Nivolumab improved patients' survival in metastatic renal cell carcinoma (mRCC). We aimed to evaluate resting energy expenditure (REE) (i.e., patients' basal metabolism) to predict efficacy.
We conducted a monocentric, observational study of mRCC patients receiving nivolumab between October 2015 and May 2020. REE was measured prior to initiating immunotherapy using indirect calorimetry to determine hypo, normo and hypermetabolism. Primary endpoint was 6-month, progression-free survival (PFS), and secondary endpoints were response rate, PFS and overall survival (OS).
Of the 51 consecutive patients, 15 (29%) were hypermetabolic, 24 (47%) normometabolic, and 12 (24%) hypometabolic. The 6-month PFS was 15% for hypermetabolic patients and 65% for non-hypermetabolic patients (p < 0.01). In the multivariate analysis, hypermetabolism was the only baseline factor predicting 6-month PFS (OR 9.91, 95%CI [1.62-60.55], p = 0.01). Disease progression was noted as the best response in 73% of hypermetabolic patients and 26% of non-hypermetabolic patients (p = 0.02). Median PFS was 2.8 and 8.7 months (p < 0.01), and median OS was 20.2 and 35.1 months (p = 0.13) in the hypermetabolic and non-hypermetabolic groups, respectively.
Our study identifies an association between mRCC patients' energy expenditure and nivolumab efficacy. The measurement of REE by indirect calorimetry in routine practice could help identify patients at risk of nivolumab failure.
Cancers. 2022 Jun 30*** epublish ***
Johanna Noel, Anne Jouinot, Jérôme Alexandre, Guillaume Ulmann, Marie Bretagne, Zahra Castel-Ajgal, Sixtine De Percin, Clémentine Vaquin-Villeminey, Marie-Pierre Revel, Michael Peyromaure, Pascaline Boudou-Rouquette, Jennifer Arrondeau, Ithar Gataa, Jean-Philippe Durand, François Goldwasser, Olivier Huillard
Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of medical oncology, Hôpital Cochin, 75014 Paris, France., Université de Paris, Institut Cochin, INSERM U-1016, CNRS UMR-8104, 75014 Paris, France., Université de Paris, URP 4466 PRETRAM, F-75006 Paris, France., Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), AP-HP, APHP.Centre, Hôpital Cochin, 75014 Paris, France., Urology Department, AP-HP, Hôpital Cochin, 75014 Paris, France.