Adjusted Skeletal Muscle Index (aSMI) correlates with outcome in metastatic Renal Cancer Cell (mRCC) patients (pts) treated with first line (1L) immunotherapy (IT)
Adjusted Skeletal Muscle Index (aSMI) correlates with outcome in metastatic Renal Cancer Cell (mRCC) patients (pts) treated with first line (1L) immunotherapy (IT)
This study aims to evaluate body composition (BC) and inflammatory parameters (IFN) variations with different 1L treatments in Metastatic Renal Cell Carcinoma (mRCC).
We conducted a multicentric retrospective analysis on patients (pts) with intermediate and high risk (IMDC score) treated with tyrosine kinase inhibitors (TKI) (25 pts) or immunotherapy (IT) Ipilimumab and Nivolumab (32 pts). General characteristics, BC and IFN were recorded at baseline and at 1rst follow-up. BC was calculated from CT scans quantifying fat (visceral and subcutaneous) [img.1] and muscle [img.2] with (SMI) without fat infiltration (adjustedSMI) at 3L vertebral level.
Img 1. CT scans at 3L vertebral level with visceral and subcutaneous fat quantification
Img 2. CT scans at 3L vertebral level with muscle quantification and HU sampling of pure muscle and pure fat
At diagnosis medians (m) were: BMI 24,4; age 61 years (range 25-79); neutrophils/lymphocytes ratio (NLR) 2,73; sarcopenic pts by Martin et al 2013 20% (TKI) and 25,8% (IT); SMI for male (M) was 50,68 (32,77-74,54), for female (F) 46,99 (35,81-74,26); aSMI for M was 41,91 (26,33-71,59), for F 33,79 (29,99-56,05). SMI decreased ≥5% in 64% of TKI and 53,6% of IT (p=0,58). Overall Survival (OS) was 12,2 months (mo) (TKI) and 35,13 mo (IT). Progression Free Survival (PFS) was 7,47 mo (TKI) and 11,12 mo (IT). OS was not significantly different neither in TKI nor IT depending for BMI or SMI. Conversely, better OS was observed with low basal NLR (< m) for TKI (p=0,008) and IT (p=0,018) and with high aSMI according m and sex in IT (0,039), but not in TKI (p=0,774).
INF and BC could help to optimize tailored 1L treatment for mRCC, in particular, with IT better muscle quality and quantity seems to have a favorable impact on outcome. Further studies are needed but these results look encouraging.
