Analysis of the relationship between heading N / L and survival in patients treated with immunotherapy in lung cancer

Background: The neutrophil-lymphocyte (N / L) ratio is a marker of general immune response in different stress situations, having shown a relationship between the quotient and the evolution of patients treated with immunotherapy (IT), emphasizing the importance of inflammation in these patients. Methods: In order to evaluate this relationship in a context of usual clinical practice, a retrospective review of patients with pulmonary neoplasia who received IT treatment in the first line or successive, between November 2015 and December 2017. Data were collected from the clinical history, with attention to baseline neutrophil and lymphocyte numbers, objective response by criteria iRECIST 1.1 and overall survival (OS) defined from the beginning of treatment until death. Results: Sixty-six patients (22 women and 44 men) with a mean age of 64 years (44-78) were analyzed. 9.1%, 9 patients (p) received immunotherapy as first line treatment, 69.7% (46p) received it as 2nd line and 21.2% (14p) as 3rd line treatment. Regarding the type of IT, 49p (74.2%) received treatment with Nivolumab and 17p (25.8%) were treated with Pembrolizumab. Two stretches of baseline N / L ratios < = 5 (low) and> 5 (high) were defined. Low ratio N / L ( < =5) was identified in 47p (71.2%) of the patients treated with IT and high ratio N/L (> 5) in 19p (20.8%). Of the 47 patients with a low ratio: 22p (46.8%) had some type of response or stabilization of their disease, 15p (31.9%) had progression and 10p (21.3%) received less than months of treatment, 5p for PS reorientation and the other 5p continue with the treatment and are pending reevaluation. Among the 19p patients with high N / L quotient: 4p (21.1%) presented response or stabilization of the disease, 15p (78.9%) presented progression or treatment was interrupted due to deterioration of the ECOG. The average survival in the group with a low N / L ratio ( < = 5) was 87.85 weeks compared to the group with a high N / L ratio (> 5) 25.74 weeks (p < 0.05). Conclusions: The N / L ratio has been identified in some studies as an adverse prognostic factor in patients treated with IT. Our data from the usual clinical practice support this theory. If these findings are confirmed in future studies, it could be used as a response biomarker for better patient selection. Legal entity responsible for the study: Fundación Biomédica Galicia Sur. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.