Predictive significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and eosinophil levels in advanced renal cell carcinoma patients treated with nivolumab and ipilimumab – a Polish multicenter, observational study

Introduction Immune checkpoint inhibitors have improved the treatment of metastatic renal cell carcinoma (RCC), with the combination of nivolumab (NIVO) and ipilimumab (IPI) showing promising results. However, not all patients benefit from these therapies, emphasizing the need for reliable, easily assessable biomarkers. Methods This multicenter study involved 116 advanced RCC patients treated with NIVO+IPI across nine oncology centers in Poland. Blood markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), eosinophils and monocytes were assessed at baseline, after three months, and before disease progression (PD). The predictive significance of these parameters was analyzed using linear regression, Kaplan-Meier survival analysis, and Cox regression models. Results After a median follow-up of 11.8 months, the progression-free survival (PFS) was 12.8 months (95% confidence interval [CI]: 5.7-28.1), while the overall survival (OS) was 27.3 months (95% CI:16-not reached). Patients with an NLR increase of ≥25% had a PFS of 8.2 (3.1-24.7) months compared to 17.5 (8.6-28.1) months in those with a rise in <25% (p=0.015). Similarly, a ≥25% increase in PLR was linked to a PFS of 6.8 (2.8-8.3) months compared to 17.4 (8.4-28.1) months (p<0.001). Multivariate analysis confirmed PLR as an independent predictor of PFS (HR 2.9, 95% CI:1.5-5.6, p=0.001), while elevated eosinophil levels were associated with a reduced risk of death (HR 0.2, 95% CI: 0.04-0.9, p=0.05). Conclusions NLR, PLR, and eosinophil levels may serve as valuable biomarkers for predicting treatment response in RCC patients receiving NIVO+IPI.