Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases

Abstract Steroids are often utilized to manage patients with non-small cell lung cancer brain metastases (NSCLCBM). Steroids and elevated neutrophil-to-lymphocyte ratio (NLR) have been associated with decreased overall survival (OS) in patients treated with immune checkpoint inhibitors (ICI). We ret...

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Autores principales:	Adam Lauko, Bicky Thapa, Mayur Sharma, Baha’eddin Muhsen, Addison Barnett, Yasmeen Rauf, Hamid Borghei-Razavi, Vineeth Tatineni, Pradnya Patil, Alireza Mohammadi, Samuel Chao, Erin S. Murphy, Lilyana Angelov, John Suh, Gene H. Barnett, Amy S. Nowacki, Nathan Pennell, Manmeet S. Ahluwalia
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f4dcac47865a41d3946306192c5da152
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spelling	oai:doaj.org-article:f4dcac47865a41d3946306192c5da1522021-12-02T14:15:53ZNeutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases10.1038/s41598-021-85328-w2045-2322https://doaj.org/article/f4dcac47865a41d3946306192c5da1522021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-85328-whttps://doaj.org/toc/2045-2322Abstract Steroids are often utilized to manage patients with non-small cell lung cancer brain metastases (NSCLCBM). Steroids and elevated neutrophil-to-lymphocyte ratio (NLR) have been associated with decreased overall survival (OS) in patients treated with immune checkpoint inhibitors (ICI). We retrospectively investigated patients treated with ICI after the diagnosis of NSCLCBM at a single tertiary care institution examing the impact of steroids and NLR. Overall survival (OS) and intracranial progression-free survival (PFS) were analyzed. 171 patients treated with ICI for NSCLCBM were included. Thirty-six received steroids within 30 days of the start of ICI, and 53 patients had an NLR ≥ 5 before the start of ICI. Upfront steroids was associated with decreased OS on multivariable analysis (median OS 10.5 vs. 17.9 months, p = .03) and intracranial PFS (5.0 vs. 8.7 months, p = .045). NLR ≥ 5 was indicative of worse OS (10.5 vs. 18.4 months, p = .04) but not intracranial PFS (7.2 vs. 7.7 months, p = .61). When NLR and upfront steroids are modeled together, there is a strong interaction (p = .0008) indicating that the impact of steroids depended on the patient’s NLR. In a subgroup analysis, only in patients with NLR < 4 was there a significant difference in OS with upfront steroids (26.1 vs. 15.6 months, p = .032). The impact of steroids on the efficacy of ICI in patients with NSCLCBM is dependent on the patient's NLR underscoring its importance in these patients. Patients with a low NLR, steroid use decreases the efficacy of ICI. These results can inform clinicians about the impact of steroids in patients treated with ICI.Adam LaukoBicky ThapaMayur SharmaBaha’eddin MuhsenAddison BarnettYasmeen RaufHamid Borghei-RazaviVineeth TatineniPradnya PatilAlireza MohammadiSamuel ChaoErin S. MurphyLilyana AngelovJohn SuhGene H. BarnettAmy S. NowackiNathan PennellManmeet S. AhluwaliaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Adam Lauko Bicky Thapa Mayur Sharma Baha’eddin Muhsen Addison Barnett Yasmeen Rauf Hamid Borghei-Razavi Vineeth Tatineni Pradnya Patil Alireza Mohammadi Samuel Chao Erin S. Murphy Lilyana Angelov John Suh Gene H. Barnett Amy S. Nowacki Nathan Pennell Manmeet S. Ahluwalia Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
description	Abstract Steroids are often utilized to manage patients with non-small cell lung cancer brain metastases (NSCLCBM). Steroids and elevated neutrophil-to-lymphocyte ratio (NLR) have been associated with decreased overall survival (OS) in patients treated with immune checkpoint inhibitors (ICI). We retrospectively investigated patients treated with ICI after the diagnosis of NSCLCBM at a single tertiary care institution examing the impact of steroids and NLR. Overall survival (OS) and intracranial progression-free survival (PFS) were analyzed. 171 patients treated with ICI for NSCLCBM were included. Thirty-six received steroids within 30 days of the start of ICI, and 53 patients had an NLR ≥ 5 before the start of ICI. Upfront steroids was associated with decreased OS on multivariable analysis (median OS 10.5 vs. 17.9 months, p = .03) and intracranial PFS (5.0 vs. 8.7 months, p = .045). NLR ≥ 5 was indicative of worse OS (10.5 vs. 18.4 months, p = .04) but not intracranial PFS (7.2 vs. 7.7 months, p = .61). When NLR and upfront steroids are modeled together, there is a strong interaction (p = .0008) indicating that the impact of steroids depended on the patient’s NLR. In a subgroup analysis, only in patients with NLR < 4 was there a significant difference in OS with upfront steroids (26.1 vs. 15.6 months, p = .032). The impact of steroids on the efficacy of ICI in patients with NSCLCBM is dependent on the patient's NLR underscoring its importance in these patients. Patients with a low NLR, steroid use decreases the efficacy of ICI. These results can inform clinicians about the impact of steroids in patients treated with ICI.
format	article
author	Adam Lauko Bicky Thapa Mayur Sharma Baha’eddin Muhsen Addison Barnett Yasmeen Rauf Hamid Borghei-Razavi Vineeth Tatineni Pradnya Patil Alireza Mohammadi Samuel Chao Erin S. Murphy Lilyana Angelov John Suh Gene H. Barnett Amy S. Nowacki Nathan Pennell Manmeet S. Ahluwalia
author_facet	Adam Lauko Bicky Thapa Mayur Sharma Baha’eddin Muhsen Addison Barnett Yasmeen Rauf Hamid Borghei-Razavi Vineeth Tatineni Pradnya Patil Alireza Mohammadi Samuel Chao Erin S. Murphy Lilyana Angelov John Suh Gene H. Barnett Amy S. Nowacki Nathan Pennell Manmeet S. Ahluwalia
author_sort	Adam Lauko
title	Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
title_short	Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
title_full	Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
title_fullStr	Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
title_full_unstemmed	Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
title_sort	neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f4dcac47865a41d3946306192c5da152
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Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases

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