The Role of Neutrophil-to-Lymphocyte Ratio in Advanced EGFR-Mutant NSCLC Patients Treated with First-Line Osimertinib

Abstract

Kuan-Chih Chen,1,* Yen-Hsiang Huang,1– 3,* Kuo-Hsuan Hsu,3,4 Jeng-Sen Tseng,1– 3,5,6 Gee-Chen Chang,6– 9 Tsung-Ying Yang1,3,10 1Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 2College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Lung Cancer Comprehensive Care and Research Center, Taichung Veterans General Hospital, Taichung, Taiwan; 4Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 5Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; 6Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan; 7Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; 8School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 9Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 10Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Jeng-Sen Tseng, Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan, Tel [phone], ext. 3232, Fax [phone], Email [email protected]: Although serum neutrophil-to-lymphocyte ratio (NLR) is correlated with the outcome of various cancer types, its role in treatment-naïve, advanced, epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients treated with osimertinib remains uncertain. We have the intention to use this biomarker to evaluate the outcomes in NSCLC.Patients and Methods: Advanced EGFR-mutant NSCLC patients receiving osimertinib as the first-line treatment were included. We evaluated the prognostic role of baseline NLR and explored its association with patients’ characteristics. A high NLR was defined as pretreatment serum NLR ≥ 5.Results: A total of 112 eligible patients were included. The objective response rate was 83.7%. The median progression-free survival (PFS) and overall survival (OS) were 20.5 months (95% CI 14.5– 26.5) and 47.3 months (95% CI 36.7– 58.2), respectively. A high NLR predicted an inferior PFS (HR 1.90 [95% CI 1.02– 3.51], P = 0.042) and OS (HR 3.85 [95% CI 1.39– 10.66], P = 0.009). Patients with stage IVB disease were more likely to have a high baseline NLR than those with stage IIIB-IVA (33.9% vs 15.1%, P = 0.029). Other patients’ characteristics did not correlate with the baseline NLR significantly. Patients with a high NLR had significantly more metastatic organs than those with a low NLR (2.5 ± 1.3 vs 1.8 ± 0.9, P = 0.012), particularly brain, liver, and bone metastasis. There was no significant association between NLR and intrathoracic metastasis.Conclusion: Baseline serum NLR could act as an important prognostic marker for EGFR-mutant NSCLC patients receiving first-line osimertinib. A high NLR was associated with higher metastatic burden, more extrathoracic metastases, and therefore, a worse outcome.Keywords: non-small cell lung cancer, epidermal growth factor receptor, osimertinib, neutrophil-to-lymphocyte ratio, treatment-naïve

Keywords

• non-small cell lung cancer
• epidermal growth factor receptor
• osimertinib
• neutrophil-to-lymphocyte ratio
• treatment-naïve