696P - Is it possible to improve the prognostic ability of the IMDC score? Validation of the Meet-URO score in metastatic renal cell carcinoma (mRCC) patients (pts) receiving first-line nivolumab plus ipilimumab in the Italian Expanded Access Program (EAP)

Background

The combination of neutrophil-to-lymphocyte ratio (NLR), IMDC score and bone metastases ini the Meet-URO score has shown to better stratify mRCC pts receiving ≥2^nd line nivolumab compared with the IMDC score identifying five distinctive prognostic groups [Ther Adv Med Oncol 2021, available at: http://bit.ly/Meet-URO15_score]. This score is an easy tool for clinical practice at no additional costs and its application on first-line immune-combination therapies is highly awaited.

Methods

The real-world series of IMDC intermediate-poor risk mRCC pts receiving first-line nivolumab plus ipilimumab in the Italian EAP was analysed. Baseline NLR, IMDC score and the presence of bone metastases were assessed. The primary endpoint was overall survival (OS). The Harrell’s c-index was calculated to compare accuracy of Meet-URO and IMDC scores, as the capability of the prognostic score to be predictive of OS.

Results

306 mRCC pts were analysed with mOS not reached, OS at 1 year (1y-OS) of 66.8% and median progression-free survival (mPFS) of 8.4 months (mo). Median follow-up was 12.7 mo. According to the IMDC score, intermediate (67.3%) and poor-risk (32.7%) pts had an 1y-OS of 77.3% and 42.2% (p<0.001) and a mPFS of 10.4 and 3.3 mo (p<0.001), respectively. Applying the Meet-URO score to the population, two prognostic groups showed overlapping survival curves (probably due to the absence of the favorable-risk group) so that the original five groups of the Meet URO score were merged in four prognostic groups: group 1-2 (29.1%), group 3 (28.8%), group 4 (33.0%) and group 5 (9.1%) characterised by distinctive 1y-OS: 91.6%, 71.8%, 50% and 21.2%, respectively (p < 0.001). These groups had also distinctive mPFS: 16.6, 7.5, 4.9 and 1.8 mo respectively (p<0.001). The Meet-URO score had a higher discriminative ability compared with the IMDC score alone (c-index of 0.72 vs 0.65) in terms of OS.

Conclusions

This analysis showed the prognostic role of the Meet-URO score also in mRCC pts treated with first-line immune-combination and its higher accuracy in survival stratification compared with the standard IMDC score.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.