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12-05-2017 | Non-small-cell lung cancer | Main feed | Article

Circulating immune cells could predict NSCLC nivolumab response

medwireNews: Baseline levels of certain immune cells could help identify patients with non-small-cell lung cancer (NSCLC) who are likely to respond to treatment with the programmed cell death protein 1 (PD-1) inhibitor nivolumab, research suggests.

The findings were presented by Marcello Tiseo (University Hospital of Parma, Italy) at the 2017 European Lung Cancer Conference (ELCC) in Geneva, Switzerland.

He told the press that nivolumab improves survival in some, but not all, patients, leading to the need for “a predictive biomarker to select patients that will benefit from this treatment to avoid unnecessary toxicity and a waste of resources in patients who will not respond.”

Currently, the expression of programmed cell death ligand 1 (PD-L1) in tumor biopsies is used as a marker, Tiseo said, “but it is not completely accurate, possibly because it does not reflect the evolving immune response.”

“Biomarkers in the blood are easier to obtain and may be better indicators of immune response.”

Among 54 previously treated NSCLC patients who were given nivolumab 3 mg/kg every 2 weeks as part of an expanded access program, those with natural killer (NK) cell counts of at least 190/μL and CD3+ cell counts of at least 1000/μL at baseline were significantly more likely to achieve a response (complete response, partial response, or stable disease) than their counterparts with counts below these thresholds.

By contrast, high baseline levels of white blood cells (≥10,000/μL) and neutrophils (≥7500/μL) were significantly associated with disease progression, as was a high neutrophil-to-lymphocyte ratio, such that patients with a ratio of at least 4:1 versus below this threshold were significantly more likely to progress.

The results were similar when assessing the relationship between these immune cells and overall survival, except that the association between high NK levels and improved survival was only borderline significant.

An independent commentator, Stefan Zimmermann, from HFR – Hôpital Cantonal in Fribourg, Switzerland, told the press: “This study found that baseline levels of certain white blood cells do have a role in predicting response to immunotherapy in patients with lung cancer.

“These new factors should be investigated in future clinical trials, together with tumour PD-L1 expression and other markers that constitute the cancer immunogram [to] predict whether or not patients will benefit from treatment.”

By Shreeya Nanda

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