Neutrophil to lymphocyte ratio and tumour burden for treatment efficacy stratification in renal cell carcinoma patients receiving nivolumab plus ipilimumab

Abstract

Background

There is a lack of surrogate markers to predict the outcomes of nivolumab plus ipilimumab (Nivo-Ipi) for advanced renal cell carcinoma (RCC), but neutrophil to lymphocyte ratio (NLR) and tumour burden are promising candidates. This study investigated biological and radiological surrogate markers in advanced RCC patients receiving Nivo-Ipi.

Materials and methods

Between 2018 and 2022, data were retrospectively collected for patients receiving Nivo-Ipi for previously untreated metastatic or locally advanced RCC with intermediate or poor risk across six centres. We assessed prognostic factors to stratify the outcomes of Nivo-Ipi, including tumour burden and NLR.

Results

The study included 129 patients with a median age of 67 years (71% men). Both NLR and tumour burden were negatively associated with tumour response; they were also independently associated with unfavourable overall survival, whereas NLR was the only factor independently associated with unfavourable progression-free survival on multivariate analysis. Combined NLR and tumour burden assessment enabled stratification of the outcomes of Nivo-Ipi. Patients with NLR <3.0 or 3.0-5.9 and tumour burden <200 mm showed significantly superior treatment outcomes relative to the other patients with NLR ≥6.0 or 3.0-5.9 and tumour burden ≥200 mm (objective response rate: 54% versus 26%; complete response rate: 16% versus 0%; median overall survival: 44.3 versus 6.1 months; median progression-free survival: 17.4 versus 4.1 months).

Conclusions

NLR and tumour burden were negatively associated with response to Nivo-Ipi in advanced RCC. Combined NLR and tumour burden assessment could efficiently stratify treatment outcomes and survival, potentially aiding treatment selection.