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Martini DJ, Liu Y, Shabto JM, Carthon BC, Hitron EE, Russler GA, Caulfield S, Kissick HT, Harris WB, Kucuk O, Master VA, Bilen MA. Novel Risk Scoring System for Patients with Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors. Oncologist 2020; 25:e484-e491. [PMID: 32162798 PMCID: PMC7066702 DOI: 10.1634/theoncologist.2019-0578] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria are the gold standard for risk-stratifying patients with metastatic renal cell cancer (mRCC). We developed a novel risk scoring system for patients with mRCC treated with immune checkpoint inhibitors (ICIs). METHODS We performed a retrospective analysis of 100 ICI-treated patients with mRCC at Winship Cancer Institute from 2015 to 2018. Several baseline variables were collected, including markers of inflammation, body mass index (BMI), and sites of metastatic disease, and all were considered for inclusion in our risk scoring system. Upon variable selection in multivariable model, monocyte-to-lymphocyte ratio (MLR), BMI, and number and sites of metastases at baseline were used for risk score calculation. Patients were categorized using four-level risk groups as good (risk score = 0), intermediate (risk score = 1), poor (risk score = 2), or very poor (risk score = 3-4). Cox's proportional hazard model and the Kaplan-Meier method were implemented for survival outcomes. RESULTS Most patients were male (66%) with clear cell renal cell carcinoma (72%). The majority (71%) received anti-programmed cell death protein-1 monotherapy. Our risk scoring criteria had higher Uno's concordance statistics than IMDC in predicting overall survival (OS; 0.71 vs. 0.57) and progression-free survival (0.61 vs. 0.58). Setting good risk (MLR <0.93, BMI ≥24, and D_Met = 0) as the reference, the OS hazard ratios were 29.5 (95% confidence interval [CI], 3.64-238.9), 6.58 (95% CI, 0.84-51.68), and 3.75 (95% CI, 0.49-28.57) for very poor, poor, and intermediate risk groups, respectively. CONCLUSION Risk scoring using MLR, BMI, and number and sites of metastases may be an effective way to predict survival in patients with mRCC receiving ICI. These results should be validated in a larger, prospective study. IMPLICATIONS FOR PRACTICE A risk scoring system was created for patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitors. The results of this study have significant implications for practicing oncologists in the community and academic setting. Importantly, these results identify readily available risk factors that can be used clinically to risk-stratify patients with metastatic renal cell carcinoma who are treated with immune checkpoint inhibitors.
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Affiliation(s)
- Dylan J. Martini
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory UniversityAtlantaGeorgiaUSA
| | - Julie M. Shabto
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Emilie Elise Hitron
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Greta Anne Russler
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
- Department of Pharmaceutical Services, Emory University School of MedicineAtlantaGeorgiaUSA
| | - Haydn T. Kissick
- Department of Urology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Wayne B. Harris
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Viraj A. Master
- Department of Urology, Emory University School of MedicineAtlantaGeorgiaUSA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
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Shabto JM, Martini DJ, Liu Y, Ravindranathan D, Brown J, Hitron EE, Russler GA, Caulfield S, Kissick H, Alemozaffar M, Ogan K, Harris WB, Master VA, Kucuk O, Carthon BC, Bilen MA. Novel risk group stratification for metastatic urothelial cancer patients treated with immune checkpoint inhibitors. Cancer Med 2020; 9:2752-2760. [PMID: 32100417 PMCID: PMC7163104 DOI: 10.1002/cam4.2932] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We developed a novel risk scoring system for urothelial cancer (UC) patients receiving immune checkpoint inhibitors (ICI). METHODS We conducted a retrospective review of 67 UC patients treated with ICI at Winship Cancer Institute of Emory University from 2015 to 2018. Using stepwise variable selection in Cox proportional hazard model and Sullivan's weighting schema, baseline platelet-to-lymphocyte ratio (PLR), presence of liver metastasis, baseline albumin, and baseline Eastern Cooperative Oncology Group performance status (ECOG PS) were used for risk scoring. Patients were categorized into good risk (risk score 0-1), intermediate risk (risk score 2-3), and poor risk (risk score 4-6). Univariable (UVA) and multivariable analysis (MVA) and Kaplan-Meier method were used to assess overall survival (OS) and progression free survival (PFS). RESULTS The Emory Risk Scoring System had C-statistics of 0.74 (Standard Error = 0.047) in predicting OS and 0.70 (Standard Error = 0.043) in predicting PFS. Compared to good risk patients, poor risk patients had significantly shorter OS and PFS in both UVA and MVA (all P < .001), and intermediate risk patients had significantly shorter OS and PFS in both UVA and MVA (all P < .03). CONCLUSIONS Risk scoring using baseline PLR, presence of liver metastasis, baseline albumin, and baseline ECOG PS may effectively predict OS and PFS in UC patients receiving ICI.
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Affiliation(s)
- Julie M Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Deepak Ravindranathan
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jacqueline Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Emilie E Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Greta A Russler
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Haydn Kissick
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehrdad Alemozaffar
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Ogan
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
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