Retrospective study of prognostic value of baseline inflammatory biomarkers in Lu-177 PSMA-617 treated mCRPC

A retrospective study at Emory Winship Cancer Institute (Atlanta, GA) evaluated baseline inflammatory biomarkers prognostic of clinical outcomes for patients with metastatic castration-resistant prostate cancer (mCRPC) treated with ¹⁷⁷Lu-PSMA-617. Baseline inflammatory markers included neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune-inflamation value (PIV), and hemoglobin-to-platelet ratio (HPR). In a cohort of 163 patients, elevated NLR (HR 2.7; p=0.002), elevated PLR (HR 2.08; p=0.015), elevated PIV (HR 2,86; p=0.002), elevated SII (HR 2.5; p=0.003) and reduced HPR (HR 0.43; p=0.011) were independent prognostic biomarkers of shortened overall survival, whereas higher NLR, PLR, and SII values were independently prognostic of shortened progression-free survival. Patients with elevated HPR and hemoglobin had higher odds of PSA50 response. A biomarker composite score stratified overall survival with good discrimination (C-index= 0.732), demonstrating a reduction in mortality risk from the high-tercile group to intermediate-tercile (HR 0.40; p=0.022) and low-tercile (HR 0.16; p<0.001). The authors conclude that baseline inflammatory markers are associated with clinical outcomes of mCRPC patients treated with ¹⁷⁷Lu-PSMA-617.