Association of Systemic Inflammation Index and Body Mass Index with Survival in Patients with Renal Cell Cancer Treated with Nivolumab

Abstract

Purpose: Inflammation indexes and body mass index (BMI) are easily evaluated, predict survival, and are potentially modifiable. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of patients with renal cell carcinoma (RCC) undergoing immune checkpoint inhibitor therapy.Experimental Design: A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil-to-lymphocyte ratio (NLR) </! 3, systemic immune inflammation index (SII) </! 1,375, and platelet-tolymphocyte ratio (PLR) </! 232. Patients were classified as high BMI (!25 kg/m 2 ) versus normal BMI (<25 kg/m 2 ).Results: Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), with 105 (33.69%) !70 years. In univariate analysis, age, performance status, BMI, SII, NLR, and PLR were able to predict outcome. In multivariate analyses, SII !1,375, BMI <25 kg/m 2 , and age !70 years independently predicted overall survival [OS; HR ¼ 2.96, 95% confidence interval (CI), 2.05-4.27; HR ¼ 1.59, 95% CI, 1.10-2.30; and HR ¼ 1.65, 95% CI, 1.07-2.55, respectively). A patient with both SII !1,375 and BMI <25 kg/m 2 was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95; P <0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P <0.0001).Conclusions: Normal BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with RCC treated with nivolumab.Four groups of SII changes: (i) low-low (baseline SII < 1,375 and follow-up SII < 1,375); (ii) low-high (baseline SII < 1,375 and follow-up SII ! 1,375); (iii) high-low (baseline SII ! 1,375 and follow-up SII < 1,375); and (iv) high-high (baseline SII ! 1,375 and follow-up SII ! 1,375).De Giorgi et al.

Retrospective Efficacy Analysis of Immune Checkpoint Inhibitor Rechallenge in Patients with Non-Small Cell Lung Cancer

“…BMI is widely used for relating weight to height, defining body size, and indicating nutritional status. In addition, a lower BMI is associated with increased mortality risk [21][22][23][24]. Our previous clinical study demonstrated that NSCLC patients with sarcopenia exhibit a significantly shorter median PFS following ICI treatment compared to that of non-sarcopenia patients [25].…”

Systemic immune‐inflammation index, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio can predict clinical outcomes in patients with metastatic non‐small‐cell lung cancer treated with nivolumab

“…Systemic immune‐inflammation index (SII) is a novel inflammatory marker which combines NLR and platelet is an independent risk factor for the development of solid cancer . Higher SII was independently associated with worse outcomes for metastatic renal cell carcinoma (RCC) patients treated with nivolumab . However, rare studies reported whether SII is associated with the prognosis of NSCLC patients treated with ICIs.…”

Improved prognosis for elderly patients with metastatic renal cell carcinoma in the era of targeted therapy

“…It is thus expected that the continuing increase of therapeutic options (including ICIs as well as targeted agents) will lead to further improvement in the prognosis for patients with mRCC in the coming years. At the same time, we expect that a more personalized therapeutic strategy will be established for older patients that is based on key molecules identified through gene sequencing in addition to conventional predictive factors for prognosis and agent efficacy (22,23) as older patients tend to have more comorbidities than younger ones.…”