e21514 Background: Although some advanced non-small cell lung cancer (aNSCLC) patients respond favorably to immune checkpoint inhibitors, a larger portion either do not respond or experience negative side effects. At present, there is no consensus on how to best predict response to immunotherapy (IO) agents. Complete blood count (CBC) data have shown correlation with both progression and survival for patients treated with IO. However, previous studies have been relatively small, or did not focus on aNSCLC. Given CBCs are measured routinely for every patient throughout their course of therapy, we used real-world data (RWD) to assess the biomarker potential of CBCs in predicting response at the start and through the course of therapy. Methods: We performed a retrospective cohort study of 11,138 lung cancer patients treated at hospitals in the Mount Sinai Health System of whom 249 aNSCLC and were treated with anti-PD1/PD-L1 therapy. We extracted and harmonized medical record data using an automated abstraction engine and evaluated the impact of changes in CBCs, including eosinophils, lymphocytes, monocytes, neutrophils, red blood cells and platelets after treatment initiation. Time to treatment discontinuation (TTD) and overall survival (OS) were our clinical endpoints. Results: Abnormal baseline levels of monocytes, neutrophils, and red bloods cells were associated with OS; counts taken between 2-8 weeks were modestly to significantly associated with poorer OS, with hazard ratios ranging from 1.7-4.7. Most strikingly, neutrophil levels above 7 (HR = 4.3, p = 3.2*10−10, 95% CI = 2.7-6.7) and a neutrophil-to-lymphocyte ratio > 5 (HR = 3.4, p = 8.0*10−8, 95% CI = 2.2-5.4) were associated with poorer OS. For those with normal neutrophil levels at baseline, progressing to high levels at 2-8 weeks resulted in a hazard for OS of 5.0 (p = 4.4*10−8, 95% CI = 2.8-9.0). Those with progression are more likely to have high neutrophil levels at baseline, or an increase in neutrophil levels from normal to high levels between baseline and 2-8 weeks or 8-14 weeks. Our results remained consistent even after controlling for factors that may affect neutrophil levels including concurrent chemotherapy, administration of neutropenia medications, or concurrent infections. Repeating the analysis with TTD as the primary endpoint showed similar but less significant trends. Conclusions: RWD showed changes in blood cell counts after anti-PD1/PD-L1 therapy were associated with OS in aNSCLC and show promise as a predictive biomarker.
Analysis of real‐world data to investigate the impact of race and ethnicity on response to
PD
‐1 and
PD‐L1
inhibitors in advanced non‐small cell lung cancers
