Pretreatment Neutrophil-to-Lymphocyte Ratio Linked to OS in Endometrial Cancer

Improved overall survival (OS) was observed in patients with recurrent endometrial cancer who were treated with immunotherapy who presented with a neutrophil-to-lymphocyte ratio (NLR) of less than 6 at baseline, according to a study published in Gynecologic Oncology.

Patients with an NLR below 6 had improved OS vs those with a ratio of 6 or greater (P <.05), and the probability of survival at 1 year was 69% (95% CI, 58%-82%) compared with 41% (95% CI, 26%-67%), respectively.

A total of 106 patients from a single institution were examined for this analysis, with 77 (72.6%) having an NLR of less than 6. Endometrioid pathology was noted in 58.5% of patients, 74.5% had 3 or more metastatic sites, and 36.8% had 2 or more lines of therapy prior to immunotherapy. Mismatch repair (MMR) deficiency was observed in 49.1% of patients, with mismatch repair status being similar between both groups.

Of those with MMR deficient tumors, 94.3% of patients were given single-agent pembrolizumab (Keytruda) and 78.7% with MMR proficient tumors were given lenvatinib (Lenvima) plus pembrolizumab.

Overall, 40.2% of patients with an NLR of less than 6 responded to treatment by the first radiographic assessment, with 29.9% of patients having a partial response (PR) and 10.4% having a complete response (CR). In those with an NLR of 6 or more, 31% of patients had a response with 27.5% having a PR and 3.4% having a CR (P = .69). In those with MMR deficiency, 50% of patients with an NLR of less than 6 had a response, with 34.2% having a PR and 15.8% having a CR, vs 35.7% of those with an NLR of 6 or more, comprised of a PR rate of 35.7% and no CRs (P = .52). Additionally, those in the MMR proficient subgroup with NLR less than 6 had an overall response rate of 33.3%, with 27.3% having a PR and 6.1% having a CR vs 28.5% in those with NLR of 6 or more comprised of a 21.4% PR rate and 7.1% CR rate (P >.095).

Investigators discovered no difference in progression-free survival in the overall cohort (PFS; P = .93). In the NLR less than 6 group, the median PFS was 9.3 months vs 7.4 months in the NLR of 6 or more group. Patients with an NLR of less than 6 received a median of 6 cycles of immunotherapy vs 5 cycles in the NLR of 6 or more group.

The median overall survival was 26 months in patients with an NLR less than 6 compared with 11 months in the NLR of 6 or more group (P = .003). In subgroups stratified by MMR status, there were no differences observed in PFS, but OS in both groups was influenced by NLR. For those with MMR deficiency, the median OS in those with an NLR of less than 6 was 45.0 months vs 13.4 months in the NLR of 6 or more group (P = .01). For those with MMR proficiency and an NLR of less than 6, the median OS was not reached vs 7.3 months in those with NLR of 6 or more (P = .01).

A total of 19.5% of patients in the NLR of less than 6 group experienced grade 3/4 adverse effects vs 17.2% in the NLR of 6 or more group. Between patients in both groups, most did not receive further therapy, but 38.9% with an NLR of less than 6 did receive subsequent treatment vs 13.8% in with an NLR of 6 or more (P = .01). Patients mostly received 1 additional line of hormonal therapy or cytotoxic chemotherapy, and this was true except for 3 instances.

Reference

Barrington DA, Calo C, Baek J, et al. Beyond mismatch repair deficiency? Pre-treatment neutrophil-to-lymphocyte ratio is associated with improved overall survival in patients with recurrent endometrial cancer treated with immunotherapy. Gynecol Oncol. Published online July 27, 2022. doi:10.1016/j.ygyno.2022.07.010