Predictive Impact of Prognostic Nutritional Index on Pembrolizumab for Metastatic Urothelial Carcinoma Resistant to Platinum-based Chemotherapy

Abstract

Background/Aim: We investigated the prognostic nutritional index (PNI), comprised of lymphocytes and albumin, as a potential prognosticator of metastatic urothelial carcinoma (mUC) patients receiving pembrolizumab. Patients and Methods: Sixty-five patients were retrospectively enrolled and classified as low (<40) and high (≥40) based on pretreatment PNI. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated. Results: In the low PNI group, significantly shorter PFS and OS were observed. PNI was shown to be an independent predictor of PFS and OS in the multivariate analysis. C-index for both PFS and OS improved with the addition of PNI to the model described in the KEYNOTE-045 study. Significantly more patients experienced initial disease progression in the low PNI group. Conclusion: PNI is a useful predictor of prognosis and disease progression in mUC patients receiving pembrolizumab. Patients and MethodsPatients. This retrospective observational study recruited 67 consecutive patients with mUC or relapsed urothelial carcinoma receiving pembrolizumab after the failure of at least one platinum-1607

Pretreatment clinical and hematologic prognostic factors of metastatic urothelial carcinoma treated with pembrolizumab: a systematic review and meta-analysis

“…In addition to high pretreatment level of NLR and CRP, percentage changes in these levels after initiation of pembrolizumab treatment were also significantly associated with OS in one study each [ 42 , 46 ]. UTUC [ 40 ] and smoking history/exposure [ 37 , 43 ] as pretreatment patients’ characteristics were significantly associated with OS. As for systemic nutritional condition, Geriatric Nutritional Risk Index [ 35 ]: a nutritional assessment tool defined by serum albumin levels and the ratio of actual to ideal body weight, Prognostic Nutritional Index[ 40 ]: a prognostic model comprising serum lymphocyte counts and albumin, and sarcopenia[ 45 ] were all significantly associated with OS.…”

“…After screening the titles and abstracts, a full-text review was performed for 42 articles. Finally, we identified 13 studies comprising 1311 patients treated with pembrolizumab for cisplatin-refractory metastatic UCs according to our inclusion criteria [35][36][37][38][39][40][41][42][43][44][45][46][47]. The characteristics of included patients and the outcomes are shown in Table 1.…”

Clinical Impact of Prognostic Nutrition Index for Advanced Gastric Cancer Patients with Peritoneal Metastases Treated Nivolumab Monotherapy

“… 11 Thus, there is increasing evidence that the PNI can be an effective prognostic marker, as well as a predictive indicator related to ICIs for various solid tumors. 12 13 14 Accordingly, this study investigated the clinical significance of the PNI for predicting the therapeutic effects of AGC patients with peritoneal metastases treated nivolumab monotherapy.…”

Impact of C-reactive Protein Flare Response in Patients With Advanced Urothelial Carcinoma Who Received Pembrolizumab

“…Furthermore, favorable ORR, PFS, and OS were observed in patients who had a CRP flare response. Recently, various biomarkers including blood cell count markers (11) or nutritional status-based markers such as prognostic nutritional index (12) were reported in pembrolizumab therapy for patients with advanced UC. Several studies on UC have reported that elevated CRP levels before surgery (13), chemotherapy (14,15), or ICIs treatment (3,7,8) were associated with poor prognosis.…”