C-reactive protein and immune-related adverse events as prognostic biomarkers in immune checkpoint inhibitor treated metastatic renal cell carcinoma patients

ABSTARCT

Background

There is an ongoing need to identify biomarkers for correct patient selection for immune-oncology treatments in metastatic renal cell carcinoma (mRCC). The aim of our study was to evaluate the prognostic role of elevated C-reactive protein (CRP) values and immune-related adverse events (irAEs) to indicate immune checkpoint inhibitors’ (ICIs) efficacy in nivolumab-treated mRCC patients.

Materials and methods

Data from 96 mRCC patients treated with nivolumab at Comprehensive Cancer Center, Helsinki University Hospital in a real-life setting were collected between 2006 and 2020 retrospectively. Patients’ baseline CRP, on-treatment (<12 weeks) CRP, and reported irAE association to median survival and outcome were analyzed using Kaplan–Meier and Cox regression.

Results

Patients with elevated baseline CRP were associated with worse overall survival (OS) and progression-free survival (PFS) when compared with normal baseline CRP. This significant correlation was also observed with patients with elevated on-treatment CRP. In multivariate survival analyses both elevated baseline and on-treatment CRP had shorter OS and PFS than patients with normal CRP: hazard ratio (HR) 2.84 (95% CI 1.48–5.42), HR 3.68 (95% CI 1.92–7.03) and PFS: HR 1.77 (95% CI 1.06–2.97), HR 2.88 (95% CI 1.75–4.73), respectively. A significant difference in OS was also seen between patients without irAE and with irAE during treatment. In multivariate survival analyses, patients without irAE had shorter OS HR 1.93 (95% CI 1.03–3.62) compared with patients with reported irAE.

Conclusions

Elevated baseline CRP, on-treatment CRP, and absence of irAE correlate with poor outcome in nivolumb-treated mRCC patients. These results suggest that monitoring CRP values as well as potential irAEs during treatment may be of use in clinical decision making.

Keywords:

• Nivolumab
• C-reactive protein
• immune-related adverse event
• biomarker
• metastatic renal cell carcinoma

Disclosure statement

K. Peltola has a consultant or advisory role for MSD Oncology, Lilly, Pfizer, Bristol-Myers Squibb, Novartis, Ipsen, Roche, stock ownership of Faron Pharmaceuticals and has received travel support from Bristol-Myers Squibb and Roche. P. Bono has received honoraria from MSD, Pfizer, Bristol-Myers Squibb, Novartis, Ipsen, Oncorena, TILT Biotherapeutics, Faron Pharmaceuticals, Eisai and Herantis Pharma, and stock ownership of TILT Biotherapeutics and Terveystalo. The other authors report no conflict of interest to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author, E. Kankkunen, upon reasonable request.