Correlation of Neutrophil to Lymphocyte Ratio and Absolute Neutrophil Count With Outcomes With PD-1 Axis Inhibitors in Patients With Advanced Non-Small-Cell Lung Cancer

Alona Zer, Mike R Sung, Preet Walia, Manjula Maganti, Catherine Labbe, Frances A Shepherd, Penelope A Bradbury, Ronald Feld, Geoffrey Liu, Melissa Iazzi, Dianne Zawisza, Nazanin Nouriany, Natasha B Leighl, Leila Khoja

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51 Citations (Scopus)


INTRODUCTION: Programmed death-1 (PD-1) axis inhibitors have become standard therapy in advanced non-small-cell lung cancer (NSCLC). Response might be delayed and pseudo-progression occasionally occurs in patients who eventually benefit from treatment. Additional markers beyond programmed death ligand 1 (PD-L1) expression are needed to assist in patient selection, response evaluation, and treatment decisions.

MATERIALS AND METHODS: The relationship between prospectively collected clinical outcomes (response, disease control rate [DCR], treatment duration, overall survival) and hematologic parameters (neutrophil to lymphocyte ratio [NLR], absolute neutrophil count [ANC], and platelet to lymphocyte ratio [PLR]) was explored retrospectively in advanced NSCLC patients treated with PD-1 axis inhibitors at a major cancer center from May 2013 to August 2016. Hematologic parameters at baseline and during treatment (week 2 or 3 and week 8) were included.

RESULTS: Of 88 patients treated with PD-1 axis inhibitors, 22 (25%) experienced partial response. Baseline NLR ≤4 was associated with superior DCR (74% vs. 50%; P = .025), treatment duration (P = .037), time to progression (P = .053), and overall survival (P = .019), with no differential association according to PD-L1 tumor expression. Lower NLR and ANC during treatment were also associated with response to treatment (P = .025 and P = .017, respectively), and treatment duration (P = .036 and P = .008). No association was found between baseline PLR and DCR, response, treatment duration, nor overall survival.

CONCLUSION: Baseline NLR ≤4 and lower NLR and ANC during treatment might correlate with disease control and treatment response and should be explored further as potential predictors of treatment benefit in larger studies.

Original languageEnglish
Pages (from-to)426-434.e1
JournalClinical Lung Cancer
Issue number5
Publication statusPublished - Sept 2018

Bibliographical note

Copyright © 2018 Elsevier Inc. All rights reserved.


  • Adenocarcinoma/drug therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Immunological/therapeutic use
  • B7-H1 Antigen/antagonists & inhibitors
  • Biomarkers, Tumor/analysis
  • Carcinoma, Large Cell/drug therapy
  • Carcinoma, Non-Small-Cell Lung/drug therapy
  • Carcinoma, Squamous Cell/drug therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms/drug therapy
  • Lymphocytes/pathology
  • Male
  • Middle Aged
  • Neutrophils/pathology
  • Prognosis
  • Prospective Studies
  • Survival Rate


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