Evaluation of the efficacy of pembrolizumab in patients with metastatic cervical cancer depending on the value of the neutrophil-lymphocyte index

Background: Cervical cancer (CC) remains one of the most pressing problems in oncology, especially in developing countries. Despite advances in treatment, survival rates for metastatic and recurrent forms of the disease remain unsatisfactory. The introduction of immunotherapy, in particular pembrolizumab, has opened up new opportunities, but the effectiveness of therapy varies among patients. In this regard, it is important to study biomarkers such as the neutrophil-lymphocyte index (NLI) to predict the response to treatment.

Objective: Evaluation of the prognostic role of the NLI in patients with metastatic cervical cancer treated with pembrolizumab and determination of its threshold value for patient stratification and optimization of treatment tactics.

Materials and methods: A retrospective study involving 80 patients with metastatic or recurrent cervical cancer and positive PD-L1 expression (CPS ≥1) was conducted. The NLI was calculated based on clinical blood test data before the start of therapy. Statistical methods were used, including the χ² criterion for qualitative variables and the Kaplan-Meier method for survival analysis.

Results: The results showed that in 57.5% of patients, the NLI exceeded 4.0, indicating the presence of systemic inflammation. A significant relationship was established between the NLI value and treatment efficacy: with NLI ≥4, the risk of progression was 80.4% versus 50% in the group with NLI <2 (p=0.038). The median progression-free survival in patients with NLI <4 was significantly higher (12.1 months versus 6.8 months with NLI ≥4; p=0.003).

Conclusion: NLI is a simple and accessible prognostic marker of response to immunotherapy in metastatic cervical cancer. The threshold NLI value (4.0) can be used to stratify patients and select the optimal treatment strategy. It is recommended to include NLI determination in the standard examination before prescribing immunotherapy and consider a more aggressive approach in patients with an increased NLI.