Baseline neutrophil-to-lymphocyte ratio (NLR) is associated with outcome of patients treated with BRAF inhibitors.
PURPOSE
The aim of this study is to verify if baseline hematological markers, in patients with advanced melanoma receiving BRAF inhibitor (BRAFi)-based therapies, are independently associated with progression free survival (PFS) and overall survival (OS).


METHODS
We retrospectively analyzed 90 patients with metastatic melanoma harboring BRAF V600 mutation, who received treatment with either BRAFi alone or combined with a MEK inhibitor (MEKi) at the recommended dosages. Study population included 28 women and 62 men. Median age was 53 years. Seventy-three (82%) patients presented with M1c disease, 49 (56%) had elevated LDH and 54 (60%) had three or more metastatic sites.


RESULTS
The median PFS was 9.1 and 3.5 months, respectively, for patients with baseline NLR < 5 and NLR ≥ 5, while median OS was 17.2 and 5.5 months, respectively, for patients with NLR < 5 and NLR ≥ 5. Multivariate analysis confirmed that baseline NLR < 5 was significantly associated with half risk of relapse (HR = 0.49; 95% CI = 0.28-0.85; p = 0.01) and half risk of death (HR = 0.46; 95% CI = 0.23-0.76; p = 0.004), independent of age, sex, stage, LDH > 2xULN, previous treatments, concomitant use of steroids and type of therapy. In patients with LDH ≥ ULN, NLR < 5 remained significantly and independently associated with improved PFS (HR = 0.28; 95% CI = 0.13-0.62; p = 0.002,) and OS (HR = 0.23; 95% CI = 0.10-0.55; p = 0.001).


CONCLUSIONS
These biomarkers are easily reproducible, affordable and costless and NLR could help to identify patients who have the best benefit from BRAF inhibitors.
['Cocorocchio|E|E|http://orcid.org/0000-0003-1184-6426', 'Martinoli|C|C|', 'Gandini|S|S|', 'Pala|L|L|', 'Conforti|F|F|', 'Stucchi|S|S|', 'Mazzarol|G|G|', 'Ferrucci|P|P|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D006801:Humans D007770:L-Lactate Dehydrogenase D008214:Lymphocytes D008297:Male D008545:Melanoma D008875:Middle Aged D009364:Neoplasm Recurrence, Local D009504:Neutrophils D047428:Protein Kinase Inhibitors D048493:Proto-Oncogene Proteins B-raf D012189:Retrospective Studies
NLR Metastatic melanoma Targeted therapy