Bladder cancer: pre-pembrolizumab NLR may predict clinical outcomes

  • Ogihara K & al.
  • Urol Oncol
  • 2 Mar 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with platinum-resistant metastatic urothelial cancer, pretreatment neutrophil-to-lymphocyte ratio (pre-NLR) levels before pembrolizumab initiation are independent predictors of disease progression and cancer-specific mortality.
  • At least 25% reduction in NLR after treatment is associated with improved PFS and cancer-specific survival. 

Why this matters

  • Elevated pre-NLR may be a novel biomarker for identifying poor pembrolizumab responders.

Study design

  • 78 patients with metastatic urothelial carcinoma received pembrolizumab after platinum-based chemotherapy between December 2017 and April 2019.
  • Funding: None disclosed.

Key results

  • 42.3% of patients had elevated pre-NLR (≥3.35).
  • 29.5% of patients had a clinical response.
  • In high vs low pre-NLR group:
    • Significant decrease in the sum of the target lesion longest diameter (18.8% vs 58.1%; P=.005).
    • Lower 6-month PFS rates (9.1% vs 45.9%; P<.001>
    • Lower 6-month cancer-specific survival rates (58.0% vs 89.1%; P=.002).
  • The mean pre-NLR level in patients with progressive or stable disease was significantly higher vs in those with complete or partial response (3.87 vs 2.64; P=.02).
  • The pre-NLR level was an independent indicator of disease progression (P<.001 and cancer-specific death>
  • Post-pembrolizumab NLR level decrease of ≥25% from the pre-NLR level was associated with significant improvement in PFS (P=.01) and cancer-specific survival (P=.022).

Limitations

  • Retrospective design.