Can neutrophil to lymphocyte ratio guide treatment choice in small cell lung cancer?

This study investigated if neutrophil to lymphocyte ratio (NLR) can be used to chose a first-line treatment in patients with small-cell lung cancer (SCLC).

They found that NLR could be used to choose a treatment for these patients.

Lung cancer is a common cancer with poor prognosis. Small cell lung cancer (SCLC) is a progressive type of LC. The first line therapy for SCLC is usually chemotherapy (CT). A combination of etoposide (Etopophos) and either carboplatin (Paraplatin) or cisplatin (Platinol) is administered. It is important to use the most suitable first-line therapy to give the best chance of survival.

Choosing either carboplatin or cisplatin depends on a several factors. They are similarly effective but have different side effects.The neutrophil to lymphocyte ratio (NLR) compares blood cell types to give an indication of the level of inflammation. High inflammation may suggest cancer progression. It is unclear if NLR can predict which first-line therapy is more effective in SCLC.  

This study included 73 patients with SCLC. Patient data were obtained from medical records. The authors calculated the NLR based on blood lab results. Patients were categorized as low (<3.8) or high (3.8 or more) NLR. They compared this to the type of treatment and survival rates. Progression-free survival (PFS; survival without cancer growing or spreading) was measured. 

The Low-NLR group had a longer PFS, overall. Overall survival rates were similar in both groups. Patients treated with etoposide/cisplatin (EP) had an average PFS of 5.36 months compared to 4.78 months in those treated with etoposide/carboplatin (EC).

In high-NLR patients, the average PFS with EP was significantly higher than EC treatment (4.59 vs. 2.63 months). However, in low-NLR patients, the average PFS with EP was similar to the EC group (5.85 months vs 6.50).

Some patients (34) also received thoracic radiotherapy (RT). In the low-NLR group, those who received RT had significantly longer PFS than those who did not. In the high-NLR group, there were no significant differences in PFS between patients who had RT and those who did not.

The authors concluded that NLR could be used to choose a first-line treatment for patients with SCLC.

The number of patients in this trial was relatively small. It is difficult to say for sure if NLR will be useful in all SCLC patients. More investigation is needed.