Neutrophil/lymphocyte ratio (NLR): a potential biomarker in patients with head and neck squamous cell carcinoma treated with immune checkpoint inhibitors

Marianna Caterino¹Giorgio Lo Giudice²Vincenzo Damiano³Francesco Perri^4*Guido Giordano⁵Davide Ciardiello⁶Aurora Mirabile⁷Mario Pirozzi⁸Andrea Pietro Sponghini⁸Vincenzo Ricci⁹Liliana Montella¹⁰Raffaele Addeo¹¹FRANCESCA VIGNANI¹²Vincenzo Famiglietti¹³Stefano Farese¹³Sara Di Lorenzo¹³Fortunato Ciardiello¹³Morena Fasano¹³

• ¹Oncology Unit, Casa di Cura Villa Salus, Messina, Italy
• ²Department of Medicine and Surgery, Kore University of Enna, Enna, Sicily, Italy
• ³Clinical Department of Oncology and Hematology, University of Naples Federico II, Naples, Campania, Italy
• ⁴G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Campania, Italy
• ⁵Department of Medical and Surgical Sciences, University of Foggia, Foggia, Apulia, Italy
• ⁶Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), Milan, Lombardy, Italy
• ⁷Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Lombardy, Italy
• ⁸SCDU Oncologia, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
• ⁹Medical Oncology Unit, Azienda Ospedaliera San Pio di Benevento, Benevento, Campania, Italy
• ¹⁰Oncology Operative Unit, Ospedale Santa Maria delle Grazie, Naples, Campania, Italy
• ¹¹Oncology Division, San Giovanni di Dio Hospital, Frattamaggiore, Italy
• ¹²Medical Oncology, Hospital Mauritian Turin, Turin, Piedmont, Italy
• ¹³Precision Medicine Department, Medical Oncology, University of Campania Luigi Vanvitelli, Caserta, Campania, Italy

Literature has shown that there is a correlation between increased circulatory inflammatory factors and negative prognosis, which can be evaluated through the using the neutrophil and lymphocyte ratio (NLR). The aim of this research is to investigate the predictive and prognostic role of the NLR in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients, treated with immunotherapy, and its correlation to the overall survival (OS), progression free survival (PFS) and objective response rate (ORR). his multicentric study coordinated by the Oncology Unit of University of Campania “Luigi Vanvitelli”, retrospectively analyzed data from 135 patients diagnosed with R/M HNSCC from 13 Italian oncological centers. Two groups were made using the median NLR value of 4.2. 71 patients (52.6%) had NLR>4 and 64 patients (47.4%) had NLR<=4. Mean OS of patients with NLR>4 was significantly shorter than that of patients with NLR<=4 (23.1 vs 37.4 months, p= 0.002). Univariable analysis showed a statistically significant correlation between OS and NLR value (p=0.002), and between OS and ECOG (p=0.022). Median PFS stratified by NLR value, was statistically significant: 6.5 vs 20 months in patients with NLR>4 and NLR<=4, respectively (p= 0.013O). ORR in the general population was 32.6%. NLR-stratified ORR confirmed the unfavorable prognostic role of high NLR: 20% if NLR<=4, and 12.5% if NLR>4. Basal NLR value lower than the cut-off of 4 is independently associated with better OS, PFS and ORR in patients with R/M HNSCC treated with immunotherapy, in first- or second- line.