TBA (23W144)

Higher neutrophil-to- lymphocyte ratio associates with poorer prognosis in advanced HCC treated with Transarterial Chemoembolization plus Immune Checkpoint Inhibitors

Author(s)

Armstrong P, Moriarty A, Evans N, O’Farrelly C, Duffy A

Department(s)/Institutions

University College Dublin, Trinity College Dublin, St. Vincent’s University Hospital

Introduction

Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a barometer of the relationship between the tumour microenvironment and the systemic immune response. Higher NLR is associated with advanced disease stage and poor overall survival outcomes in a range of cancer types including hepatocellular carcinoma (HCC).

Aims/Background

To evaluate NLR as a prognostic biomarker in patients treated with Transarterial Chemoembolisation (TACE) plus tremelimumab and durvalumab in advanced hepatocellular carcinoma as part of a clinical trial.

Method

Patients with HCC (Childs Pugh A/B7; Barcelona Clinic Liver Cancer Stage B/C; ECOG 0/1; sorafenib-naïve or experienced) were enrolled in a clinical trial (UCDCRC/19/01 EudraCT no. 2019-002767-98) of tremelimumab in combination with durvalumab and subtotal TACE performed on week 6. Full blood count including differential sample assessments were performed at baseline and weekly. NLR was defined as absolute neutrophil count divided by absolute lymphocyte count. Patients were divided into groups according to evidence of clinical benefit.

Results

13 patients enrolled in the trial. 12 were evaluable for treatment response at 6 months and survival information followed up to date (two years). 6 (50%) patients were classified as responders. We saw an association between higher index NLR and poorer outcomes (p = 0.015, Spearman’s Rho -0.725). The diagnostic performance of NLR for treatment response was assessed using receiver operated characteristic curves (ROC). The area under the ROC was 0.91 (95% CI: 0.76-1, p = 0.016). Four patients (31%) were alive at two years. Lower index NLR associated with overall survival at two years (p = 0.034, Spearman Rho 0.6).

Conclusions

Our pilot study suggests that pre-treatment NLR is a quantitative inflammatory biomarker which correlates with clinical and survival benefit in a clinical trial evaluating response to TACE plus immune checkpoint blockade.