies,” she and her colleagues wrote.
Cases included in the review involved advanced non–small cell lung cancer (NSCLC) patients with a median age of 66 years who were treated with nivolumab or pembrolizumab at the Mayo Clinic from January 2010 to April 2017. Most (91%) were white, 4.5% were African American, 1.9% were Asian, 0.6% were native Hawaiian/Pacific Islander, and 1.9% were other ethnicities. Slightly more than half (53%) were men, and diagnoses included adenocarcinoma (69%), squamous disease (29%) and other (3%). Half had one prior line of chemotherapy, 22% had two prior lines, and 10% had three or more prior lines. The majority (72%) had Eastern Cooperative Oncology Group performance status of 1 or 2, and 34% had CNS disease.
Pembrolizumab was given intravenously at a dose of 2 mg/kg every 21 days (11 patients), and nivolumab was given intravenously at a dose of 3 mg/kg every 14 days (146 patients). Clinical response was assessed every 8-12 weeks by CT of the chest, abdomen and pelvis, and also – in some cases – by brain MRI.
The findings are notable because, although combination chemotherapy with a platinum-based doublet has, for the last decade, been the backbone of initial systemic therapy for patients whose tumor does not have driver mutations, monoclonal antibodies targeting PD-1 or its ligand PD-L1 have shown improvements in progression-free survival and overall survival in certain patients with metastatic or locally advanced lung cancer, the investigators explained.
Prior studies in melanoma patients treated with immunotherapy targeting the cytotoxic T-lymphocyte antigen 4 pathway and PD-1/PD-L1 pathways have identified predictive or prognostic hematological markers of outcomes. However, data with respect to hematologic markers in lung cancer are sparse, and given the high cost, significant immune-related side effects, and rapidly expanding number of indications for immunotherapy in NSCLC, there is a need for reliable biomarkers to help predict response and outcomes, they said.
In a separate presentation at the NCCN conference, John A. Thompson, MD , of the Fred Hutchinson Cancer Research Center, Seattle, noted that some progress has been made in the area of predicting response to immune checkpoint inhibitors in NSCLC patients. Namely, the value of tumor PD-L1 expression and tumor mutation burden for predicting outcomes was highlighted in a recent study by Rizvi et al ., who concluded that “the incorporation of both TMB [tumor mutation burden] and PD-L1 expression into multivariable predictive models should result in greater predictive power.” .
“This is a first step in our evolution and our progress toward a better biomarker. I think when we add in other factors like gene expression, we may be able to develop an even more robust biomarker that will help us select appropriate patients for therapy,” he said.
Dr. Soyano and her colleagues noted, however, that these measures, as well as tumor infiltrating immune cells, which have also been shown to have predictive value, require special testing and/or processing.
Furthermore, the optimal cutoff with PD-L1 expression is debatable, they said.
CBC data is more readily available, and also appears to have predictive and prognostic value, they said, concluding that the findings warrant further investigation in a larger, prospective study.
The authors reported having no disclosures.
SOURCE: Soyano A et al. NCCN Poster 075 .