• William J Mullally, John Greene, Emmet J Jordan, Anne M Horgan, Miriam O'Connor, and Paula M Calvert.
• Department of Medical Oncology, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland. willmullally@gmail.com.
• Ir J Med Sci. 2023 Feb 1; 192 (1): 838783-87.

BackgroundThe (derived) neutrophil-to-lymphocyte ratio (dNLR) is a potential predictive biomarker in the era of checkpoint inhibitors (CPI). An elevated dNLR is associated with worse outcomes across several malignancies. However, there is no clearly defined cut-off in the clinical setting.AimTo compare outcomes in patients prescribed CPI with a baseline dNLR0 > 3 and dNLR0 ≤ 3. The dNLR6 was measured 6 weeks later to determine its impact on patient overall survival (OS).MethodsProspectively maintained pharmacy databases in a regional cancer centre were interrogated for patients who were prescribed CPI in the advanced setting between January 2017 and May 2020.ResultsThere were 121 patients with advanced cancer and a median age of 68 (range 30 to 88) years. Forty-four percent (n = 53) received prior systemic therapy. Patients with an initial dNLR0 > 3 when compared with a dNLR0 ≤ 3 had significantly shorter median progression-free survival (PFS), 3 vs. 14 months (p = 0.001) and median OS, 6.4 vs. 30.2 months (p = 0.001). Patients with an initial dNLR0 > 3 and increased dNLR at 6 weeks (dNLR6) had significantly reduced median PFS (3.5 vs. 14.7 months, p = 0.03) and OS (5.7 vs. 16.3, p = 0.03) when compared with those whose dNLR decreased. In the dNLR0 ≤ 3 cohort, any increased dNLR when compared with decreased dNLR after 6 weeks of CPI had significantly reduced PFS (8.4 months vs. NR, p = 0.01) and OS (24.2 months vs. NR, p = 0.02).ConclusionsLower pre-CPI treatment dNLR is associated with improved OS. A decrease in dNLR during treatment confers improved OS.© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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