Practice Update: Oncology

ESMO 2017 21

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. S ystemic immune-inflammation was found to be amore powerful predictive system than the other inflammatory In the future, we will assess the capacity of changes in

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 management of these patients. When further validated, these useful and cheap biomarkers will be applied easily in clinical practice. these biomarkers during nivolumab treatment to further improve the clinical

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

easily in clinical practice.” www.practiceupdate.com/c/58038

© ESMO 2017 Congress

VOL. 1 • NO. 3 • 2017