Prognostic role of systemic inflammation indexes in metastatic urothelial carcinoma treated with immunotherapy

Aim: Inflammation indexes had been associated with overall survival (OS) and immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitors (ICIs). Materials & methods: in 72 patients treated with ICIs for metastatic urothelial carcinoma (mUC) we evaluate differences in OS, response rate and toxicities, according to baseline inflammation indexes values. Results: neutrophil-to-lymphocite ratio (NLR) <3 was associated to longer progression-free survival (PFS; 4.9 vs 3.1 months) and OS (15.7 vs 7.6 months); monocyte-to-lymphocite ratio (MLR) <0.4 was associated to longer PFS (4.6 vs 2.8 months). Overall response rate (ORR), disease control rate (DCR) were higher in these patients. Patients with an irAE had longer PFS and OS. Conclusion: baseline inflammatory indexes are prognostic for mUC patients treated with ICIs.Plain language summaryBetween 2019 and 2021, 72 patients received immunotherapy for a metastatic urothelial carcinoma at our institution. We detected markers of inflammation from a common blood test (neutrophils, lymphocytes, platelets and monocytes). We analyzed the role of these markers in our patients. Patients with a lower ratio of these biomarkers at baseline had a significantly longer time to disease progression. They also has a longer survival and higher chance of disease reduction. Moreover, patients with a specific ratio (NLR) increasing more than 0.5, after the first cycle of therapy, had a worse prognosis. It is necessary to evaluate the role of these markers in a trial with new patients enrolled in a prospective way. In fact, the role of these marker in predicting survival and adverse events could be very important for patients' management.Tweetable abstractSystemic inflammation indexes (NLR, MLR) are associated to PFS, OS, ORR and DCR in metastatic urotelial carcinoma, treated with immunotherapy.