The Prognostic Role of High Blood Cholesterol in Advanced Cancer Patients Treated With Immune Checkpoint Inhibitors

Abstract Background A low absolute lymphocyte/monocyte ratio (LMR) in the peripheral blood is associated with poor prognosis in various cancers; however, its role as a predictive biomarker has not been well defined in the era of treatment with immune checkpoint inhibitors (ICI). Methods We queried a database of advanced cancer patients treated with at least one dose of ICI from 2011 to 2017 to study the association of LMR with overall survival (OS). We calculated LMR at baseline and a median of 21 days after the first cycle of ICI (on-treatment LMR), and defined low if < 2 and high if ≥ 2. OS was calculated from the initiation of ICI to date of death or censored at last follow-up. Results 1077 patients met the criteria for this study. Patients with low baseline LMR had a shorter median OS compared to patients with a high baseline LMR (8.5 vs 18.1 months, p < 0.01). In patients with a low baseline LMR, who on-treatment LMR increased to high had longer median OS compared to those whose on-treatment LMR remained low (16.8 vs 7.8 months, p < 0.001). Patients with a high baseline LMR and in whom on-treatment LMR remained high had longer median OS compared to patients with low on-treatment LMR (23.9 vs 9.2 months, p < 0.001). In multivariate analysis, high on-treatment LMR was most strongly associated with longer survival compared to low on-treatment LMR, regardless of baseline LMR. Conclusions Higher baseline and early changes in on-treatment LMR are associated with improved OS in cancer patients receiving ICI.

Download Full-text

Symptomatic COVID-19 in advanced-cancer patients treated with immune-checkpoint inhibitors: prospective analysis from a multicentre observational trial by FICOG

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920968463 ◽

2020 ◽

Vol 12 ◽

pp. 175883592096846

Author(s):

Melissa Bersanelli ◽

Diana Giannarelli ◽

Ugo De Giorgi ◽

Sandro Pignata ◽

Massimo Di Maio ◽

...

Keyword(s):

Mortality Rate ◽

Influenza Vaccination ◽

Cancer Patients ◽

Advanced Cancer ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Advanced Cancer Patients ◽

Laboratory Confirmation ◽

The Difference

Background: This prospective, multicentre, observational INVIDIa-2 study is investigating the clinical efficacy of influenza vaccination in advanced-cancer patients receiving immune-checkpoint inhibitors (ICIs), enrolled in 82 Italian centres, from October 2019 to January 2020. The primary endpoint was the incidence of influenza-like illness (ILI) until 30 April 2020. All the ILI episodes, laboratory tests, complications, hospitalizations and pneumonitis were recorded. Therefore, the study prospectively recorded all the COVID-19 ILI events. Patients and methods: Patients were included in this non-prespecified COVID-19 analysis, if alive on 31 January 2020, when the Italian government declared the national emergency. The prevalence of confirmed COVID-19 cases was detected as ILI episode with laboratory confirmation of SARS-CoV-2. Cases with clinical-radiological diagnosis of COVID-19 (COVID-like ILIs), were also reported. Results: Out of 1257 enrolled patients, 955 matched the inclusion criteria for this unplanned analysis. From 31 January to 30 April 2020, 66 patients had ILI: 9 of 955 cases were confirmed COVID-19 ILIs, with prevalence of 0.9% [95% confidence interval (CI): 0.3–2.4], a hospitalization rate of 100% and a mortality rate of 77.8%. Including 5 COVID-like ILIs, the overall COVID-19 prevalence was 1.5% (95% CI: 0.5–3.1), with 100% hospitalization and 64% mortality. The presence of elderly, males and comorbidities was significantly higher among patients vaccinated against influenza versus unvaccinated ( p = 0.009, p < 0.0001, p < 0.0001). Overall COVID-19 prevalence was 1.2% for vaccinated (six of 482 cases, all confirmed) and 1.7% for unvaccinated (8 of 473, 3 confirmed COVID-19 and 5 COVID-like), p = 0.52. The difference remained non-significant, considering confirmed COVID-19 only ( p = 0.33). Conclusion: COVID-19 has a meaningful clinical impact on the cancer-patient population receiving ICIs, with high prevalence, hospitalization and an alarming mortality rate among symptomatic cases. Influenza vaccination does not protect from SARS-CoV-2 infection.

Download Full-text