The Prognostic Value of Pre-treatment Hemoglobin (Hb) in Patients With Advanced or Metastatic Gastric Cancer Treated With Immunotherapy

BackgroundBiomarkers such as prevailing PD-L1 expression and TMB have been proposed as a way of predicting the outcome of immunotherapy in patients with advanced gastric cancer (AGC) and metastatic gastric cancer (MGC). Our study aims to investigate whether there is a link between pretreatment hemoglobin (Hb) levels and survival to immunotherapy in patients with AGC and MGC.MethodsWe retrospectively reviewed patients with AGC or MGC treated at the oncology department of the Chinese PLA general hospital receiving PD-1 inhibitor. The Propensity Score Matching (PSM) (1:1) was performed to balance potential baseline confounding factors. Progression-free survival (PFS) and overall survival (OS) was analyzed among different Hb level (normal Hb group and decreased Hb group). Objective response rate (ORR), disease control rate (DCR) were also analyzed. Univariate analysis and multivariate analysis were performed further to validate the prognostic value of Hb level.ResultsWe included 137 patients with AGC and MGC who received PD-1 inhibitors (including Pembrolizumab, Nivolumab, Sintilimab, Toripalimab) in this study. After PSM matching, there were no significant differences between the two groups for baseline characteristics. Within the matched cohort, the median PFS was 7.8 months in the normal Hb level group and 4.3 months in the decreased Hb group (HR 95% CI 0.5(0.31, 0.81), P=0.004). The OS was 14.4 months with normal Hb level as compared with 8.2 months with decreased Hb level(HR 95% CI 0.59(0.37, 0.94), P=0.024). The ORR was 40.7% and DCR was 83.0% in the normal Hb group, while the ORR was 25.5% and DCR was 85.1% in the decreased Hb group. No significant differences were found in the ORR and DCR between the two groups (P=0.127, P=0.779). Univariate analysis and multivariate analysis showed that Hb level was only independent predictor for PFS and baseline Hb level was significant prognostic factor influencing the OS. Only when patients had normal Hb level, anti-pd-1 monotherapy or combined with chemotherapy was superior to anti-pd-1 plus anti-angiogenic therapy with respect to PFS (10.3 m vs 2.8 m, HR 95% CI 0.37(0.15, 0.95), P=0.031) and OS(15 m vs 5.7 m, HR 95% CI 0.21 (0.08, 0.58), P=0.001).ConclusionsOur study have demonstrated that pretreatment Hb level was an independent prognostic biomarker in term of PFS and OS with immunotherapy for AGC and MGC patients. Correction of anemia for GC patients as immunotherapy would be a strategy to improve the survival. More data was warranted to further influence this finding.

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Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Journal of Immunology Research ◽

10.1155/2021/2549295 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Miaomiao Gou ◽

Tongtong Qu ◽

Zhikuan Wang ◽

Huan Yan ◽

Yanhai Si ◽

...

Keyword(s):

Gastric Cancer ◽

Response Rate ◽

Univariate Analysis ◽

Objective Response ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Formula Group

Background and Aims. Biomarkers for systemic inflammation have been introduced into clinical practice for risk-rating in cancer patients’ treatment. This study is aimed at confirming the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) as an effective biomarker for patients with metastatic gastric cancer (MGC) receiving anti-PD-1 agents. Method. Patients with MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The study analyzed the association of NLR and overall survival (OS) or progression-free survival (PFS) and antitumor response rate with PD-1 inhibitors. Results. 137 patients were included in the final analysis. The area under the curve value of NLR for 6-month OS was 0.71. The best cut-off value for NLR was 3.23. NLR < 3.23 was associated with longer OS ( HR = 0.38 , 95% CI, 0.26-0.57, p < 0.001 ) and PFS ( HR = 0.42 , 95% CI, 0.29-0.62, p < 0.001 ) in patients with MGC. No significant difference was observed in the objective response rate (ORR) (35.8% vs. 28.6%, p = 0.377 ) and disease control rate (DCR) (86.4% vs. 78.6%, p = 0.229 ) in the NLR < 3.23 group and in the NLR ≥ 3.23 group, respectively. Univariate analysis and multivariate analysis found that NLR was an independent prognosis biomarker for PFS and OS. Conclusions. Pretreatment elevated NLR was significantly associated with inferior PFS and OS in patients with MGC who received anti-PD-1 inhibitors. Clinicians need to consider patients with elevated NLR for decisions on immunotherapy strategy.

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Olaparib plus paclitaxel in patients with recurrent or metastatic gastric cancer: A randomized, double-blind phase II study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4013 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4013-4013 ◽

Cited By ~ 22

Author(s):

Yung-Jue Bang ◽

Seock-Ah Im ◽

Keun-Wook Lee ◽

Jae Yong Cho ◽

Eun-Kee Song ◽

...

Keyword(s):

Gastric Cancer ◽

Parp Inhibitor ◽

Objective Response ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Double Blind ◽

Protein Levels ◽

Common Grade ◽

Atm Protein ◽

Grade 3

4013 Background: Our multicenter study compared the efficacy of the oral PARP inhibitor olaparib plus paclitaxel (O/P) vs paclitaxel alone (P) as second-line therapy in pts with recurrent/metastatic gastric cancer (GC) (NCT01063517). As initial preclinical data suggested that responsiveness of GC cell lines to olaparib was associated with low ATM protein levels, our study was enriched for pts with low ATM tumors (ATM–) by IHC (50% randomized vs 14% screening prevalence). Methods: Eligible pts were randomized 1:1 (stratified by ATM status) to receiveolaparib 100 mg bid (tablet form) plus paclitaxel (80 mg/m2 iv on days 1, 8, 15 per 28-day cycle) or placebo plus paclitaxel until progression or investigator decision. After combination therapy, pts could take olaparib 200 mg bid monotherapy or placebo until progression. Co-primary endpoints: progression-free survival (PFS; RECIST v1.1) in all pts and ATM– pts. Secondary endpoints: overall survival (OS), objective response rate (ORR), safety. Results: 123/124 randomized pts were treated (O/P=61; P=62). Baseline characteristics were generally well balanced. Use of post-progression therapy was similar in both arms (O/P=48.4%; P=43.5%) as was median paclitaxel duration (O/P=17 wks; P=16 wks); 18 pts received monotherapy (O/P=11; P=7). More pts in the O/P than P arm had delays (79 vs 63%) and reductions (41 vs 27%) in paclitaxel dosing. The most common grade ≥3 AEs in the O/P and P arms were neutropenia (56 vs 39%) and anemia (11 vs 11%). Conclusions: Olaparib plus paclitaxel was well tolerated and led to a statistically significant improvement in OS, but not PFS, vs paclitaxel alone in both all pts and ATM– pts, with a larger benefit in ATM– pts. Clinical trial information: NCT01063517. [Table: see text]

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Prognostic value of baseline complete blood count components in advanced gastric cancer patients: A multicenter retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16528 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16528-e16528

Author(s):

Shereef Ahmed Elsamany ◽

Ahmed Zeeneldin ◽

Emad Tashkandi ◽

Ayman Ahamd Rasmy ◽

Waleed Abozeed ◽

...

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Serum Albumin ◽

Cancer Patients ◽

Eosinophil Count ◽

Univariate Analysis ◽

Metastatic Gastric Cancer ◽

Neutrophil Percentage ◽

Gastric Cancer Patients ◽

Doublet Chemotherapy

e16528 Background: Gastric cancer (GC) is one of the most prevalent malignant types in the world and an aggressive disease with a poor 5-year survival. Pretreatment CBC-based biomarkers, including blood neutrophil, lymphocyte, monocyte, and platelet counts; hemoglobin (Hb) levels; and their combinations, such as the neutrophil-lymphocyte ratio(NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio (PLR), have been reported to reflect systemic and local inflammation associated with cancer progression and prognosis. There has been growing interest in using CBC-based measures as biomarkers for GC. Methods: This chart-review study aimed to evaluate the effect of baseline levels of different components of routine CBC examination as well as other patients and disease characteristics on progression free survival (PFS) and overall survival (OS) in metastatic gastric cancer patients. Total 135 metastatic gastric cancer patients who had diagnosed and treated in three oncology centers in Saudi Arabia from 2011 to 2016 were incorporated. Various potential prognostic factors had measured in univariate and multivariate analysis. Results: After a median follow up of 21.4 months, the median OS / PFS were 11.0 and 6.1 months, respectively. Higher albumin level ( > 3g/dl), low neutrophil percentage ≤ 75%, high lymphocyte percentage > 15%, neutrophil /lymphocyte ≤ 2.5, high eosinophil count > 0.4 k/ml, and EOX/EOF chemotherapy vs. doublet chemotherapy were associated with better PFS in univariate analysis. Conversely, in multivariate analysis, only serum albumin and eosinophil levels were related to PFS. In univariate analysis, higher serum albumin (3 g/dl), low neutrophil percentage ≤ 75%, high lymphocyte percentage > 15%, neutrophil/lymphocyte ≤2.5, high eosinophil count > 0.4 k/ml, receiving 1st line chemotherapy vs. no chemotherapy, receiving > 6 cycles of chemotherapy, receiving EOX/EOF chemotherapy vs. doublet chemotherapy, platelet count ≤450 k/ml, male gender were associated with better OS. In multivariate analysis, lower neutrophil percentage, higher serum albumin, male sex and higher number of chemotherapy cycles were independently associated with OS. Conclusions: Higher eosinophil level was associated with improved PFS while lower neutrophil percentage and higher number of chemotherapy cycles were independent predictors of OS. Higher albumin levels independently predicted better OS and PFS.

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A phase Ib study of alofanib, an allosteric FGFR2 inhibitor, in patients with advanced or metastatic gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.tps466 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. TPS466-TPS466

Author(s):

Galina Statsenko ◽

Mikhail Fedyanin ◽

Vladimir Moiseyenko ◽

Liubov Yu Vladimirova ◽

Ilya Tsimafeyeu ◽

...

Keyword(s):

Gastric Cancer ◽

Standard Dose ◽

Objective Response ◽

Growth Factor Receptor ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Maximum Tolerated Dose ◽

Inhibitory Effect ◽

Pharmacokinetic Parameters ◽

And Function

TPS466 Background: Fibroblast growth factor receptor 2 (FGFR2) is amplified or overexpressed in 3% to 61% of patients with gastric cancer and associated with a poor prognosis. Acquired mutations in FGFR2 develop resistance to multikinase inhibitors. Besides, resistance to monoclonal antibodies depends on the type of FGFR2 isoforms IIIc or IIIb expressed by cancer cells. Alofanib (RPT835) is a novel selective allosteric inhibitor of FGFR2. Alofanib could bind to the non-active site of FGFR2 extracellular domain and had an inhibitory effect on FGF2-induced phosphorylation of FRS2α. On preclinical models no severe organ and function test changes were observed. Based on these results, alofanib has advanced into clinical evaluation. Methods: RPT835GC1B is a Phase 1b study, being conducted in at least four sites in Russia, evaluating the safety and preliminary efficacy of alofanib in patients with advanced and metastatic gastric adenocarcinoma pretreated with ≥ 1 previous lines of therapy. This trial consists of two parts. The standard dose-escalation part (design 3+3) aims to establish the maximum tolerated dose (MTD) or recommended phase 2 dose (R2PD) as a primary endpoint. The first part of the study includes a 28-day period when alofanib is administered daily intravenously for 5-days followed by a 2-day interval (rest). There are five dose levels: 50, 100, 165, 250, and 350 mg/m2. The dose-expansion phase accrues additional 20 patients, where comprehensive information to be collected. Secondary endpoints include pharmacokinetic parameters, rate of adverse events, progression-free survival, overall survival, and objective response rate. All patients will receive alofanib until disease progression or unacceptable toxicity. FGFR2 amplification, fusion, and overexpression will be assessed as well. Clinical trial information: NCT04071184.

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Third- and later-line treatment in advanced or metastatic gastric cancer: a systematic review and meta-analysis

Future Oncology ◽

10.2217/fon-2019-0429 ◽

2020 ◽

Vol 16 (2) ◽

pp. 4409-4418 ◽

Cited By ~ 4

Author(s):

Alessandro Rizzo ◽

Veronica Mollica ◽

Angela Dalia Ricci ◽

Ilaria Maggio ◽

Maria Massucci ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Overall Survival ◽

Supportive Care ◽

Meta Analysis ◽

Objective Response ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Best Supportive Care ◽

Free Survival

Aim: We performed a systematic review and meta-analysis to investigate the efficacy and safety of third-line (TLT) and salvage treatment (ST) in advanced or metastatic gastric cancer. Materials & methods: Eligible studies included randomized clinical trials assessing TLT and ST versus placebo or best supportive care. Outcomes of interest included: overall survival, objective response rate and disease control rate in TLT; progression-free survival in ST; grade 3–4 adverse events in ST. Results: The use of TLT and ST was superior to placebo or best supportive care in terms of prolonging overall survival and progression-free survival. Hematological toxicities were more frequent in ST. Conclusion: TLT and ST are considerable and tolerable treatment options for patients with advanced or metastatic gastric cancer. Given the substantial heterogeneities affecting the efficacy analyses, these results have to be interpreted cautiously.

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Nomogram for predicting overall survival (OS) in patients (pts) treated with liposomal irinotecan (nal-IRI) ± 5-fluorouracil/leucovorin (5-FU/LV) in metastatic pancreatic ductal adenocarcinoma (mPDAC) previously treated with gemcitabine-based therapy in NAPOLI-1.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.459 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 459-459

Author(s):

Andrea Wang-Gillam ◽

Richard Hubner ◽

Beloo Mirakhur ◽

Floris A de Jong ◽

Bruce Belanger ◽

...

Keyword(s):

Multivariate Analysis ◽

Clinical Decision Making ◽

Predictive Accuracy ◽

Cox Model ◽

Univariate Analysis ◽

Objective Response ◽

Progression Free Survival ◽

Ductal Adenocarcinoma ◽

Relative Significance ◽

Previously Treated

459 Background: Results from NAPOLI-1 (NCT01494506), a phase 3 study in pts with mPDAC previously treated with gemcitabine-based therapy, demonstrated an improvement in OS (primary endpoint), progression-free survival, and objective response rate with nal-IRI+5-FU/LV vs 5-FU/LV. The MPACT study reported a nomogram to predict OS using baseline pt variables in previously untreated mPDAC. We conducted an exploratory post hoc analysis of NAPOLI-1 variables to develop a nomogram to predict OS in the post-gemcitabine setting. Methods: In NAPOLI-1, pts were randomized to receive nal-IRI 80 mg/m2 q2w + 5-FU/LV, nal-IRI 100 mg/m2 q3w, or 5-FU/LV. Univariate and multivariate analyses determined factors significantly predictive of OS. A multivariable Cox model was created using these factors to develop a nomogram that assigned points equal to the weighted sum of relative significance of each variable. Predictive accuracy of the nomogram as measured by the concordance index (c-index) was evaluated by internal bootstrap validation. Results: Data from the 417-pt univariate analysis and 399-pt multivariate analysis (18 pts excluded for missing baseline data) were used. Eight of 21 variables were retained in the multivariate analysis (p < 0.01 except BMI [p=0.08]). Conclusions: In NAPOLI-1, predictors of OS were nal-IRI+5-FU/LV treatment, KPS, NLR, albumin level, baseline CA19-9, stage 4 at diagnosis, BMI, and presence of liver metastasis. The nomogram, which will distinguish between risk groups and may aid in clinical decision making, will be presented in the poster. Clinical trial information: NCT01494506. [Table: see text]

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Interim analysis of fluorodeoxyglucose uptake in patients with metastatic or recurrent gastric cancer treated with fluoropyrimidine based chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.44 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 44-44

Author(s):

Suk-young Lee ◽

Jaeseon Uh ◽

Sang Cheul Oh

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Fdg Pet ◽

Interim Analysis ◽

Univariate Analysis ◽

Progression Free Survival ◽

Ct Scanning ◽

Interim Pet ◽

Pet Ct ◽

Fdg Pet Ct

44 Background: The role of 18F-FDG PET/CT scanning in advanced gastric cancer (AGC) is still under investigation. We evaluated its prognostic role in patients with recurrent or metastatic AGC who received fluoropyrimidine based chemotherapy. Methods: Forty-six patients with metastatic or recurrent AGC who had the baseline and interim PET/CT scanning during the palliative chemotherapy were analyzed. The lesion with the highest SUVmax value among target lesions was determined to be a main target (SUVmax1), and interim SUVmax of the target lesion was measured after several cycles (4-12 cycles) of chemotherapy (SUVmax2). The formula calculating metabolic change follows: ΔSUVmax2-SUVmax1 (%) = (SUVmax2-SUVmax1)/SUVmax1 * 100 Results: Patients with SUVmax1 value > 6 had a significantly higher response rate than those with the lower SUVmax1 (73.9% vs. 26.1%, p=0.036). SUVmax2 < 5 was significantly associated with better overall survival (OS) (p=0.035) with univariate analysis. ΔSUVmax2- SUVmax1 > -20% or appearance of new lesions with 18F-FDG PET/CT scanning at interim analysis was significantly associated with worse OS (p=0.027). ΔSUVmax2- SUVmax1 > -20% or new lesions (p=0.03) was the only factor significantly independently associated with OS using multivariate analysis (Table). Female (p=0.028), SUVmax2 > 5 (p=0.002), and ΔSUVmax2-SUVmax1 value > -20% (p=0.004) were significantly associated factors with worse progression free survival (PFS) using univariate analysis. Both SUVmax2 (p=0.028) and ΔSUVmax2-SUVmax1 value (p=0.043) were the significant factors associated with PFS using multivariate analysis. Conclusions: Analysis ofmetabolic change by interim PET/CT scanning is useful in predicting prognosis in patients with recurrent or metastatic AGC undergoing fluoropyrimidine based chemotherapy. [Table: see text]

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Pretreatment Platelet-to-Lymphocyte Ratio (PLR) is associated with prognosis in gastric cancer patients with immunotherapy

10.21203/rs.3.rs-690380/v1 ◽

2021 ◽

Author(s):

Miaomiao Gou ◽

Yong Zhang

Keyword(s):

Gastric Cancer ◽

Response Rate ◽

Univariate Analysis ◽

Objective Response ◽

Area Under The Curve ◽

Progression Free Survival ◽

Final Analysis ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference

Abstract Background: previous studies had demonstrated that system inflammation indexes were associated with prognosis ability in various cancers. We aim to explore the prognostic value of platelet to lymphocyte ratio (PLR) in patients with advanced or metastatic gastric cancer (AGC or MGC) receiving immunotherapy. Method: patients with AGC and MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and August 2020 were reviewed. The study analyzed the association of PLR and overall survival (OS) or progression-free survival (PFS) and anti-tumor response rate with immunotherapy.Results: 137 patients were included in the final analysis. The area under the curve values of PLR for 6 months PFS was 0.68(P<0.05). The best cut-off value for PLR was 816.43. Patients in PLR <816.43 group had PFS of 7.9m compared to 4.3m in PLR>= 816.43 group (HR = 0.61`, 95% CI, 0.42-0.89, p < 0.001).OS in PLR <816.43 group was longer than PLR>= 816.43 group (11.1m vs 9.2m, HR = 0.62`, 95% CI, 0.42-0.93, p < 0.001). The objective response rate (ORR) and disease control rate (DCR) were 34.1% and 84.6% respectively in PLR <816.43 group while 30.4% and 80.4% in the>= 816.43 group. No significant difference was observed among two group in terms of ORR and DCR (p=0.669, p=0.536). Univariate analysis and multivariate analysis found that PLR was an independent prognosis biomarker for PFS and OS(p<0.05). Conclusions: Pre-treatment PLR was significantly associated with PFS and OS in patients with AGC and MGC who received immunotherapy. Clinicians might consider patients with elevated PLR as one factor for decisions on immunotherapy strategy.

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Clinical Study of Sintilimab as Second-Line or Above Therapy in Patients With Advanced or Metastatic Gastric Cancer: A Retrospective Study

Frontiers in Oncology ◽

10.3389/fonc.2021.741865 ◽

2021 ◽

Vol 11 ◽

Author(s):

Caiyun Nie ◽

Huifang Lv ◽

Yingjun Liu ◽

Beibei Chen ◽

Weifeng Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Combination Therapy ◽

Therapeutic Strategy ◽

Objective Response ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Second Line ◽

Free Survival ◽

Grade 3 ◽

Systemic Therapies

BackgroundThe present study was conducted to analyze the clinical efficacy and safety of sintilimab as second-line or above therapy for patients with advanced or metastatic gastric cancer.MethodsPatients with advanced or metastatic gastric cancer that progressed after prior systemic therapies and treated with sintilimab from March 2019 to July 2020 were retrospectively analyzed in this study. The primary end point was progression-free survival (PFS). Secondary end points included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety.ResultsFifty-two patients with advanced or metastatic gastric cancer received sintilimab monotherapy or combination therapy after they failed from prior systemic therapies. Eight patients achieved partial response (PR), 26 patients had stable disease (SD), and 18 patients had progressive disease (PD). The ORR and DCR were 15.4% (8/52) and 65.4% (34/52), respectively. Median PFS was 2.5 months (95% CI = 2.0–3.0), and median OS was 5.8 months (95% CI = 4.9–6.7). The ORR and DCR were 30.0% (6/20) and 80.0% (16/20), respectively, in intestinal subtype, which were superior than in non-intestinal subtype (ORR: 6.3%, DCR: 56.3%). Patients with intestinal subtype obtained longer PFS (4.0 vs. 1.9) and OS (9.0 vs. 4.1) than those with non-intestinal subtype. The incidence of grade 3–4 adverse events was 44.2%.ConclusionsSintilimab monotherapy or combination therapy provides a feasible therapeutic strategy for patients with advanced or metastatic gastric cancer who failed from prior systemic therapies. The efficacy of sintilimab in intestinal subtype was superior than that in non-intestinal subtype.

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Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and hemoglobin (Hb) predict immunotherapy outcomes in patients with advanced or metastatic gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16075 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16075-e16075

Author(s):

Miaomiao Gou ◽

Yong Zhang ◽

Huan Yan ◽

Haiyan Si ◽

Zhikuan Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Response Rate ◽

Objective Response ◽

Progression Free Survival ◽

Final Analysis ◽

Metastatic Gastric Cancer ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference

e16075 Background: This study aimed to confirm the prognostic role of pretreatment neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), hemoglobin (Hb) levels as effective and convenient biomarkers for patients with advanced or metastatic gastric cancer (AGC or MGC) receiving immunotherapy. Methods: patients with AGC and MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The receiver operating characteristic analyses for predicting 6 months PFS by the NLR, PLR was used to identify an appropriate cut-off value. The study analyzed the association of NLR, PLR, Hb and overall survival (OS) or progression-free survival (PFS) and anti-tumor response rate with immunotherapy respectively. Results: 137 patients were included in the final analysis. 71 patients were administered immunotherapy in the first line and the rest of the patients in the second or further line. 92 patients had received immunotherapy combined with chemotherapy, whereas 45 patients had undertaken immunotherapy monotherapy or with anti-angiogenesis. The best cut-off value for NLR was 3.23 and for PLR was 816.43. NLR <3.23 was associated with longer OS (HR = 0.38, 95% CI, 0.26-0.57, p < 0.001) and PFS (HR = 0.42, 95% CI, 0.29-0.62, p < 0.001) in patients with AGC or MGC. Patients in PLR<816.43 group had prolonged PFS (7.9m vs 4.3m, p<0.001) and OS (11.1m vs9.2m, p<0.001) than in PLR>=816.43 group. The median PFS was 7.8m in the normal Hb level group (Hb>=110g/L) and 4.3m in the decreased Hb group (Hb<110g/L) (HR=0.5, 95% CI 0.31, 0.81, P=0.004). The OS was 14.4m with normal Hb level as compared with 8.2m with decreased Hb level( HR=0.59, 95% CI 0.37, 0.94, P=0.024). No significant difference was observed in objective response rate (ORR) and disease control rate (DCR) in the different NLR, PLR, Hb group, respectively. Univariate and multivariate analysis found that NLR, PLR, Hb were independent prognostic biomarkers for PFS and OS (p<0.05). Conclusions: pre-treatment NLR, PLR, Hb was significantly associated with PFS and OS in patients with AGC and MGC who received immunotherapy. Clinicians need to consider patients with elevated NLR and PLR or decreased Hb level for decisions on immunotherapy strategy.

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