Background: High (NLR) has been associated with inferior (OS) in patients (pts) with advanced stage NSCLC. Case series suggest potentially improved benefits of cytotoxic chemotherapy administration post immuno. but little is known about NLR associations with outcomes in patients receiving salvage ramucirumab plus docetaxel (RD). We evaluated the potential predictive value of NLR and timing of PD1 inhibition with PFS and OS in pts with metastatic NSCLC treated with RD. Methods: Retrospective analysis pts with metastatic NSCLC who received at least one treatment with RD regimen between April 2015 and May 2017. Associations between NLR and both PFS and OS were assessed using Mann-Whitney-Wilcoxon tests. Cutoffs of NLR of 5.0 (based on published data) were analyzed for differences in median OS and PFS. Results: 62 pts were analyzed: 47% were male, 85% former/current smoker, 76% Caucasian. 47 of these also received immuno. during their treatment course, 66% prior to RD regimen whereas 34% received immuno. after RD. Pts who received immune. had significantly superior OS than those who did not receive immuno. (median not reached vs 7.43 mos, p = 0.03) within one-year follow-up. Whether pts received RD followed by immuno. or immuno. followed by RD there were no significant survival differences from start of treatment. For entire cohort, baseline NLR ≤ 5 was associated with superior survival (median OS 20.86 mos for NLR ≤ 5 vs 5.78 mos for NLR > 5, p = 0.01) and superior PFS (median PFS 6.01 mos for NLR ≤ 5 vs 2.76 mos for NLR > 5, p = 0.03). Albumin at baseline (HR = 0.44, p = 0.01) and 6 weeks was significantly associated with OS(HR = 0.38, (p = 0.01) on RD. Conclusions: Low NLRs and higher albumins at baseline & 6 wks were associated with a prolonged PFS and OS in advanced NSCLC pts treated with RD. In this small retrospective study, pts who did not receive immune. had shorter OS. Comparison of the sequence of RD and immune showed no significant PFS or OS difference. Additional data are needed to evaluate the potential impact of treatment sequence.