Prognostic Stratification by the Meet-URO Score in Real-World Older Patients With Metastatic Renal Cell Carcinoma (mRCC) Receiving Cabozantinib: A Subanalysis of the Prospective ZEBRA Study (Meet-URO 9)

• Published in: Clinical genitourinary cancer 2024-04, Vol.22 (2), p.126-133.e2
• Main Authors: Damassi, Alessandra, Cremante, Malvina, Signori, Alessio, Rebuzzi, Sara Elena, Fornarini, Giuseppe, Giudice, Giulia Claire, Maruzzo, Marco, Procopio, Giuseppe, Sorarù, Mariella, Di Napoli, Marilena, Fratino, Lucia, Santini, Daniele, Grillone, Francesco, Ballestrin, Melissa, Dionese, Michele, Nasso, Cecilia, Catalano, Fabio, Murianni, Veronica, Rescigno, Pasquale, Anpalakhan, Shobana, Banna, Giuseppe Luigi, Basso, Umberto, Buti, Sebastiano
• Format: Article
• Language: English
• Subjects: Aged; Anilides; Carcinoma, Renal Cell - pathology; Elderly; Humans; Kidney Neoplasms - pathology; Nivolumab - therapeutic use; Prognosis; Prognostic factors; Prognostic score; Prospective Studies; Pyridines; Renal Carcinoma; Retrospective Studies; Tyrosine kinase inhibitor
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2023.10.001

•Meet-URO Score adds NLR and bone metastases to the IMDC classification in mRCC.•It showed higher prognostic accuracy in ≥2nd line nivolumab or cabozantinib mRCC.•It demonstrated higher accuracy in 1st line nivolumab-ipilimumab mRCC.•Meet-URO score is also more accurate in older mRCC patients receiving cabozantinib. The addition of neutrophil to lymphocyte ratio (NLR) and bone metastases to the IMDC classification provided by the Meet-URO score, resulted in higher prognostic accuracy in metastatic renal cell carcinoma (mRCC) patients receiving ≥2nd line nivolumab or cabozantinib in 2 retrospective analyses and 1st line nivolumab-ipilimumab in an expanded access programme. Prognostic estimates for older mRCC patients might be key for clinical decision-making. The outcome of real-world older (≥70 years) mRCC patients treated with any line cabozantinib within the multicenter observational prospective ZEBRA (Meet-URO 9) study was analyzed according to the baseline Meet-URO score. The primary endpoint was overall survival (OS). The discriminative ability by Harrell's c-index and calibration were assessed to compare the Meet-URO and IMDC scores. A total of 104 mRCC patients received cabozantinib as 1st (38%), 2nd (20%), or ≥3rd (41%) line. With a median follow-up of 11.2 months, the median OS (mOS) was of 18.4 months. According to the IMDC score, favorable (15%), intermediate (65%) and poor-risk (19%) patients had a mOS not reached, of 15.6 and 5.7 months respectively (p = .011). According to the Meet-URO score groups, mOS was not reached in both group 1 (10%) and group 2 (25%), while in group 3 (33%), group 4 (25%) and group 5 (8%) mOS was of 13.6, 12.5, and 3.7 months, respectively (p < .001). The discriminative ability of the Meet-URO score was maintained by merging groups 1 to 2 vs. 3 to 4 vs. 5 (p < .001). The Meet-URO score (with either the original 5-group stratification or the modified 3-group one) showed higher accuracy than the IMDC score (c-index of 0.686 and 0.676 vs. 0.622). This analysis confirmed the prognostic accuracy of the Meet-URO score in older mRCC patients treated with cabozantinib and its role as a convenient tool for informing the patient and clinical decisions. Prognostic estimates for older mRCC patients might be key for clinical decision-making.The outcome of real-world older mRCC patients treated with any line cabozantinib study was analyzed according to the baseline Meet-URO score.Meet-URO score is a valid prognostic tool in older m