Pretreatment neutrophil-to-lymphocyte ratio and mutational burden as biomarkers of tumor response to immune checkpoint inhibitors
Open accessAbstract
Treatment with immune checkpoint inhibitors (ICI) has demonstrated clinical benefit for a wide range of cancer types. Because only a subset of patients experience clinical benefit, there is a strong need for biomarkers that are easily accessible across diverse practice settings. Here, in a retrospective cohort study of 1714 patients with 16 different cancer types treated with ICI, we show that higher neutrophil-to-lymphocyte ratio (NLR) is significantly associated with poorer overall and progression-free survival, and lower rates of response and clinical benefit, after ICI therapy across multiple cancer types. Combining NLR with tumor mutational burden (TMB), the probability of benefit from ICI is significantly higher (OR = 3.22; 95% CI, 2.26-4.58; P < 0.001) in the NLR low/TMB high group compared to the NLR high/TMB low group. NLR is a suitable candidate for a cost-effective and widely accessible biomarker, and can be combined with TMB for additional predictive capacity.
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Melanoma patients on PD-1 therapy with high NLR had worse overall and progression-free survival than those with low NLR.
“Consistent with published studies in multiple settings21–24, PD-1-treated patients with melanoma with a high NLR had poorer survival (OS/PFS) than those with a low NLR.”
From Intestinal microbiota signatures of clinical response and immune-related adverse events in melanoma patients treated with anti-PD-1 (2022) · cites this paper as [22]
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- Authors
- Valero, C., Lee, M., Hoen, D., Weiss, K., Kelly, D. W., Adusumilli, P. S., Paik, P. K., Plitas, G., Ladanyi, M., Postow, M. A., Ariyan, C. E., Shoushtari, A. N., Balachandran, V. P., Hakimi, A. A., Crago, A. M., Long Roche, K. C., Smith, J. J., Ganly, I., Wong, R. J., Patel, S. G., Shah, J. P., Lee, N. Y., Riaz, N., Wang, J., Zehir, A., Berger, M. F., Chan, T. A., Seshan, V. E., & Morris, L. G. T.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Corresponding author
- Chan, Timothy A.
- Seshan, Venkatraman E.
- Morris, Luc G. T.
- ORCID
- Valero, Cristina
- Lee, Mark
- Weiss, Kate
- Kelly, Daniel W.
- Adusumilli, Prasad S.
- Paik, Paul K.
- Plitas, George
- Ladanyi, Marc
- Postow, Michael A.
- Ariyan, Charlotte E.
- Shoushtari, Alexander N.
- Balachandran, Vinod P.
- Hakimi, A. Ari
- Crago, Aimee M.
- Smith, J. Joshua
- Ganly, Ian
- Wong, Richard J.
- Patel, Snehal G.
- Shah, Jatin P.
- Lee, Nancy Y.
- Riaz, Nadeem
- Wang, Jingming
- Zehir, Ahmet
- Berger, Michael F.
- Chan, Timothy A.
- Seshan, Venkatraman E.
- Morris, Luc G. T.
- Venue
- Nature Communications
- Published
- 2021-02-01
- Volume
- 12
- Issue
- 1
- Pages
- 729-729
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC7851155
- OpenAlex
- W3127371144
- Cited by
- 441
- References
- 57
- Citations by year
- 2026: 53 · 2025: 74 · 2024: 116 · 2023: 92 · 2022: 80 · 2021: 26
- FWCI
- 28.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fundación Alfonso Martín Escudero (N/A)
- U.S. Department of Health & Human Services | NIH | National Cancer Institute (R01 CA205426, R35 CA232097)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Ferroptosis and cancer prognosis
- Keywords
- immune checkpoint inhibitors, neutrophil-to-lymphocyte ratio, tumor mutational burden, predictive biomarkers, tumor response, overall survival, progression-free survival, cancer immunotherapy, prognostic factors
- MeSH terms
- Progression-Free Survival, Immune Checkpoint Inhibitors, Aged, Female, Follow-Up Studies, Humans, Lymphocytes, Male, Middle Aged, Neoplasms, Neutrophils, Predictive Value of Tests, Retrospective Studies, Lymphocyte Count, Drug Resistance, Neoplasm, Mutation Rate
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