Clinical Scorecard: Evaluating Prognostic Models for Overall Survival in Patients with Metastatic Renal and Urothelial Cancers Treated with Immunotherapy: Which Model Should Be Selected?

At a Glance

Key Highlights

• Immunotherapy is standard care for mRCC and mUC but not all patients benefit, necessitating prognostic tools.
• Four blood biomarker-based scores (mGPS, SII, NLR, NER) were evaluated for predicting overall survival.
• High SII and NLR correlate with worse survival; high eosinophil count (low NER) associates with improved outcomes.

Guideline-Based Recommendations

Diagnosis

• Use blood biomarkers including neutrophil, lymphocyte, eosinophil counts, CRP, and albumin to calculate prognostic scores.
• Calculate mGPS, SII, NLR, and NER at baseline prior to immunotherapy initiation.

Management

• Consider prognostic scores to identify patients less likely to benefit from immunotherapy to avoid overtreatment.
• Integrate mGPS with radiologic staging for enhanced prognostic assessment during therapy monitoring.

Monitoring & Follow-up

• Monitor changes in prognostic scores during treatment to inform therapy optimization.
• Use validated cut-off values from ROC analyses to stratify patients by risk.

Risks

• Immunotherapy is generally well tolerated but may increase healthcare burden if used indiscriminately.
• Overtreatment in patients unlikely to benefit can be avoided by applying prognostic scoring systems.

Patient & Prescribing Data

120 patients with metastatic renal cell or urothelial carcinoma treated with immunotherapy

Median age 66 years; mUC patients older than mRCC; prior therapies differ by tumor type; average 5 IO cycles administered; prognostic scores correlate with survival outcomes.

Clinical Best Practices

• Calculate and utilize mGPS, SII, NLR, and NER scores at baseline to guide immunotherapy decisions.
• Apply ROC-derived cut-offs to stratify patients and predict overall survival.
• Incorporate prognostic scores alongside clinical and radiologic data for comprehensive patient assessment.
• Use evidence-based scoring systems to reduce unnecessary immunotherapy exposure and optimize treatment plans.

References

• Approval of enfortumab vedotin and pembrolizumab combination therapy
• SAUL trial evaluating atezolizumab in metastatic urothelial carcinoma
• Safety and tolerability of immunotherapy in urological cancers
• Healthcare burden and variable benefit of immunotherapy
• Prognostic value of NLR and SII in SAUL trial
• ARON-1 study on SII in metastatic renal cell carcinoma
• Modified Glasgow prognostic score in urological cancers
• Integration of mGPS in therapy monitoring
• Neutrophil-to-eosinophil ratio and outcomes in mRCC
• Eosinophil count association with disease progression risk