Correlation of Performance Status and Neutrophil-Lymphocyte Ratio With Efficacy in Radioiodine-Refractory Differentiated Thyroid Cancer Treated With Lenvatinib.

BACKGROUND Radioiodine-refractory differentiated thyroid cancer (RR-DTC) has a low 10-year patient-survival rate and is challenging to treat. Lenvatinib is a multikinase inhibitor approved for treatment of RR-DTC. This study aims to assess Eastern Cooperative Oncology Group performance status (ECOG PS) and neutrophil-to-lymphocyte ratio (NLR) as prognostic markers for patients with RR-DTC treated with lenvatinib. METHODS In this retrospective analysis of SELECT, patients randomly assigned to receive lenvatinib were classified according to baseline ECOG PS (0 or 1) or baseline NLR (≤3 or >3). The effects of baseline ECOG PS and NLR on progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were evaluated. Additionally, the effects of baseline ECOG PS on the change in diameter of target lesions and correlations between baseline NLR and the sum of the diameters of target lesions were calculated. RESULTS Among patients who received lenvatinib, patients with a baseline ECOG PS of 0 had statistically improved PFS (hazard ratio [HR] 0.52 [95% confidence interval (CI): 0.35-0.77]; P=0.001), OS (HR 0.42 [95% CI: 0.26-0.69]; P=0.0004), and ORR (odds ratio [OR] 3.51 [95% CI: 2.02-6.10]; P 3. Moreover, patients with a baseline NLR ≤3 had a trend toward increased ORR (OR 1.57 [95% CI: 0.94-2.64]; P=0.08) compared to patients with a baseline NLR >3. Treatment-emergent adverse events were generally similar among patients who received lenvatinib, irrespective of patients' ECOG PS at baseline. CONCLUSIONS Lower ECOG PS and NLR may provide prognostic value for improved efficacy in patients with RR-DTC.  .