• Alessandro Russo, Marco Russano, Tindara Franchina, Maria R Migliorino, Giuseppe Aprile, Giovanni Mansueto, Alfredo Berruti, Alfredo Falcone, Michele Aieta, Alain Gelibter, Antonio Russo, Sandro Barni, Michele Maio, Olga Martelli, Francesco Pantano, Daniela Iacono, Lorenzo Calvetti, Silvia Quadrini, Elisa Roca, Enrico Vasile, Marco Imperatori, Mario Occhipinti, Antonio Galvano, Fausto Petrelli, Luana Calabrò, Giulia Pasquini, Salvatore Intagliata, Giuseppina R R Ricciardi, Giuseppe Tonini, Daniele Santini, and Vincenzo Adamo.
• Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy.
• Adv Ther. 2020 Mar 1; 37 (3): 1145-1155.

IntroductionImmune checkpoint inhibitors have provided substantial benefit in non-small cell lung cancer (NSCLC) with unprecedented results in terms of survival. However, the identification of reliable predictive biomarkers to these agents is lacking and multiple clinicopathological factors have been evaluated. The aim of this study was to analyze the potential role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lactate dehydrogenase (LDH) levels in patients with pretreated NSCLC receiving nivolumab.MethodsThis was a retrospective multicenter study involving 14 Italian centers, evaluating the role of some laboratory results in patients with NSCLC treated with nivolumab in the second or later lines of therapy for at least four doses and with a disease re-staging.ResultsA total of 187 patients with available pretreatment laboratory results were included. NLR levels below 5 were associated with an improvement in terms of both progression-free survival (PFS) (p = 0.028) and overall survival (OS) (p = 0.001), but not in terms of overall response rate (ORR) or disease control rate (DCR). Moreover, PLR levels below 200 were associated with longer PFS (p = 0.0267) and OS (p = 0.05), as well as higher ORR (p = 0.04) and DCR (p = 0.001). In contrast, LDH levels above the upper normal limit (UNL) were not associated with significant impact on patient outcomes.ConclusionsPatients with pretreated NSCLC and high pretreatment levels of NLR and PLR may experience inferior outcomes with nivolumab. Therefore, in this subgroup of patients with poor prognosis the use of alternative therapeutic strategies may be a valuable option, especially in programmed cell death ligand 1 (PD-L1)-negative patients and/or in the presence of other additional poor prognostic factors.

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