Researchers at the 2023 ASCO Annual Meeting evaluated the use of myeloid cells, including monocytes and eosinophilis, as prognostic biomarkers for patients with non-small cell lung cancer (NSCLC) who have been treated with cemiplimab. 

The study was conducted using data from the phase 3 EMPOWER-Lung 1 and EMPOWER-Lung 3 trials for patients with NSCLC who have been treated with cemiplimab. In total, 691 patients from the EMPOWER-Lung 1 trial and 769 patients from the EMPOWER-Lung 3 trial were included in the study. The researchers used multiple quantitative analytic methods, including multivariable Cox regression and conditional trees, to evaluate the prognostic capacity of neutrophil/lymphocyte ratio (NLR) and peripheral myeloid cells in study participants.  

Multiple factors, including NLR, had significant prognostic associations with overall survival (OS) and progression-free survival (PFS) in this patient population, findings showed. For patients with NLR > 3.98, median OS was 10 months (range 9-13), while patients with NLR ≤ 3.98  had a median OS of 20 (range 17-24) months (HR: 2.04, 95% CI: 1.60-2.61; P < .001). The median PFS was 4 months (range 4-6) vs 6 months (range 6-7) (HR: 1.80, 95% CI: 1.50-2.18; P < .001) in each respective group.

In their multivariable analyses, the authors found monocytes (OS HR: 1.72, 95% CI: 1.29-2.30; P < .001; PFS HR: 1.37, 95% CI: 1.08-1.75; P = .010) and log eosinophils (OS HR: 0.90, 95% CI: 0.85-0.97; P = .003; PFS HR: 0.93, 95% CI: 0.88-0.98; P = .004) were significantly associated with OS and PFS in both studies. In addition, the neutrophil and monocyte/lymphocyte ratio showed to be the top predictor of both OS and PFS in their decision tree analysis. Peripheral blood cell count correlations were not affected by tumor PD-L1 levels (P < .15 for all markers), according to the authors.

“Clinically actionable peripheral blood cell count parameters, incorporating putative immunosuppressive myeloid cells (neutrophils and monocytes) and protective lymphocytes and eosinophils, may help predict response to anti-PD-1 therapy in advanced NSCLC,” researchers concluded.

Reference:
Murray JC, McIntyre DAG, Anagnostou V, et al. Peripheral myeloid cells as prognostic markers in patients (patients) with non-small cell lung cancer (NSCLC) treated with cemiplimab: Pooled analysis of EMPOWER-Lung 1 and EMPOWER-Lung 3 phase 3 trials. J Clin Oncol. 2023;41 (16): abstract 9028. doi:10.1200/JCO.2023.41.16_suppl.9028