The Pan-Immune-Inflammation Value Predicts the Survival of Patients with ER-positive, HER-2-Negative Metastatic Breast Cancer Treated with CDK4/6 inhibitors

Aim: To define the prognostic value of pan immune-inflammation
value (PIV) in patients with estrogen receptor (ER) positive, Human
epidermal growth factor receptor-2 (HER-2) negative metastatic breast
cancer receiving cyclin-dependent kinase 4/6 (CDK4/6) inhibitors.
Material and Method: The present study enrolled patients diagnosed
with HR-positive, HER-2 negative metastatic breast cancer who were
treated with novel CDK4/6 inhibitors palbociclib or ribociclib at
Suleyman Demirel University Hospital, Turkey, and Antalya Hospital of
Health Sciences University, Turkey from 2015 to 2020. The cut-off value
of c-reactive protein albumin ratio (CRP/alb), neutrophil lymphocyte
ratio (N/L), lymphocyte monocyte ratio( L/M), platelet lymphocyte
ratio (Plt/L), systemic immune-inflammation index (SII), and PIV is
determined by using the receiver operating characteristic (ROC)
analysis. Progression-free survival (PFS) comparisons of palbociclib and
ribociclib treatments, and CRP/alb, N/L, SII, and PIV were performed
using Kaplan-Meier curves and median survival times. PIV was
calculated as neutrophil x platelet x monocyte /lymphocyte count
(10⁹/L).
Results: Ninety-one patients were included in this study. The patients’
mean age was 58.4±11.7 years. At a median follow-up of 48 months,
11% (10) of patients died. 53.8% (49) of patients had the metastatic
disease when they were diagnosed. 87.9% (80) were postmenopausal,
and 39.6% (36) received ribociclib, 60.4% (55) palbociclib. The cutoff
value of PIV is calculated as 476.5 using the receiver operating
characteristic (ROC) analysis. The Cox regression analysis for PFS
showed that PIV (HR:4.68; p=0.022) and drugs combined with CDK4/6
(HR:4.68; p=0.022) were the only independent prognostic markers
for PFS. Median progression-free difference was not significantly
significant between ribociclib and palbociclib groups (27.9 vs 25.5
months respectively; %95 CI, 25.9-29; p=0.654).
Conclusions: PIV is a simple and inexpensive, easily calculated marker
to predict the survival of patients with ER-positive, HER-2-negative
metastatic breast cancer. This technique can assist physicians in putting
tailored and focused treatment plans in place. Between ribociclib and
palbociclib, there is no statistically significant difference in PFS.