Practice Update: Oncology

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Systemic Immune-Inflammation Index, Neutrophil-
Lymphocyte Ratio, and Platelet-Lymphocyte Ratio are Robust
Predictors of Outcome of Nivolumab Therapy for Metastatic
Renal Cell Carcinoma
Systemic immune-inflammation index, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio have been found to
be robust predictors of outcome of nivolumab therapy for metastatic renal cell carcinoma.
Systemic immune-inflammation was
found to be amore powerful predictive
system than the other inflammatory
indexes.
This outcome of a verification of the prog-
nostic impact of inflammatory indexes
based on baseline values of neutrophils,
lymphocytes, and/or platelets in patients
with metastatic renal cell carcinoma treated
with nivolumab was reported at the Euro-
pean Society for Medical Oncology (ESMO)
2017 Congress, from September 8–12.
Ugo De Giorgi, MD, PhD, of the Istituto
Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST), Istituto di Ricovero e
Cura a Carattere Scientifico, Meldola, Italy,
explained that biomarkers of outcome after
immune-checkpoint blockade are needed
in advanced renal cell carcinoma.
Dr. De Giorgi and colleagues set out to
verify the prognostic impact of inflamma-
tory indexes based on baseline values and
neutrophils, lymphocytes, and/or platelets
in patients with advanced clear-cell renal
cell carcinoma.
“We wanted to evaluate the impact of
inflammatory indexes to predict clinical
outcome in patients with renal cell cancer
who are treated with nivolumab,” he said.
Patients who had received at least one
dose of nivolumab 3 mg per kilogram of
body weight every 2 weeks in the Italian
Expanded Access Program after at least
one prior systemic therapy for metastatic
renal cell carcinoma were enrolled.
Pretreatment systemic immune-inflamma-
tion index, defined as platelets x neutrophils/
lymphocytes; neutrophil-to-lymphocyte ratio,
defined as neutrophils/lymphocytes; and
platelet-to-lymphocyte ratio, defined as plate-
lets/lymphocytes, were evaluated to identify
a potential correlation with overall survival.
Overall survival was estimated by the
Kaplan-Meier method and compared
with the log-rank test. The impact of
systemic immune-inflammation index,
neutrophil-lymphocyte ratio, and plate-
let-lymphocyte ratio on overall survival was
evaluated by Cox regression analyses and
on the best overall response rate by binary
logistic regression.
A total of 346 patients with metastatic renal
cell carcinoma treated with nivolumab were
included. Systemic immune-inflammation
≥1375, neutrophil-lymphocyte ratio ≥3, and
platelet-lymphocyte ratio ≥232 were con-
sidered elevated (high-risk groups).
One-year overall survival in the low- and high
systemic immune-inflammation index group
was 77% and 36%, respectively (P < .0001).
One-year overall survival in the low and
high neutrophil-lymphocyte ratio group
was 76% and 58%, respectively (P < .0001).
One-year overall survival in the low and
high platelet-lymphocyte ratio group was
76% and 45%, respectively (P < .0001).
Likewise, best objective response rate
was higher in patients with low systemic
immune-inflammation index (P = .008), low
neutrophil-lymphocyte ratio (P = .06), and
low platelet-lymphocyte ratio (P = .004).
In multivariate analysis adjusted for age,
gender, Memorial Sloan Kettering Cancer
Center risk score, Eastern Cooperative
Oncology Group performance status,
the presence of liver, brain and/or bone
metastases, systemic immune-inflamma-
tion index, neutrophil-lymphocyte ratio,
and platelet-lymphocyte ratio, the model
identified systemic immune-inflammation
index as the strongest factor associated
with overall survival (P < .0001).
Dr. De Giorgi concluded that systemic
immune-inflammation index, neutrophil-
lymphocyte ratio, and platelet-lymphocyte
ratio are robust predictors of outcome
in patients with metastatic renal cell
carcinoma treated with nivolumab.
Systemic immune-inflammation index is
a more powerful predictive system than
the other inflammatory indexes in these
patients.
The results were impressive,” Dr. De Giorgi
said, “inasmuch as they showed a strong
prognostic impact of inflammatory indexes
based on only whole blood counts of neu-
trophils, lymphocytes, and platelets.”
He added, “In the future, we will assess
the capacity of changes in these biomark-
ers during nivolumab treatment to further
improve the clinical management of these
patients. When further validated, these use-
ful and cheap biomarkers will be applied
easily in clinical practice.”
In the future, we will assess
the capacity of changes in
these biomarkers during
nivolumab treatment to
further improve the clinical
management of these patients.
When further validated, these
useful and cheap biomarkers
will be applied easily in
clinical practice.
© ESMO 2017 Congress
ESMO 2017 21
VOL. 1 • NO. 3 • 2017