Evidence mapPaperPMID 40907238Full record

ArticleBreast (Edinburgh, Scotland)2025

Baseline neutrophil-lymphocyte ratio (NLR) predicts toxicity and survival in HR+/HER-2 breast cancer patients treated with CDK4/6 inhibitors.

Omar Badran, Ali Darawshe, Sireen Sharif, Samih Yosef, Gil Bar-Sela

Abstract read
In one paragraph

Article in Breast (Edinburgh, Scotland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Pretreatment neutrophil-to-lymphocyte ratio (NLR) as a potential risk marker for febrile neutropenia (FN) in breast and ovarian cancer during first-cycle chemotherapy.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Article
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Omar BadranDepartment of Oncology, Emek Medical Center, Afula, postal code 1812201, Israel; Technion Integrated Cancer Center, Faculty of Medicine, Technion, Haifa, postal code 3125401, Israel.
Ali DarawsheDepartment of Oncology, Emek Medical Center, Afula, postal code 1812201, Israel.
Sireen SharifResearch Authority, Emek Medical Center, Afula, postal code 1812201, Israel.
Samih YosefDepartment of Oncology, Emek Medical Center, Afula, postal code 1812201, Israel.
Gil Bar-SelaDepartment of Oncology, Emek Medical Center, Afula, postal code 1812201, Israel; Technion Integrated Cancer Center, Faculty of Medicine, Technion, Haifa, postal code 3125401, Israel. Electronic address: gil_ba@clalit.org.il.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been associated with prognosis in various malignancies. Its role in predicting toxicity and survival in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors remains unclear.

methodsThis retrospective cohort study included 2218 patients with HR+/HER2- metastatic breast cancer treated with palbociclib or ribociclib between 2017 and 2024, using data from Israel's largest health maintenance organization. We compared baseline NLR values between patients who developed grade 4 neutropenia (absolute neutrophil count <0.5 × 10

resultsPatients with grade 4 neutropenia had significantly higher baseline NLR values compared to those with higher neutrophil counts. The effect size was large in all comparisons. Patients with an NLR of ≥2.5 had a shorter median progression-free survival (PFS) than those with an NLR of <2.5. Hepatotoxicity was more frequently observed in patients with NLR <2.5, while the incidence of dermatologic adverse events was similar across groups.

conclusionsElevated baseline NLR is associated with an increased risk of severe neutropenia and shorter progression-free survival in patients treated with CDK4/6 inhibitors. These findings highlight a potential link between systemic inflammation and treatment outcomes, suggesting that NLR may be a valuable predictive biomarker in this setting.

Indexed as

Breast NeoplasmsLymphocytesNeutropeniaNeutrophilsProtein Kinase InhibitorsAcrylamidesAdultAgedAminopyridinesCyclin-Dependent Kinase 4Cyclin-Dependent Kinase 6Erb-b2 Receptor Tyrosine KinasesFemaleHumansIsraelLeukocyte CountAcrylamidesAminopyridinesCDK4 protein, humanCDK6 protein, humanCyclin-Dependent Kinase 4Cyclin-Dependent Kinase 6ERBB2 protein, humanErb-b2 Receptor Tyrosine KinasespalbociclibPiperazinesProtein Kinase InhibitorsPurinesPyridinesReceptors, EstrogenReceptors, ProgesteroneribociclibCDK4/6 inhibitorsHematologic toxicityMetastatic breast cancerNeutropeniaNeutrophil-to-lymphocyte ratio (NLR)Progression-free survival

Identifiers

PMID40907238
PMCPMC12446499

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.