Session: MP29: Prostate Cancer: Advanced (including Drug Therapy) II
MP29-10: Prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving prostate-specific membrane antigen (PSMA) targeted radionuclide therapy (TRT)
Introduction: PSMA TRT is a promising therapy for patients with mCRPC. Known prognostic factors for mCRPC include CALGB (Halabi) risk group and baseline circulating tumor cell (CTC) count. Here, we report associations between NLR and PSA response and overall survival (OS) in men with mCRPC treated on sequential prospective clinical trials at a single institution. Methods: Patients treated on prospective studies from 2000 to 2021 were included in this analysis. Variables assessed: baseline neutrophil count:lymphocyte count ratio, baseline CTC count (CellSearch, favorable vs unfavorable), CALGB risk group, and administered radioactivity level. We used a Cox proportional hazards model to investigate the association between NLR and OS and logistic regression to determine the association between NLR and >50% PSA decline (PSA50). Results: 180 patients were included in this analysis. Median age 71 (IQR 66-77.5), PSA 57.3 ng/mL (21.3-294.9), 80 (44.4%) prior chemotherapy, 86 (47.7%) prior abiraterone or androgen receptor signaling inhibitor, 167 (92.8%) bone metastases, 141 (78.3%) nodal metastases, 113 (62.8%) CALGB high-risk group. 94 (52.2%) received 177Lu-J591, 51 (28.3%) 177Lu-PSMA-617, 28 (15.6%) 225Ac-J591, 7 (3.9%) 90Y-J591. Median ANC 4.1 (IQR 3.1-5.1), ALC 1 (0.75-1.5), NLR 3.75 (2.63-5.92). On univariate analysis, higher NLR was associated with worse OS (HR 1.06, 95%CI 1.02-1.09, p=0.002) and trended toward lower rates of PSA50 (HR 1.08; 95% CI 0.99-1.17, p=0.067). On multivariable analysis, after controlling for CTC count and CALGB risk group, the relationship between higher NLR and worse OS persisted (HR 1.05; 95% CI 1.003-1.11, p=0.036). Stratifying patients by low vs high NLR (relative to median NLR), patients with low NLR had longer OS (23.7 vs 15 months, p=0.024). Conclusions: For patients with mCRPC receiving PSMA TRT, NLR may have prognostic implications with higher NLR associating with lower likelihood of PSA response and shorter overall survival. SOURCE OF Funding: NIH, Department of Defense, Weill Cornell Medicine, Prostate Cancer Foundation
.jpeg.jpg "Judith Stanglkremser, MD,PhD (she/her/hers) photo")