Absolute neutrophil count in peripheral blood predict prognosis in lung cancer patients treated with anlotinib

Background: Anlotinib is a multi-targeted tyrosine kinase inhibitor which can antagonize tumor angiogenesis and tumor cell proliferation. In the field of lung cancer treatment, anlotinib has been widely used as a third-line therapy. However, reliable prognostic markers predicting the efficacy are lacking. Methods: Patients with advanced lung cancer treated with anlotinib monotherapy were enrolled. Cox regression were conducted to analyze the significant factors related to the progression free survival (PFS) and overall survival (OS). According to the median cut-off value of inflammation index, the objective response rate (ORR) was compared. Meanwhile, we created survival curves between two groups and used receiver operating characteristic (ROC) curve analysis to assess the ability of the inflammation index to predict 10-month mortality. Results: The median PFS was 5.5 months (IQR, 4.0-8.0) and the median OS (mOS) was 9.5 months (IQR, 6.8-11.2). The ORR and DCR was 16.9% and 84.5%, respectively. According to the results of Cox analysis, ANC were the only indicators relative with both PFS (HR=1.095, 95% CI 1.030-1.163, P=0.003) and OS (HR=1.057, 95% CI 1.003-1.113, P=0.037). In the ANC＞4.32 group, ORR was relative lower (8.1% vs 26.5%, P=0.057) but with no significance; The PFS and OS was relative shorter (median PFS 5.0 [95% CI 4.4-9.6] vs 7.0 [95% CI 4.4-5.7], P=0.024; median OS 7.3 [95% CI 4.7-10.0] vs 17.6 [95% CI 12.3-22.9], P＜0.001) (Fig 1&2). ANC had relatively high discriminatory ability to predict 10-month mortality with the AUC of 0.729.Conclusion: Patients with lower level of ANC might be the beneficiary of anlotinib.