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Neutrophil-to-eosinophil ratio as a biomarker for clinical outcomes in advanced stage melanoma patients treated with anti-PD-1 therapy |
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| Authors: | Vincent Pozorski Yeonhee Park Yusuf Mohamoud Dahlia Tesfamichael Hamid Emamekhoo Alexander Birbrair Mark R Albertini Vincent T Ma |
| Institution: | 1. University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA;2. Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA;3. Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
Department of Internal Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, Wisconsin, USA;4. University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA Department of Dermatology, University of Wisconsin-Madison, Madison, Wisconsin, USA;5. Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA Department of Internal Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, Wisconsin, USA Department of Dermatology, University of Wisconsin-Madison, Madison, Wisconsin, USA William S. Middleton Memorial Veterans Hospital, Madison, Wisonsin, USA;6. Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA |
| Abstract: | Neutrophil-to-lymphocyte ratios (NLR) and eosinophil counts are associated with improved survival in melanoma patients treated with immune checkpoint inhibitors, but no study has investigated neutrophil-to-eosinophil ratios (NER) as a predictive indicator in this population. In this retrospective study evaluating anti-PD-1 treated patients with advanced melanoma, progression-free survival (PFS), overall survival (OS), objective response rates (ORR), and risk of high-grade (grade ≥3) immune-related adverse events (irAEs) were compared between groups defined by median pretreatment NLR and NER as well as median NLR and NER at 1-month post-treatment. Lower baseline NLR and NER were associated with improved OS HR: 0.504, 95% CI: 0.328–0.773, p = .002 and HR: 0.442, 95% CI: 0.288–0.681, p < .001, respectively] on univariate testing. After accounting for multiple covariates, our multivariate analysis found that lower pretreatment NER was associated with better ORR (by irRECIST) (OR: 2.199, 95% CI: 1.071–4.582, p = .033) and improved OS (HR: 0.480, 95% CI: 0.296–0.777, p = .003). Baseline NLR, 1-month NLR, and 1-month NER were not associated with ORR, PFS, or OS outcomes; but 1-month NER correlated with lower risk of grade ≥3 irAEs (OR: 0.392, 95% CI: 0.165–0.895, p = .029). Our findings suggest baseline NER merits additional investigation as a novel prognostic marker for advanced melanoma patients receiving anti-PD-1-based regimens. |
| Keywords: | biomarker immune checkpoint inhibitors immunotherapy melanoma metastatic melanoma neutrophil-to-eosinophil ratio neutrophil-to-lymphocyte ratio |