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Effectiveness of Nivolumab-Based Immunotherapy and Prognostic Stratification by the Meet-URO Score in Real-World Older Patients with Metastatic Renal Cell Carcinoma - Beyond the Abstract

The incidence of renal cell carcinoma (RCC) increases with age, yet older patients remain underrepresented in clinical trials.1 Clinicians are often uncertain whether immune checkpoint inhibitors (ICIs) provide comparable benefit in this population and which prognostic models best guide treatment decisions.

In our multicenter study of 889 patients with metastatic RCC treated with nivolumab alone or with ipilimumab,2,3 we focused on 336 patients aged ≥70 years. We observed that treatment outcomes were comparable to those of younger patients: median overall survival (OS) was 25.1 months in ≥70 vs 23.5 months in <70 years (HR 1.02, p=0.82), while median progression-free survival (PFS) was 7.8 vs 6.3 months (HR 0.93, p=0.40).

We also assessed prognostic stratification tools. The IMDC score maintained its prognostic validity in older adults, but the Meet-URO score - which incorporates neutrophil-to-lymphocyte ratio and presence of bone metastases to the IMDC2 - showed superior accuracy (c-index 0.66 vs 0.63), identifying five distinct risk groups. In patients ≥70 years, survival curves stratified by the Meet-URO score showed clear separation across prognostic classes, ranging from 50 months in group 1 to 3.7 months in group 5 (p<0.001). Similarly, median PFS ranged from 16.5 months in group 1 to 2.5 months in group 5 (p<0.001) (Figure 1).


Fig.1: Progression-free survival and overall survival in patients aged ≥ 70 by the Meet-URO (A and B) and the IMDC (C and D) scores.

These results highlight two clinically relevant messages:

  1. Outcomes in older patients with mRCC receiving nivolumab-based immunotherapy are comparable to those in younger patients.
  2. The Meet-URO score provides refined prognostic stratification, helping to identify both patients likely to derive long-term benefit and those with limited expected outcomes.
Prospective studies are needed to further confirm these findings and to optimize prognostic stratification and treatment decision-making in older patients with mRCC.

Written by: Veronica Murianni, MD, Medical Oncology, Azienda Sanitaria Locale 1 Imperiese, Ospedale Sanremo, Italy

On behalf of the Meet-URO Group

References:

  1. Padala SA, Barsouk A, Thandra KC, et al. Epidemiology of renal cell carcinoma. World J Oncol 2020;11:79–87. https://doi.org/10.14740/wjon1279.
  2. Rebuzzi SE, Signori A, Banna GL, et al. Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: the development of a novel prognostic score (Meet-URO 15 study). Ther Adv Med Oncol 2021;13: 1–13. https://doi.org/10.1177/17588359211035225.
  3. 14. Basso U, Paolieri F, Rizzo M, et al. Compassionate use program of ipilimumab and nivolumab in intermediate or poor risk metastatic renal cell carcinoma: a large multicenter Italian study. Cancers (Basel) 2022;14:2293.
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