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. 2020 Oct 1;21(10):2955-2960.
doi: 10.31557/APJCP.2020.21.10.2955.

Chronological Changes in Neutrophil/lymphocyte Ratio in Advanced Gastric Cancer Patients Treated with Nivolumab: a Report of Nine Cases

Naohiko Nakamura  1 , Shinichi Kinami  1 , Jun Fujita  1 , Daisuke Kaida  1 , Yasuto Tomita  1 , Takashi Miyata  1 , Hideto Fujita  1 , Hiroyuki Takamura  1 , Nobuhiko Ueda  1 , Takeo Kosaka  1
Affiliations

Chronological Changes in Neutrophil/lymphocyte Ratio in Advanced Gastric Cancer Patients Treated with Nivolumab: a Report of Nine Cases

Naohiko Nakamura et al. Asian Pac J Cancer Prev. .

Abstract

Background: Nivolumab has been approved for use in advanced gastric cancer (GC) after third-line chemotherapy in Japan. However, it remains difficult to predict favorable nivolumab response before treatment.

Methods: We evaluated the clinical course with a focus on the chronological changes in neutrophil/lymphocyte ratio (NLR) throughout the chemotherapy and assessed the relationship between nivolumab response and chronological changes in NLR before nivolumab administration.

Results: We experienced nine cases who received nivolumab monotherapy for unresectable advanced or postoperative recurrent GC. Nivolumab was used as third-line chemotherapy in all patients, and partial response (PR) and stable disease (SD) were observed in two patients each. Nivolumab treatment resulted in progressive disease (PD) in five patients. In patients with PR or SD, changes in the NLR tended to correspond to the response of target metastatic lymph nodes to first- and second-line chemotherapy. In the four cases with PR or SD following nivolumab, ∆NLRresponses that was the difference in the degree of decline during the most effective pretreatment chemotherapy were 1.39, 0.73, 1.62, and 1.22. However, the patients with PD showed lower ∆NLRresponses, at 0.66, 0.66, 0.25, 0.13, and -0.05 in the five cases. Mean ∆NLRresponses in the patients with PR or SD and patients with PD were 1.17 and 0.33, respectively (P = 0.0008).

Conclusions: We experienced nine GC cases treated with nivolumab and assessed the association between chronological NLR changes throughout chemotherapy and tumor response to nivolumab. Changes in NLR during pretreatment chemotherapy might predict tumor response to nivolumab monotherapy in patients with advanced GC.<br />.

Keywords: Gastric cancer; neutrophil/lymphocyte ratio; nivolumab.

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Figures

Figure 1
Figure 1
Gastric Cancer Treatments and Chronological Changes in NLR and Target Lesions in the Nine Cases. Case 1 and 2 showed partial response (PR) to nivolumab. Case 3 and 4 showed stable disease (SD) to nivolumab. Case 5, 6, 7, 8, and 9 showed progressive disease (PD) to nivolumab. Neutrophil/lymphocyte ratio, NLR; cisplatin, CDDP; ramucirumab, RAM; (nab-) paclitaxel, (nab-) PTX; oxaliplatin, L-OHP; capecitabine, Cape
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