Dados do Trabalho

Título

Prognostic Role of Complete Blood Count in Non-Small Cell Lung Cancer Patients Undergoing Immune Checkpoint Inhibitor Therapy

Introdução

Background: Lung cancer causes 1.8 million annual deaths, primarily from non-small cell lung cancer (NSCLC) constituting 85% of cases. Immunotherapy targeted at immune checkpoint inhibitors (ICI) has shown significant advances, being composed of monoclonal antibodies capable of modulating the homeostasis of co-stimulatory and co-inhibitory signals, which are critical in maintaining immunological tolerance. Despite promising results there is a lack of robust prognostic markers that indicate response to ICIs.

Objetivo

Aim: This study aimed to investigate the prognostic role of the complete blood count (CBC) and to develop a valuable prognostic model for patients with NSCLC undergoing ICIs therapy.

Métodos

Methods: A retrospective medical records review was performed in advanced NSCLC patients treated with ICIs at Barretos Cancer Hospital (Brazil) (CEP: 1772/2019). The values of baseline CBC were analyzed, with a median value used as a cutoff. Demographic characteristics, such as age, sex, smoking status, histology, staging, PD-L1 status, and treatment, were collected from medical records upon admission. The primary outcomes evaluated included overall survival (OS) and progression-free survival (PFS), assessed through Kaplan-Meier analysis using the log-rank test. Additionally, Cox regression analysis was employed to evaluate the prognostic factors and receiver operating characteristic analysis (ROC) was employed for predictive value. All analyzes were performed using the SPSS software.

Resultados

Results: The study cohort comprises 55 patients, with an average age of 62 years old (range: 48.2 - 79.8 years old), consisting of 58.2% males and 41.8% females. The smoking history of the patients revealed that only 10.9% had never smoked. Adenocarcinoma was the predominant histological type, comprising 60.0% of the cases, followed by 34.5% of SCC. In the cohort, 65.4% showed PD-L1 positive status, with 23.6% having low expression (1-49%) and 41.8% having high expression (>50%). The study also demonstrated a noteworthy correlation between components of the CBC and the clinical outcomes among NSCLC patients. Specifically, patients with lower baseline monocyte counts (<712.0/mm³) exhibited a significantly elevated OS rate p= 0.006 and also demonstrated an improved PFS outcome p= 0.050. Furthermore, an assessment of eosinophil counts in patients with disease progression revealed that those with eosinophil counts exceeding (>151.0/mm³) displayed a significant increase in PFS p=0.002.

Conclusões

CBC values are valuable for exploring biomarkers due to accessibility. Monocyte counts might unveil insights into macrophage dynamics, indicating possible hindered M2 macrophage differentiation in patients with lower counts. Higher eosinophil levels might boost inflammation, aiding CD8+ T cell recruitment and enhancing cytotoxicity. These observations suggest a potential shift in the inflammatory context, favorably influencing the immune response and, hence, amplifying ICI therapy responsiveness.

Palavras-chave

Non-Small Cell Lung Cancer, Immunotherapy, Biomarkers.

Financiador do resumo

This research was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, grant number 2019/07111-9 and by institutional funding of Barretos Cancer Hospital (Brazil). Tostes, K. was a recipient of a scholarship from FAPESP (2021/08352-0). Arantes, LMRB. was a recipient of a scholarship from FAPESP (2021/04100-6) and a recipient of a Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Produc-tivity (Brazil) fellowship.