Division of Medical Oncology of Melanoma, Sarcoma and Rare Tumors, Istituto Europeo di Oncologia IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
Department of Experimental Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.
Clin Transl Oncol. 2020 Oct;22(10):1818-1824. doi: 10.1007/s12094-020-02320-y. Epub 2020 Feb 27.
The aim of this study is to verify if baseline hematological markers, in patients with advanced melanoma receiving BRAF inhibitor (BRAFi)-based therapies, are independently associated with progression free survival (PFS) and overall survival (OS).
We retrospectively analyzed 90 patients with metastatic melanoma harboring BRAF V600 mutation, who received treatment with either BRAFi alone or combined with a MEK inhibitor (MEKi) at the recommended dosages. Study population included 28 women and 62 men. Median age was 53 years. Seventy-three (82%) patients presented with M1c disease, 49 (56%) had elevated LDH and 54 (60%) had three or more metastatic sites.
The median PFS was 9.1 and 3.5 months, respectively, for patients with baseline NLR < 5 and NLR ≥ 5, while median OS was 17.2 and 5.5 months, respectively, for patients with NLR < 5 and NLR ≥ 5. Multivariate analysis confirmed that baseline NLR < 5 was significantly associated with half risk of relapse (HR = 0.49; 95% CI = 0.28-0.85; p = 0.01) and half risk of death (HR = 0.46; 95% CI = 0.23-0.76; p = 0.004), independent of age, sex, stage, LDH > 2xULN, previous treatments, concomitant use of steroids and type of therapy. In patients with LDH ≥ ULN, NLR < 5 remained significantly and independently associated with improved PFS (HR = 0.28; 95% CI = 0.13-0.62; p = 0.002,) and OS (HR = 0.23; 95% CI = 0.10-0.55; p = 0.001).
These biomarkers are easily reproducible, affordable and costless and NLR could help to identify patients who have the best benefit from BRAF inhibitors.
本研究旨在验证基线血液学标志物是否与接受 BRAF 抑制剂（BRAFi）治疗的晚期黑色素瘤患者的无进展生存期（PFS）和总生存期（OS）独立相关。
我们回顾性分析了 90 例携带 BRAF V600 突变的转移性黑色素瘤患者，这些患者以推荐剂量接受 BRAFi 单药或联合 MEK 抑制剂（MEKi）治疗。研究人群包括 28 名女性和 62 名男性。中位年龄为 53 岁。73 例（82%）患者为 M1c 期疾病，49 例（56%）乳酸脱氢酶升高，54 例（60%）有 3 个或更多转移部位。
基线 NLR<5 和 NLR≥5 的患者中位 PFS 分别为 9.1 和 3.5 个月，中位 OS 分别为 17.2 和 5.5 个月。多变量分析证实，基线 NLR<5 与复发风险降低一半（HR=0.49；95%CI=0.28-0.85；p=0.01）和死亡风险降低一半（HR=0.46；95%CI=0.23-0.76；p=0.004）显著相关，与年龄、性别、分期、LDH>2xULN、既往治疗、类固醇同时使用和治疗类型无关。在 LDH≥ULN 的患者中，NLR<5 与改善的 PFS（HR=0.28；95%CI=0.13-0.62；p=0.002）和 OS（HR=0.23；95%CI=0.10-0.55；p=0.001）显著且独立相关。
这些生物标志物易于重现、经济实惠且无需成本，NLR 有助于识别从 BRAF 抑制剂中获益最大的患者。
