Abstract 305P
Background
Immune checkpoint inhibitors (ICIs) have expanded their indications to various carcinomas and are contributing to the improvement of prognosis. On the other hand, treatment interruptions and deaths due to immune-mediated adverse events (irAEs), sometimes severe, have been reported. In recent years, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been reported as predictive factors for the onset of irAE, but few are limited to carcinoma or ICI. In this study, we investigated the significance of NLR and PLR as predictors of irAE development following nivolumab monotherapy for metastatic renal cell carcinoma (mRCC).
Methods
We retrospectively investigated 83 patients diagnosed with mRCC who received nivolumab monotherapy from the second line onwards at Nara Medical University and its related facilities. We assessed the association of NLR and PLR at the start of nivolumab monotherapy with all-grade irAEs (all-grade irAEs) and grade ≥3 irAEs (G3≥ irAEs).
Results
Of the 83 patients, 33 (39.7%) had all-grade irAEs and 12 (14.5%) had G3 ≥ irAEs.The breakdown of all grade irAEs was interstitial pneumonia (IP) in 8 cases and skin disorder in 7 cases. G3 ≥ irAEs included 4 cases of IP, 3 cases of adrenal insufficiency, 2 cases of type 1 diabetes, and 1 case each of myocarditis, myasthenia gravis, and cholangitis. We compared the background factors of 50 who did not develop all-grade irAEs and 33 who did, and 71 who did not and 12 who did develop G3 ≥ irAEs.There were no differences in age, gender, number of prior lines of therapy, presence or absence of primary tumor resection, CRP, Alb, IMDC risk classification, primary tumor pathology, metastatic sites, and number of metastatic sites. PLR was higher in the all-grade irAE group than in the non-aggressive group (P = 0.012). Both NLR and PLR were higher in the G3 ≥ irAE group than the non-aggressive group (P = 0.016, 0.0025, respectively).
Conclusions
NLR and PLR values at the start of nivolumab monotherapy in mRCC may help prevent G3 ≥ irAE.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Department of Urology, Nara Medical University.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.