Neutrophil-to-lymphocyte ratio is superior to platelet-to-lymphocyte ratio as a prognostic predictor in advanced non-small-cell lung cancer treated with first-line platinum-based chemotherapy

BackgroundInduction with four cycles of platinum-based chemotherapy was the standard of care for metastatic non-small cell lung cancer (NSCLC) until the approval of immune checkpoint blockade (ICB) in the first-line setting. Switch maintenance therapy has shown promise in improving survival by exposing patients to novel, non-cross–resistant agents earlier in their treatment course.MethodsWe performed this open-label, three-arm, randomized phase II study (NCT02684461) to evaluate three sequences of consolidation with pembrolizumab and nab-paclitaxel in patients without progressive disease post induction chemotherapy. Consolidation was either sequential with pembrolizumab for four cycles followed by nab-paclitaxel for four cycles (P→A), nab-paclitaxel followed by pembrolizumab (A→P), or concurrent nab-paclitaxel and pembrolizumab for four cycles (AP).ResultsTwenty patients were randomized before the study was closed early due to the approval of first-line checkpoint inhibitors. We found that consolidation is feasible and well tolerated, with 30% of patients experiencing grade 3 toxicity. The median progression-free survival and OS in months (95% CI) in P→A were 10.1 (1.5–NR), 27.6 (1.7–NR); 8.4 (1.2–9.0), 12.7 (4.4–NR) in A→P; and 10.2 (5.1–NR), NR. Quality of life as measured by FACT-L improved in the majority of patients during the course of the study.ConclusionSequential and concurrent consolidation regimens are well tolerated and have encouraging overall survival in patients with metastatic NSCLC.

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Prognostic value of Platelet-to-Lymphocyte Ratio (PLR) and IL-6 in patients with small cell lung cancer

Diagnostyka Laboratoryjna ◽

10.5604/01.3001.0013.7698 ◽

2018 ◽

Vol 54 (3) ◽

pp. 137-144

Author(s):

Ewa Wójcik ◽

Zofia Stasik ◽

Urszula Rychlik ◽

Jadwiga Tarapacz ◽

Jan Kanty Kulpa ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Tumour Marker ◽

Small Cell ◽

Disease Stage ◽

Small Cell Lung ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Favourable Prognosis

Background: In order to identify patients with the most favourable prognosis, the effect of baseline level of interleukin-6 (IL-6) and platelet-to-lymphocyte ratio (PLR) on survival was analysed in patients with small cell lung cancer.<br>Material and Methods: 159 patients with small cell lung cancer were enrolled. Full blood count enabling computing the PLR, as well as NSE, ProGRP and IL-6 levels were done in all participants.<br>Results: We demonstrated significant effect of disease stage, performance status, sex, initial NSE, ProGRP and IL-6 levels as well as PLR on survival of patients with SCLC. In subgroups with normal initial levels of ProGRP (below 50.36 ng/L) and NSE (below 20.95 μg/L), the IL-6 level above 6.0 ng/L worsens the prognosis by 28% and 29%, respectively. In a subgroup with elevated initial ProGRP, the difference in survival between patients with normal vs elevated IL-6 level at baseline was 25%, whereas in a subgroup with elevated initial NSE it was 14%. The between-subgroup differences in PLR were less considerable. There was a significant effect of PLR on patient survival in a subgroup with normal initial NSE level and elevated initial ProGRP level.<br>Conclusion: In subgroups of SCLC patients identified based on initial tumour marker levels, IL-6 level can be a source of reliable prognostic information, whereas the effect of PLR is less marked. Patients with normal tumour marker levels and IL-6 below 6 ng/L at baseline have the most favourable prognosis.

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