Better melanoma outcomes with a lower NLR, neutrophil-to-lymphocyte ratio! (Again...)

Yes, I've been yelling about this for a while!!  Here are tons of posts/articles:  More than you ever wanted to know on NLR - neutrophil-to-lymphocyte ratio!  In these data sets you will find:

• Increased baseline NLR was associated with poorer outcomes generally.
• Multiple studies demonstrate that an NLR less than 5 showed improved progression free survival.
• A retrospective review showed that increased NLR in high risk, NON-metastatic melanoma patients resulted in poorer outcomes, indicating that Stage III patients might take that measure into account when thinking about how aggressively they should treat their disease.  That result was replicated from a study at Huntsman, where they found that an NLR greater than 2.5 in Stage III patients was a strong predictor of recurrence. 

Now, there's this:

Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab. Capone, Giannarelli, Mallardo, ... Ascierto .  J Immunother Cancer. 2018 Jul 16.

Previous studies have suggested that elevated neutrophil-to-lymphocyte ratio (NLR) is prognostic for worse outcomes in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors.

This was a retrospective analysis of 97 consecutive patients with stage IV melanoma who were treated with nivolumab. Baseline NLR and derived (d) NLR were calculated and, along with other characteristics, correlated with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analyses. ... In univariate analysis, increasing absolute neutrophil count (ANC), NLR, dNLR and lactate dehydrogenase (LDH) (continuous variables) were all significantly associated with OS. Only NLR and LDH maintained a significant association with OS in multivariate analysis. Patients with baseline NLR greater than/= to 5 had significantly worse OS and PFS than patients with NLR less than 5, as did patients with baseline dNLR greater than/= to 3 versus less than 3. Optimal cut-off values were greater than/= to 4.7 for NLR and greater than/= to 3.8 for dNLR. Using this greater than/= to 4.7 cut-off for NLR, the values for OS and PFS were overlapping to the canonical cut-off for values, and dNLR less than 3.8 was also associated with better OS and PFS. 

Both Neutrophil-to-lymphocyte ratio (NLR) and derived (d) NLR were associated with improved survival when baseline levels were lower than cut-off values. NLR and dNLR are simple, inexpensive and readily available biomarkers that could be used to help predict response to immunotherapy in patients with advanced melanoma.

So, the question seems to be, How low can we go???  Cause when it comes to NLR, it looks like the lower the better for our prognosis!!  Still, this is not the whole answer to melanoma care and therapy.  It is one thing to check and speak with your doc about when making the best possible treatment plan for your melanoma.  Hang in there, ratties!!! - c