Presentation Authors: Yukari Bando*, Mariko Sakamoto, Yasuyoshi Okamura, Kotaro Suzuki, Takuto Hara, Tomoaki Terakawa, Junya Furukawa, Kenichi Harada, Nobuyuki Hinata, Yuzo Nakano, Masato Fujisawa, Kobe, Japan
Introduction: Nivolumab, a programmed cell death protein-1 (PD-1) antibody, is one of the most effective therapeutic agents for advanced renal cell carcinoma (RCC). Biomarkers predicting response to this treatment are needed to better select patients most likely to benefit. Neutrophil-to-lymphocyte ratio (NLR) is a prognostic and predictive biomarker in various malignancies. We sought to identify predictive markers of nivolumab response in patients with advanced RCC, including NLR.
Methods: A retrospective review was performed for 109 consecutive patients with metastatic or unresectable RCC treated with nivolumab from December 2016 to September 2018 at our institution and seven related institutions. Landmark analysis was conducted to explore the prognostic value of NLR at baseline on overall survival. Cox and logistic regression models allowed for adjustment of age, platelet count, IMDC risk classification, experience of cytoreductive nephrectomy, histological type, number of prior therapies, NLR at baseline, and the occurrence of immune-related adverse events (irAE).
Results: IMDC risk groups were: 15.6% favorable, 56.9% intermediate, and 27.5% poor risk. The treatment line of nivolumab was 2nd in 44, 3rd in 34, and 4th line or later in 31 patients. The best response to nivolumab was as follows: complete response in 4 patients (4.1%), partial response in 25 patients (26.0%), stable disease in 35 patients (36.5%), and progression disease in 32 patients (33.3%). Median overall survival (OS) after nivolumab was not reached, median progression-free survival was 8 months, and median time to treatment failure was 6 months. Regarding irAE, 51 symptoms were observed in 31 patients. NLR at baseline (NLR>3.3) was found to be related to OS with nivolumab, whereas there were no significant relationships with age, platelet count, IMDC risk classification, experience of cytoreductive nephrectomy, histological type, number of prior therapies, and the occurrence of irAE.
Conclusions: NLR at baseline was associated with OS with nivolumab in Asian patients with metastatic RCC treated with nivolumab.