Inflammatory biomarkers show high prognostic value in metastatic renal cell carcinoma

The modified Glasgow prognostic score (mGPS), based on C-reactive protein (CRP) and albumin, 2 inflammatory biomarkers found in the blood, demonstrated the ability to predict responses and outcomes in patients with metastatic renal cell carcinoma (mRCC), according to a post hoc analysis published in JAMA Oncology.^1,2

On-treatment mGPS showed superior prognostic information compared with IRC-RECIST, with a C-index of .651 for on-treatment mGPS vs .574 for IRC-RESIST.

For the study, investigators assessed the use of on-treatment mGPS compared with radiologic staging alone based on data from the phase 3 IMmotion151 study (NCT02420821) and the phase 2 IMmotion150 study (NCT01984242). The IMmotion151 discovery cohort included a total of 915 patients, of whom 861 had evaluable baseline mGPS and 691 had evaluable on-treatment mGPS. The IMmotion150 validation cohort consisted of 305 patients, of whom 199 had evaluable on-treatment mGPS.

All patients received atezolizumab (Tecentriq) (plus bevacizumab [Avastin]) or sunitinib (Sutent) for the management of mRCC. Survival analyses were based on overall survival (OS) and progression-free survival (PFS).

Among patients in the IMmotion151 cohort, 17 of 181 (21.0%) patients classified as having high-risk disease at baseline by the mGPS died prior to initial radiologic staging, compared with 4 of 94 (.8%) of patients with low-risk disease and 20 of 286 (7.0%) of those with intermediate-risk disease.

During the on-treatment analysis, mGPS showed significant prognostic information for low- and intermediate-risk subgroups. Among patients with intermediate-risk disease at baseline, 37.4% improved to on-treatment low-risk and experienced a 12-month OS of 92.8%. In comparison, 50.9% of patients remained at intermediate risk and experienced a 12-month OS of 74.7%, and 11.7% deteriorated to high risk and had a 12-month OS of 50.3%.

Further, patients in the intermediate-risk group at baseline who progressed to low-risk disease had a 12-month PFS of 57.3%, compared with a PFS of 13.6% among those who deteriorated to high-risk.

The investigators also compared mGPS with the Response Evaluation Criteria in Solid Tumors (RECIST), assessed by an independent review committee (IRC-RECIST). On-treatment mGPS showed superior prognostic information compared with IRC-RECIST, with a C-index of .651 (95% CI, 0.588-0.714) for on-treatment mGPS vs .574 for IRC-RESIST (95% CI, 0.528-0.619). Further, on-treatment mGPS demonstrated independent prognostic value in predicting outcomes among patients in the disease control group compared with IRC-RECIST (HR, 1.63; 95% CI, .89-3.00; P = .11 for SD vs CR/PR).

In addition, on-treatment mGPS was able to identify a high-risk group (n = 26) of patients among those within the disease control group that had a comparable OS to patients who had progressive disease at initial staging (median OS, 17.1 vs 16.1 months; 12-month OS, 71.6% vs 66.5%).

Findings from the discovery cohort were validated using data from the IMmotion151 study. Investigators also found that on-treatment mGPS allowed for outcome prediction as early as 6 weeks (median 43 days) following the start of therapy.

“Because the first routine staging is usually performed 8 to 12 weeks after the start of therapy, early on-treatment mGPS could open a potential window for early therapy adjustments,” the authors wrote.

References

1. Saal J, Bald T, Eckstein M, et al. Integrating on-treatment modified Glasgow prognostic score and imaging to predict response and outcomes in metastatic renal cell carcinoma. JAMA Oncol. Published online June 22, 2023. Accessed June 28, 2023. doi:10.1001/jamaoncol.2023.1822

2. Study improves prediction of therapy response in patients with metastatic renal cell carcinoma. News release. Universitätsklinikum Bonn. June 22, 2023. Accessed June 28, 2023. https://www.newswise.com/articles/improved-therapy-response-prediction-in-metastatic-renal-cell-carcinoma?sc=sphr&xy=10016681