The addition of neutrophil-to-lymphocyte ratio (NLR) and bone metastases to the International Metastatic RCC Database Consortium (IMDC) score (by the Meet-URO score) has been shown to better stratify pretreated metastatic renal cell carcinoma (mRCC) patients receiving nivolumab. This study aimed to validate the Meet-URO score in patients receiving cabozantinib to assess its predictivity and prognostic role.
A multicenter retrospective analysis evaluated mRCC patients receiving ⩾second-line cabozantinib. NLR, IMDC score and bone metastases were assessed before the start of cabozantinib. The primary endpoint was overall survival (OS). Harrell's c-index was calculated to compare the accuracy of the prediction of the two scores.
Overall, 174 mRCC patients received cabozantinib as second and third line (51.7% and 48.3%, respectively) with a median follow-up of 6.8 months. A shorter median overall survival (mOS) was observed for the IMDC poor-risk group, NLR ⩾3.2 and the presence of bone metastases, while the IMDC intermediate-risk group had a similar mOS to the favourable-risk one. Applying the Meet-URO score, three risk groups were identified: group 1 (55.2% of patients) with a score of 0-3, group 2 (38.5%) with a score of 4-8 and group 3 (6.3%) with a score of 9. Compared to group 1 (mOS: 39.4 months), a statistically significant worse mOS was observed in group 2 (11.2 months) and group 3 (3.2 months) patients, respectively. The Meet-URO c-index score was 0.640, showing a higher discriminative ability than the IMDC score (c-index: 0.568).
This analysis showed that the Meet-URO score provides a more accurate prognostic stratification than the IMDC score in mRCC patients treated with ⩾second-line cabozantinib besides nivolumab. Moreover, it is an easy-to-use tool with no additional costs for clinical practice (web-calculator is available at: https://proviso.shinyapps.io/Meet-URO15_score/). Future investigations will include the application of the Meet-URO score to the first-line immunotherapy-based combination therapies.
Therapeutic advances in medical oncology. 2022 Feb 26*** epublish ***
Sara Elena Rebuzzi, Luigi Cerbone, Alessio Signori, Matteo Santoni, Veronica Murianni, Ugo De Giorgi, Giuseppe Procopio, Camillo Porta, Michele Milella, Umberto Basso, Francesco Massari, Marco Maruzzo, Roberto Iacovelli, Nicola Battelli, Luca Carmisciano, Giuseppe Luigi Banna, Sebastiano Buti, Giuseppe Fornarini
Medical Oncology Unit, Ospedale San Paolo, Via Genova, 30, 17100 Savona, Italy., Inserm U981, Villejuif, France., Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy., Oncology Unit, Macerata Hospital, Macerata, Italy., Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy., SS Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy., Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy., Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy., Medical Oncology Unit, University Hospital of Parma, Parma, Italy.