Novel Risk Scoring System for Patients with Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors.

• Type of Material: Article
• Authors: Dylan J. Martini, Emory University; Yuan Liu, Emory University; Julie M. Shabto, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.; Bradley Carthon, Emory University; Emilie Hitron, Emory University; Greta Russler, Emory University; Sarah Caulfield, Emory University; Haydn Kissick, Emory University; Wayne Harris, Emory University; Omer Kucuk, Emory University; Viraj Master, Emory University; Mehmet Bilen, Emory University
• Language: English
• Date: 2020-03
• Publisher: AlphaMed Press & Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. The Oncologist published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1634/theoncologist.2019-0578
• Title of Journal or Parent Work: The Oncologist
• Volume: 25
• Issue: 3
• Start Page: e484
• End Page: e491
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of the Winship Cancer Institute of Emory University and NIH/National Cancer Institute under award number P30CA138292.
• Keywords: Body composition; Risk scoring system; Inflammation; Immunotherapy; Prognostic markers; Renal cell carcinoma
• Research Categories: Health Sciences, Oncology; Biology, Biostatistics; Health Sciences, Immunology; Biology, Bioinformatics

Abstract

BACKGROUND: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria are the gold standard for risk-stratifying patients with metastatic renal cell cancer (mRCC). We developed a novel risk scoring system for patients with mRCC treated with immune checkpoint inhibitors (ICIs). METHODS: We performed a retrospective analysis of 100 ICI-treated patients with mRCC at Winship Cancer Institute from 2015 to 2018. Several baseline variables were collected, including markers of inflammation, body mass index (BMI), and sites of metastatic disease, and all were considered for inclusion in our risk scoring system. Upon variable selection in multivariable model, monocyte-to-lymphocyte ratio (MLR), BMI, and number and sites of metastases at baseline were used for risk score calculation. Patients were categorized using four-level risk groups as good (risk score = 0), intermediate (risk score = 1), poor (risk score = 2), or very poor (risk score = 3-4). Cox's proportional hazard model and the Kaplan-Meier method were implemented for survival outcomes. RESULTS: Most patients were male (66%) with clear cell renal cell carcinoma (72%). The majority (71%) received anti-programmed cell death protein-1 monotherapy. Our risk scoring criteria had higher Uno's concordance statistics than IMDC in predicting overall survival (OS; 0.71 vs. 0.57) and progression-free survival (0.61 vs. 0.58). Setting good risk (MLR <0.93, BMI ≥24, and D_Met = 0) as the reference, the OS hazard ratios were 29.5 (95% confidence interval [CI], 3.64-238.9), 6.58 (95% CI, 0.84-51.68), and 3.75 (95% CI, 0.49-28.57) for very poor, poor, and intermediate risk groups, respectively. CONCLUSION: Risk scoring using MLR, BMI, and number and sites of metastases may be an effective way to predict survival in patients with mRCC receiving ICI. These results should be validated in a larger, prospective study. IMPLICATIONS FOR PRACTICE: A risk scoring system was created for patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitors. The results of this study have significant implications for practicing oncologists in the community and academic setting. Importantly, these results identify readily available risk factors that can be used clinically to risk-stratify patients with metastatic renal cell carcinoma who are treated with immune checkpoint inhibitors.