Neutrophil-to-lymphocyte ratio and outcomes in melanoma. Yep, AGAIN!!!!!

Y'all know I've been yelling about simple blood tests in melanoma that can help diagnose, evaluate tumor type, progression, and response to therapy for years!!!  Here are just a few zillion posts on the subject:  Simple blood tests that tells us where we are with our melanoma....AGAIN (and again, and again, and again)!!

Now, there's this:

High baseline neutrophil-to-lymphocyte ratio predicts worse outcome in patients with metastatic BRAF-positive melanoma treated with BRAF and MEK inhibitors. Teterycz, Jagofzinska-Mucha, Cybulska-Stopa, et al. Melanoma Res. 2018 May 18.  

Neutrophil-to-lymphocyte ratio (NLR) has been shown to be prognostic in several solid malignancies. There are limited data regarding its value during novel therapies in patients with melanoma. The aim of the study was to assess the practical utility of this ratio in patients with BRAF-mutant melanoma treated with a combination of BRAF and MEK inhibitors (BRAFi/MEKi). We included 215 patients with inoperable or metastatic melanoma who underwent BRAFi/MEKi treatment between October 2015 and June 2017. Baseline NLR and other complete blood count-derived inflammatory markers were tested for association with overall survival and progression-free survival in univariate and multivariate models. On-treatment NLR was also assessed for relationship with these outcomes using the time-dependent Cox's proportional hazard model. Prognostic model based on NLR and lactate dehydrogenase (LDH) levels was also developed. Patients with NLR values more than four had poorer progression-free survival (1-year rates 51.6 vs. 26.7%) and overall survival (1-year rates 77.3 vs. 53.1%). In a multivariate model adjusted for LDH levels, metastatic sites and age baseline NLR ratio and delay in starting MEKi were deemed statistically significant. In a model based on NLR and LDH, 1-year survival rates were 57, 40 and 23%, respectively if zero, one or both factors were elevated. Our results demonstrate the usefulness of NLR and a predictive model based on combinations of NLR and LDH as a prognostic markers during BRAFi/MEKi treatment. Our real-world data confirm the efficacy of BRAFi/MEKi therapy showed in the clinical trials.

So these researchers developed a prognostic model based on NLR (the neutrophil-to-lymphocyte ratio).  They found that melanoma peeps with values greater than 4 had poorer PFS than those with lower ratios (51% vs 26% at one year).  When they adjusted those numbers to also address LDH levels, metastatic sites and age....the melanoma peeps' baseline NLR and a delay starting treatment with a MEK inhibitor were found to be statistically significant.  When all those factors were included, they found that 1 year survival rates were 57% if neither LDH nor NLR were elevated, 40% if only one factor was elevated, and 23% when both were.

I wouldn't bet the farm on this algorithm alone, and most of this is not news, but all the lab values I've been yelling about can contribute meaningful information that can impact treatment decisions for melanoma peeps!  So, docs and researchers, lets make this a routine part of patient care, shall we???? - c