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Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases
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 retrospectiv...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021556/ https://www.ncbi.nlm.nih.gov/pubmed/33820922 http://dx.doi.org/10.1038/s41598-021-85328-w |
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author | Lauko, Adam Thapa, Bicky Sharma, Mayur Muhsen, Baha’eddin Barnett, Addison Rauf, Yasmeen Borghei-Razavi, Hamid Tatineni, Vineeth Patil, Pradnya Mohammadi, Alireza Chao, Samuel Murphy, Erin S. Angelov, Lilyana Suh, John Barnett, Gene H. Nowacki, Amy S. Pennell, Nathan Ahluwalia, Manmeet S. |
author_facet | Lauko, Adam Thapa, Bicky Sharma, Mayur Muhsen, Baha’eddin Barnett, Addison Rauf, Yasmeen Borghei-Razavi, Hamid Tatineni, Vineeth Patil, Pradnya Mohammadi, Alireza Chao, Samuel Murphy, Erin S. Angelov, Lilyana Suh, John Barnett, Gene H. Nowacki, Amy S. Pennell, Nathan Ahluwalia, Manmeet S. |
author_sort | Lauko, Adam |
collection | PubMed |
description | 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 | Online Article Text |
id | pubmed-8021556 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-80215562021-04-07 Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases Lauko, Adam Thapa, Bicky Sharma, Mayur Muhsen, Baha’eddin Barnett, Addison Rauf, Yasmeen Borghei-Razavi, Hamid Tatineni, Vineeth Patil, Pradnya Mohammadi, Alireza Chao, Samuel Murphy, Erin S. Angelov, Lilyana Suh, John Barnett, Gene H. Nowacki, Amy S. Pennell, Nathan Ahluwalia, Manmeet S. Sci Rep Article 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. Nature Publishing Group UK 2021-04-05 /pmc/articles/PMC8021556/ /pubmed/33820922 http://dx.doi.org/10.1038/s41598-021-85328-w Text en © The Author(s) 2021, corrected publication 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Lauko, Adam Thapa, Bicky Sharma, Mayur Muhsen, Baha’eddin Barnett, Addison Rauf, Yasmeen Borghei-Razavi, Hamid Tatineni, Vineeth Patil, Pradnya Mohammadi, Alireza Chao, Samuel Murphy, Erin S. Angelov, Lilyana Suh, John Barnett, Gene H. Nowacki, Amy S. Pennell, Nathan Ahluwalia, Manmeet S. Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases |
title | 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_short | 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 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021556/ https://www.ncbi.nlm.nih.gov/pubmed/33820922 http://dx.doi.org/10.1038/s41598-021-85328-w |
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