The neutrophil-lymphocyte ratio has a role in predicting the effectiveness of nivolumab in Japanese patients with metastatic renal cell carcinoma: a multi-institutional retrospective study

Abstract

Background: The neutrophil-lymphocyte ratio (NLR) is a well-known prognostic marker in various cancers. However, its role as a predictive marker for the effectiveness of nivolumab in patients with metastatic RCC (mRCC) remains unclear. We evaluated the relationships between the NLR and progression-free survival (PFS) or overall survival (OS) in mRCC patients treated with nivolumab. Methods: The data of 52 mRCC patients who received nivolumab therapy were collected from seven institutes and evaluated. The median follow-up period from treatment with nivolumab was 25.2 months (IQR 15.5-33.2). Results: The median duration of nivolumab therapy was 7.1 months (IQR 2.9-24.4). The objective response rate was 25% and the 1-and 2-year PFS rates were 46.2 and 25.2%, respectively. The median NLR values at baseline and 4 weeks were 3.7 (IQR 2.7-5.1) and 3.3 (IQR 2.4-5.7), respectively. In the multivariate analysis, an NLR of ≥3 at 4 weeks was an independent predictor of PFS (P = 0.013) and OS (P = 0.034). The 1-year PFS of patients with an NLR of < 3 at 4 weeks was better than that of those with an NLR of ≥3 (75% versus 29%, P = 0.011). The 1-year OS of patients with an NLR of < 3 at 4 weeks was also better than that of those with an NLR of ≥3 (95% versus 71%, P = 0.020). Conclusions: Although the baseline NLR was not associated with PFS or OS, an NLR of ≥3 at 4 weeks after the initiation of therapy might be a robust predictor of poor PFS and OS in mRCC patients undergoing sequential treatment with nivolumab.

Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: the development of a novel prognostic score (Meet-URO 15 study)

“… 14 , 15 Similar studies on inflammatory indices in mRCC treated with nivolumab reported comparable results; however, it should be noted that they are mainly monocentric analysis investigating only one or few indices in a lower number of patients. 4 , 26 – 38 …”

“…In the era of ICIs, inflammatory indices have mostly been studied in advanced melanoma and non-small lung cancer patients, 17 – 21 while fewer and smaller studies have been conducted in patients treated with immunotherapy for genitourinary tumors, 22 – 25 including mRCC. 4 , 26 – 38 …”

“…[12][13][14][15][16] In the era of ICIs, inflammatory indices have mostly been studied in advanced melanoma and non-small lung cancer patients, [17][18][19][20][21] while fewer and smaller studies have been conducted in patients treated with immunotherapy for genitourinary tumors, [22][23][24][25] including mRCC. 4,[26][27][28][29][30][31][32][33][34][35][36][37][38] The Meet-URO 15 is a multicenter, retrospective study investigating the correlation of baseline peripheral blood inflammatory indices with efficacy and activity outcomes in pre-treated mRCC patients receiving nivolumab in clinical practice. This leads to the development of a composite clinical prognostic score.…”

Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker for Patients With Metastatic Renal Cell Carcinoma Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

“…After examining titles and abstracts, 19 studies were identified. A total of seven studies had insufficient data following a full-text review, leaving 12 records included according to the eligibility criteria (Figure 1) (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The literature search was performed by two investigators, and any disagreements between them were settled by consensus.…”

“…Currently, although several studies have explored the prognostic value of NLR in patients receiving immunotherapy for RCC (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), it is still difficult to verify the prognostic role of NLR in patients with RCC treated with ICIs. Certain studies have suggested that the NLR is not associated with the prognosis of patients with RCC treated with immunotherapy (21,26). Additionally, some of the published studies had a small sample size (17,18,28).…”