Treatment at relapse for synovial sarcoma of children and adolescents: A multi-institutional European retrospective analysis

PURPOSE

Though the prognosis for pediatric patients with localised synovial sarcoma (SS) is generally good, the chances of being cured after relapse are limited. This study describes a retrospective multi-institutional series of relapsing SS patients treated at six selected European referral centers for pediatric sarcoma.

PATIENTS AND METHODS

The study included 41 patients <21 years with relapsing SS, treated between 2002 and 2022. The analysis included patient's characteristics at first diagnosis, first-line treatments, clinical findings at relapse, and second-line treatment modalities.

RESULTS

The first relapse occurred within 3-132 months (median 18 months) after first diagnosis and was local in 34%, metastatic in 54%, and both in 12%. Treatment at first relapse included surgery in 56% of cases, radiotherapy in 34%, and systemic therapy in 88%. In all, 36 patients received second-line medical treatment, that was chemotherapy in 32 cases (with 10 different regimens) and targeted therapy in four. No patient was included in an early-phase clinical trial as second-line therapy-line therapy. Overall response rate was 42%. Median event-free survival (EFS) was 12 months, postrelapse 5-year EFS was 15.8%. Median overall survival (OS) was 30 months, postrelapse 5-year OS was 22.2%. At the Cox's multivariable regression analysis, OS was significantly associated with time and type of relapse.

CONCLUSION

Pediatric patients with relapsed SS have a poor prognosis and generally receive an individualized approach, due to the lack of a uniform standardized approach. New comprehensive strategies are needed to improve the knowledge on the biologic landscape of SS and develop tailored prospective clinical trials.

Role of neutrophil-to-lymphocyte, platelet-to-lymphocyte and myelocite-to-lymphocyte ratio as prognostic markers for immunotherapy response in patients with advanced solid tumors, a retrospective analysis from a single institution

e14529

Background: PD-L1 is the only biomarker that has been accepted to identify patients who could potentially benefit from immune checkpoint inhibitors (ICIs) administration, but also PD-L1 negative tumors respond to immunotherapy. However, other biomarkers have been proposed but they are too expensive and actually, there is not a consensus for detection and analytical methods. Thus, there is an urgent need for inexpensive and reproducible tests to better optimize the clinical use of ICIs. Recent findings suggest that host parameters may help to select patients to treat with ICIs: performance status (PS) and some laboratory parameters, such as lactate dehydrogenase (LDH) and blood cells count. Inflammation and inflammatory response have been considered surrogate biomarkers of host immunity. An elevated neutrophil-to-lymphocyte (NLR), myeloid-to-lymphocyte (MLR) and platelet-to-lymphocyte (PLR) ratio have been associated with systemic inflammation and some evidences suggest that these biomarkers could play a role as prognostic factors. Methods: We performed a retrospective analysis of 250 patients treated with ICIs at our institution. The associations between basal NLR, MLR and PLR, clinicopathological features and their impact on progression free survival (PFS), overall survival (OS) and toxicities were assessed. Results: From May 2015 to January 2022, 250 patients were screened, of whom 66 were excluded from the analysis. A total of 184 patients (64.7% men), with a median age of 68 years (37-90) a PS 0 (52.2%), 1 (39.7%) and 2 (8.1%), were enrolled. The primary tumor origin was lung (93 adenocarcinoma, 19 squamous, 14 small cell lung cancer), urothelial (33), melanoma (4) and renal (21). Nivolumab was used in 103 patients, Pembrolizumab in 67 and atezolizumab in 18. At 24 months median follow up there were 131 progression diseases and 122 deaths. Overall, the median value of NLR, PLR and MLR was 3.15 (1-41), 168 (4-797) and 3.5 (0-245), respectively. Lower values of NLR and PLR were associated with a better median PFS (HR for NLR 1.7, 95% CI 1.2-2.4, p = 0.002; HR for PLR 2.2, 95% CI, 1.6 - 3.2, p < 0.0001) and OS (HR for NLR 1.5, 95%CI 1.1-2.2, p = 0.017; HR for PLR 1.9, 95%CI 1.3-2.7 p < 0.0001). MLR was not statistically significant. According to primary tumor origin, renal cancer reported a value significantly under the median of NLR and PLR (p = 0.015 and p = 0.021 respectively). Toxicity and clinico-pathological factors showed a significant association between female sex and both severe fatigue (p = 0.002) and pain (p = 0.018). Pain was also related to younger age (p = 0.009) and to a PS ≥2 (p = 0.003). Conclusions: Our study shows that NLR and PLR represent inexpensive, reproducible and reliable markers that may help identifying patients who can have a greater benefit from immunotherapy.