External validation of the novel prognostic Meet-URO score in Metastatic Renal Cell Carcinoma on First Line Immune-combination therapy.

Ghose A.; Signori A.; Brown N.; Haywood S.; Tapia J.; Vijay A.; Cheung M.; Mahajan I.; Fiala O.; Abrol R.; Chauhan V.; Soe Y.S.Y.; Zargham A.; Ashley S.; Smith M.; Hardy O.; Johnston E.; Sarwer A.; Tun K.K.; Challapalli A.; Shrestha R.; Urun Y.; Meegan J.; Rescigno P.; Parkes J.; Smalley B.; Anpalakhan S.; Buono F.; Poprach A.; Teoh J.Y.C.; Murianni V.; Catalano F.; Bimbatti D.; Buti S.; Fornarini G.; Banna G.; Rebuzzi S.E.

External validation of the novel prognostic Meet-URO score in Metastatic Renal Cell Carcinoma on First Line Immune-combination therapy.

All Authors

Ghose A.

Signori A.

Brown N.

Haywood S.

Tapia J.

Vijay A.

Cheung M.

Mahajan I.

Fiala O.

Abrol R.

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LTHT Author

Buono, Francesco

LTHT Department

Leeds Cancer Centre
Oncology

Publication Date

2024

Item Type

Conference Abstract

Subject

CARCINOMA , KIDNEY NEOPLASMS , NEPHRECTOMY , ANTINEOPLASTIC COMBINED CHEMOTHERAPY PROTOCOLS , NEOPLASM METASTASIS , DRUG THERAPY, COMBINATION

Abstract

Objective: First-line immune-combination therapy based on immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) are the new mainstay in metastatic renal cell cancer (mRCC). In this setting, there is a dearth of standard prognostic/predictive parameters to guide treatment choice. The novel prognostic Meet-URO score (IMDC score + bone metastases and neutrophil-to-lymphocyte ratio - NLR) showed a higher prognostic accuracy than IMDC in 306 patients on first-line nivolumab + ipilimumab in the Italian Expanded Access Program (PMID: 36493602). Hence, the necessity to externally validate and expand to other first-line immune-combination settings. Method(s): Twenty-seven European centres were included. Baseline patient and tumour characteristics were collected, including the IMDC score along with the presence of pre-treatment bone metastases, neutrophils, and lymphocytes for calculating the Meet-URO score. The prognostic performance of Meet-URO and IMDC scores were compared and defined by the Harrell's c-index. Result(s): 1174 mRCC patient data was retrospectively collected. The median age was 64. 72.8% were male, 54.2% received nephrectomy, 62% were metastatic at diagnosis and 86.7% had clear-cell histology. 35% had bone metastases and 51.6% had NLR >= 3.2. 672 (57.2%) patients received ICI-ICI (nivolumab + ipilimumab) whereas 502 (42.8%) an ICI-TKI combination, mainly avelumab + axitinib (27.1%) and pembrolizumab + lenvatinib (14.3%). Overall, median overall survival (mOS) was 36.2 months (95% CI 31.1 - 38.5) with a median follow up of 15.5 months. The c-index of Meet-URO resulted higher than IMDC score (0.68 vs 0.65). In particular, the mOS resulted more distinctive within the Meet-URO prognostic groups: 45.8 months for group 1 (12.9% of patients), 55.0 for group 2 (25.7%), 38.1 for group 3 (23.5%), 20.9 months for group 4 (29.6%) and 10.4 for group 5 (8.2%). On the other hand, mOS was 45.8 months for IMDC favorable-risk (19.5% of patients), 38.2 for intermediate-risk (53.7%) and 16.2 for poor-risk (26.8%). Conclusion(s): In this large-scale real-world external validation analysis on mRCC patients receiving first-line immune-combinations, Meet-URO confirmed higher prognostic accuracy compared to IMDC. A further validation is planned in the ongoing Italian prospective Meet-URO 33 (REGAL) study (PMID: 38914928).