ORLANDO—Baseline and changed neutrophil to lymphocyte ratio (NLR) predict targeted treatment responses in patients with metastatic renal cell carcinoma (mRCC), according to a study (Abstract 404) presented during the 2015 Genitourinary Cancers Symposium.1

NLR is a biomarker of inflammation; a change in NLR during treatment is referred to as NLR conversion.

“When adjusted for known prognostic factors in mRCC, a baseline NLR greater than 3 is an adverse prognostic factor and a decrease in NLR from high to low with targeted therapy is associated with favorable outcomes in overall survival (OS), progression-free survival (PFS) and response rates,” reported lead study author Nimira S. Alimohamed, MD, of the Tom Baker Cancer Centre in Calgary, Alberta, Canada. “An increase in NLR with targeted therapy had the opposite effect.”

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“NLR conversion with targeted therapy is an early biomarker of treatment efficacy,” she said.

The study authors identified two sets of patients diagnosed with metastatic renal cell carcinoma (mRCC) who were treated with targeted therapy: 1,199 patients from the IMDC training cohort and a validation cohort of 4,350 patients from pooled prospective randomized controlled trials of targeted therapy, Dr. Alimohamed reported.

“NLR was examined at initiation of first-line targeted therapy and at 6 weeks after,” Dr. Alimohamed said. “Median baseline NLR was 3.4 and 2.9 in the [IMDC] training and validation cohorts, respectively. NLR greater than 3.0 at baseline was independently associated with OS and PFS in both the training and validation cohorts.”

In the IMDC training cohort, for example, higher baseline NLR (>3) was associated with an OS of 14.6, compared to 28.1 months for lower NLR (HR=1.45; P<0.001).

A decrease in high baseline NLR by week 6 of targeted therapy was associated with longer OS compared to NLR that remained high after targeted therapy (21.4 vs. 9.7 months; HR=0.57, P<0.001).

The study “confirms that patients with mRCC with an elevated NLR at baseline have inferior outcomes compared to those with a low NLR,” Dr. Alimohamed concluded.


  1. Alimohamed NS, Templeton AJ, Knox JJ, et al. Change in neutrophil to lymphocyte ratio as a prognostic and predictive marker in response to targeted therapy for metastatic renal cell carcinoma. 2015 Genitourinary Cancers Symposium. Abstract 404.