The Pan-Immune-Inflammation-Value Predicts the Survival of Patients with Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Advanced Breast Cancer Treated with First-Line Taxane-Trastuzumab-Pertuzumab

Francesca Ligorio, Giovanni Fucà, Emma Zattarin, Riccardo Lobefaro, Luca Zambelli, Rita Leporati, Carmen Rea, Gabriella Mariani, Giulia V Bianchi, Giuseppe Capri, Filippo de Braud, Claudio Vernieri, Francesca Ligorio, Giovanni Fucà, Emma Zattarin, Riccardo Lobefaro, Luca Zambelli, Rita Leporati, Carmen Rea, Gabriella Mariani, Giulia V Bianchi, Giuseppe Capri, Filippo de Braud, Claudio Vernieri

Abstract

Different peripheral blood parameters have emerged as prognostic biomarkers in breast cancer (BC), but their predictive role in Human Epidermal growth factor Receptor 2 positive (HER2+) advanced BC (aBC) patients receiving dual anti-HER2 blockade remains unclear. We evaluated the impact of the Pan-Immune-Inflammatory Value (PIV), defined as the product of peripheral blood neutrophil, platelet, and monocyte counts divided by lymphocyte counts, on the prognosis of HER2+ aBC patients treated with first line trastuzumab-pertuzumab-based biochemotherapy. We also evaluated the association between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the monocyte to lymphocyte ratio (MLR) and clinical outcomes. Cox regression models were used to estimate the impact of these variables, as well as of other clinically relevant covariates, on patient survival. We included 57 HER2+ aBC patients treated with taxane-trastuzumab-pertuzumab in our Institution. High baseline MLR, PLR, and PIV were similarly predictive of worse PFS at univariate analysis, but only high PIV was associated with a trend toward worse PFS at multivariable analysis. Regarding OS, both high PIV and MLR were associated with significantly worse patient survival at univariate analysis, but only the PIV was statistically significantly associated with worse overall survival at multivariable analysis (HR 7.96; 95% CI: 2.18-29.09). Our study reveals the PIV as a new and potent predictor of OS in HER2+ aBC patients treated with first line trastuzumab-pertuzumab-containing biochemotherapy. Prospective studies are needed to validate this new prognostic parameter in HER2+ aBC.

Keywords: HER2-positive breast cancer; MLR; NLR; PIV; PLR; trastuzumab + pertuzumab.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Progression Free Survival according to baseline PIV, PLR, MLR and NLR values. Kaplan–Meier curves representing patient PFS according to baseline PIV (A), PLR (B), MLR (C), and NLR (D) categories. The median value of each parameter was used as a threshold for the definition of the parameter categories (high vs. low). PFS: Progression-free survival; PIV: Pan-Immune -Inflammation Value; MLR: monocyte to lymphocyte ratio; PLR: platelet to lymphocyte ratio. NLR: neutrophil to lymphocyte ratio. The I symbol indicates patients censored at the time of data cut off and analysis.
Figure 2
Figure 2
Overall Survival according to PIV, PLR, MLR, and NLR. Kaplan–Meier curves representing patient OS according to baseline PIV (A), PLR (B), MLR (C) and NLR (D) categories. The median value of each parameter was used as a threshold for the definition of the parameter categories (high vs. low). OS: Overall survival; PIV: Pan-Immune-Inflammation Value; MLR: monocyte to lymphocyte ratio; PLR: platelet to lymphocyte ratio. NLR: neutrophil to lymphocyte ratio. The I symbol indicates patients censored at the time of data cut off and analysis.

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