4CPS-187 Prognostic value of haematological inflammatory markers in patients with metastatic non-small cell lung cancer treated with pembrolizumab

Background and importance Proinflammatory status has been associated with worse outcomes in patients treated with immunotherapy. Aim and objectives To evaluate the prognosis role of haematological inflammatory markers in patients with metastatic non-small cell lung cancer (mNSCLC) treated with prembrolizumab. Material and methods This was an ambispective study that included mNSCLC patients with PD-L1 expression level ≥50% treated with firstline pembrolizumab between January 2017 and June 2019. Data collected included age, gender, PD-L1 expression level, baseline Eastern Cooperative Oncology Group (ECOG) performance status (PS), baseline absolute neutrophil count (ANC), lymphocytes, leucocytes, monocytes and platelets. Neutrophil to lymphocyte ratio (NLR; ANC/lymphocyte count), lymphocyte to monocyte ratio (LMR; lymphocyte count/monocyte count) and platelet to lymphocyte ratio (PLR; platelet count/lymphocyte count) were calculated. NLR ≥5, LMR 144 000 were considered as cut-off values. We analysed response rate, progression free survival (PFS) and overall survival (OS). The Kaplan–Meier method was used to estimate PFS and OS and multivariate Cox proportional hazard modelling. Results Forty-two patients were included (71.4% men, n=30) and mean age was 67 years (±8.2). PD-L1 expression levels were ≥90% in 31% of patients (n=13). Most patients had an ECOG PS of 0–1 (n=30). Partial response, stable disease and disease progression were recorded in 31% (n=13), 28.6% (n=12) and 19% (n=8), respectively. The remaining 21.4% died before response evaluation. Median PFS and OS were 5.4 months (95% CI 0–11.1) and 10.3 months (95% CI 8.9–11.7), respectively. In the multivariate analysis, NLR ≤5 was identified as an independent predictor of PFS (hazard ratio (HR)=0.73; 95% CI 0.14–0.97) and OS (HR=0.16; 95% CI 0.052–0.52). ECOG performance status score of 0–1 was also significantly correlated with a higher SLP (HR=0.24; 95% CI 0.082–0.73) and SG (HR=0.20; 95% CI 0.058–0.72). PLR ≤144 was only an independent predictor of PFS (HR=0.21; 95% CI 0.065–0.67). Conclusion and relevance Baseline NLR and ECOG were correlated with PFS and OS in patients with mNSCLC treated with pembrolizumab as firstline therapy. PLR >144 was also an independent predictor of PFS, but not OS. NLR might be a cost effective prognostic biomarker for firstline pembrolizumab treatment in mNSCLC patients. References and/or acknowledgements 1. Agullo-Ortuno, Gomez-Martin, Ponce S, et al. Blood predictive biomarkers for patients with non-small-cell lung cancer associated with clinical response to nivolumab. Clin Lung Cancer 2019:S1525-7304(19):30255–4. No conflict of interest.