High neutrophil-to-lymphocyte ratio (NLR) is associated with treatment failure and death in patients who have melanoma treated with PD-1 inhibitor monotherapy Journal Article


Authors: Bartlett, E. K.; Flynn, J. R.; Panageas, K. S.; Ferraro, R. A.; Sta.Cruz, J. M.; Postow, M. A.; Coit, D. G.; Ariyan, C. E.
Article Title: High neutrophil-to-lymphocyte ratio (NLR) is associated with treatment failure and death in patients who have melanoma treated with PD-1 inhibitor monotherapy
Abstract: Background: An elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor survival in patients with cancer, including those who receive immunotherapies. The authors sought to investigate NLR as a biomarker of treatment outcomes in patients with melanoma who were treated with PD-1 inhibition. Methods: Patients undergoing initial treatment with PD-1 inhibitor monotherapy for stage IV melanoma at a single center from 2012 to 2015 were included. Clinical characteristics and the NLR at baseline and before subsequent treatment cycles were collected. The time to treatment failure (TTF) and overall survival (OS) were evaluated using Kaplan-Meier and landmark analyses. Results: Among 224 study patients, 63 (28%) had a baseline NLR ≥5. The baseline NLR was significantly associated with Eastern Cooperative Oncology Group performance status and the number of involved metastatic sites. With a median follow-up of 39 months in survivors, a baseline NLR ≥5 was independently associated with shorter OS (hazard ratio, 2.0; 95% CI, 1.3-2.9) and TTF (hazard ratio, 1.7; 95% CI, 1.2-2.4). An NLR increase ≥30% during the first 2 cycles of treatment was associated with worse OS (median, 47 vs 13.5 months; P <.001) and a trend toward shorter TTF (12.8 vs 5.9 months; P =.05). A combined baseline NLR ≥5 and an NLR increase ≥30% identified a small cohort with markedly shortened OS (median, 5.8 months) and TTF (median, 1.8 months). Conclusions: Elevated baseline NLR and an increased NLR early during treatment are prognostic for TTF and OS in patients who have melanoma treated with PD-1 inhibitor monotherapy. Combined, these biomarkers can widely risk-stratify patients for treatment failure and survival. © 2019 American Cancer Society
Keywords: adult; treatment outcome; aged; treatment failure; major clinical study; overall survival; cancer staging; follow up; melanoma; multiple cycle treatment; cohort analysis; cancer mortality; cancer survivor; trend study; metastatic melanoma; nivolumab; time to treatment; human; male; female; priority journal; article; checkpoint inhibitor; pembrolizumab; neutrophil lymphocyte ratio; pd-1 inhibitor; neutrophil-to-lymphocyte ratio
Journal Title: Cancer
Volume: 126
Issue: 1
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2020-01-01
Start Page: 76
End Page: 85
Language: English
DOI: 10.1002/cncr.32506
PUBMED: 31584709
PROVIDER: scopus
PMCID: PMC6906249
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Michael Andrew Postow
    215 Postow
  2. Katherine S Panageas
    353 Panageas
  3. Charlotte Eielson Ariyan
    91 Ariyan
  4. Daniel Coit
    454 Coit
  5. Jessica Flynn
    27 Flynn