Hematological parameters in EGFR-mutated advanced NSCLC patients treated with TKIs: predicting survival and toxicity

ABSTRACT

Background: The aim of this study was to analyze the prognostic value of pre-treatment hematological parameters in EGFR-mutated non-small cell lung cancer patients treated with tyrosine-kinase inhibitors (TKIs).

Patients and methods: Patients with EGFR mutations were treated with EGFR-TKIs in the first line until progression/unacceptable toxicity. Hematological parameters were derived from the absolute baseline differential counts of a complete blood count. The associations between the patients’ and tumor characteristics were analyzed using Pearson Chi-Square, Fisher’s exact, t-test, and Mann–Whitney tests. Cutoff values were determined using ROC curves, and correlation with survival was examined by Kaplan–Meier method and Cox regression.

Results: Patients with NMR<12.62 had a longer PFS compared to patients with higher NMR values (12.0 vs. 10.0 months, p = 0.054) and a significantly longer OS (20.0 vs. 11.0 months, p = 0.010). The same parameter was confirmed as a predictors of favorable response in the patient subgroup with activating EGFR mutations. Patients with NLR>2.9 and LMR<2.5 more often presented with paronichia and diarrhea, and patients with PLR>190 more often had paronichia, diarrhea and hyperbilirubinemia.

Conclusion: Low baseline value of the hematological parameter NMR has shown potential as a routine, low-cost, and minimally invasive predictor of survival in EGFR-TKI-treated NSCLC patients.

KEYWORDS:

• EGFR
• hematological parameters
• lung cancer
• toxicity
• tyrosine kinase inhibitors

Author contributions

VJ – concept, design, materials, data collection and/or processing, analysis and/or interpretation, literature search, writing manuscript, critical review of the manuscript; KSV – concept, design, supervision, writing manuscript, critical review of the manuscript; JS – concept, design, data collection and/or processing, analysis and/or interpretation, writing manuscript, critical review of the manuscript; NS – analysis and/or interpretation, data collection, and/or processing, critical review of the manuscript; MM – data collection and/or processing, analysis and/or interpretation, critical review of the manuscript; DR – resources, materials, data collection and/or processing, critical review of the manuscript; MC – concept, design, supervision, resources, materials, data collection and/or processing, analysis and/or interpretation, literature search, writing manuscript, critical review of the manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and/or ethical restrictions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Study approval

All analyses presented in this study are part of routine clinical practice approved by the Ethics Committee of the Institute for Oncology and Radiology of Serbia and were performed in accordance with the Helsinki Declaration of 1975, as revised in 2013. All patients signed an informed consent.

Additional information

Funding

This study was supported by the Ministry of Education and Science of the Republic of Serbia [Agreement No.451-03-9/2021-14/200043]. JS and MC are supported by the Science Fund of the Republic of Serbia [PROMIS TRACEPIGEN project No. 6060876].