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Mean platelet volume, thrombocytosis, and survival in non-small cell lung cancer patients treated with first-line pembrolizumab alone or with chemotherapy

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Abstract

Introduction

Patients treated with immune checkpoint inhibitors (ICIs) may not response to treatment and are at risk for immune-related adverse events (irAEs). Platelet function has been linked to both oncogenesis and immune evasion. We studied the association between the change in mean platelet volume (MPV), platelet count, survival, and the risk of developing irAEs in patients with metastatic non-small cell lung cancer (NSCLC) who have received first-line ICI.

Methods

In this retrospective study, delta (∆) MPV was defined as the difference between cycle 2 and baseline MPV. Patient data were collected via chart review, and Cox proportional hazard and Kaplan–Meier method were used to assess the risk and estimate median overall survival.

Results

We identified 188 patients treated with first-line pembrolizumab, with or without concurrent chemotherapy. There were 80 (42.6%) patients received pembrolizumab monotherapy, and 108 (57.4%) received pembrolizumab in combination with platinum-based chemotherapy. Patients whose MPV (∆MPV ≤ 0) decreased had hazard ratio (HR) = 0.64 (95% CI 0.43–0.94) for death with p = 0.023. Patients with ∆MPV ≤ − 0.2 fL (median), there was a 58% increase in the risk of developing irAE (HR = 1.58, 95% CI 1.04–2.40, p = 0.031). Thrombocytosis at baseline and cycle 2 was associated with shorter OS with p = 0.014 and 0.039, respectively.

Conclusion

Change in MPV after 1 cycle of pembrolizumab-based treatment was significantly associated with overall survival as well as the occurrence of irAEs in patients with metastatic NSCLC in the first-line setting. In addition, thrombocytosis was associated with poor survival.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

∆MPV:

Delta mean platelet volume

ECOG:

Eastern Cooperative Oncology Group performance status

HR:

Hazard ratio

IQR:

Interquartile range

irAEs:

Immune-related adverse events

MPV:

Mean platelet volume

NSCLC:

Non-small cell lung cancer

PD-L1:

Programmed death-ligand 1

OS:

Overall survival

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Acknowledgements

The authors would like to thank the Biostatistics Shared Resource at The Ohio State University Comprehensive Cancer Center, Columbus, OH for statistical support. Dr. Owen is supported by the LUNGevity Foundation Career Development Award.

Funding

This study was supported by the National Institutes of Health (P30CA016058). Research support provided by the REDCap project and The Ohio State University Center for Clinical and Translational Science grant support (National Center for Advancing Translational Sciences, Grant UL1TR002733).

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA

    Mingjia Li, Gabrielle Lopez, Parthib Das, Madison Grogan, Sandip Patel, Abdul Miah, Daniel Spakowicz, Gabriel Tinoco, Zihai Li, Kai He, Erin Bertino, Asrar Alahmadi, Regan Memmott, Jacob Kaufman, Peter G. Shields, David P. Carbone, Carolyn J. Presley, Gregory A. Otterson & Dwight H. Owen

  2. Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, USA

    Songzhu Zhao & Lai Wei

  3. College of Medicine Medical Scientist Training Program, The Ohio State University, Columbus, USA

    Karthik Chakravarthy

  4. Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA

    Karthik Chakravarthy, Daniel Spakowicz, Zihai Li, Kai He, Jacob Kaufman, Peter G. Shields, David P. Carbone, Carolyn J. Presley & Dwight H. Owen

  5. College of Medicine, The Ohio State University, Columbus, USA

    Austin Secor & Nitya Surya

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  1. Mingjia Li
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Contributions

ML and DO contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mingjia Li.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was reviewed and approved by the institutional review board (IRB 2018C0177) at the Ohio State University.

Consent to participate

This was a retrospective study and a waiver for consent from each individual patient was approved by the institutional review board.

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Li, M., Zhao, S., Lopez, G. et al. Mean platelet volume, thrombocytosis, and survival in non-small cell lung cancer patients treated with first-line pembrolizumab alone or with chemotherapy. Cancer Immunol Immunother 72, 2067–2074 (2023). https://doi.org/10.1007/s00262-023-03392-9

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