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ELCC 2017: White Blood Cell Count May Predict Response to Lung Cancer Immunotherapy

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Key Points

  • A greater number and concentration of natural killer cells at baseline was associated with response to nivolumab, as was an increase in the number of natural killer cells during treatment.
  • Responders to nivolumab also had a greater number and concentration of CD8–positive T cells that expressed programmed cell death protein 1.

White blood cell counts may predict whether patients with lung cancer will benefit from immunotherapy, according to research presented by Tiseo et al at the 2017 European Lung Cancer Conference (ELCC, Abstract 30PD).

“Immune checkpoint inhibitors such as nivolumab [Opdivo] and pembrolizumab [Keytruda] significantly improve overall survival in some—but not all—patients with non–small cell lung cancer (NSCLC),” said lead author Marcello Tiseo, MD, PhD, Coordinator of DMT Thoracic Oncology, University Hospital of Parma, Italy. “Researchers are looking 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.”

He continued: “[Programmed cell death ligand 1 (PD-L1)] expression in a biopsy of tumor tissue is used to select patients, 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.”

Study Findings

This study assessed the ability of white blood cell counts to predict whether lung cancer patients responded to treatment with nivolumab. The study included 54 patients with NSCLC who received nivolumab at a dose of 3 mg/kg every 14 days. White blood cell counts were performed at baseline, after two nivolumab cycles, and after four nivolumab cycles. The researchers compared white blood cell counts between responders and nonresponders to nivolumab.

The researchers found that white blood cell counts at baseline and during therapy predicted whether patients would respond to nivolumab treatment. A greater number and concentration of natural killer cells at baseline was associated with response to nivolumab, as was an increase in the number of natural killer cells during treatment. Responders to nivolumab also had a greater number and concentration of CD8–positive T cells that expressed programmed cell death protein 1 (PD-1).

Dr. Tiseo said, “The number and function of natural killer cells and the frequency of PD-1 expression in CD8–positive T cells could be predictive biomarkers for nivolumab treatment in advanced NSCLC. The identification of a panel of blood predictive biomarkers would enable the early identification of patients most likely to benefit from anti–PD-1 and anti–PD-L1 treatment.”

Commentary

Commenting on the findings, Stefan Zimmermann, MD, Senior Consultant, Medical Oncology Department, HFR–Hôpital Cantonal, Fribourg, Switzerland, said, “In the current era of precision medicine and increasing health-care costs, we urgently need proper predictive biomarkers to select patients that will benefit from a specific therapy.”

He continued, “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 tumor PD-L1 expression and other markers that constitute the cancer immunogram, [to] predict whether or not patients will benefit from treatment.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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