Baseline modified Glasgow prognostic score associated with survival in metastatic urothelial cell carcinoma treated with immune checkpoint inhibitors.

Abstract

BACKGROUND\nThe modified Glasgow Prognostic Score (mGPS), a clinical tool that incorporates albumin and C-reactive protein, has proven useful in the prognostication of multiple cancers. Several immune checkpoint inhibitors (ICI) have been approved for the treatment of metastatic urothelial cell carcinoma (mUC) but a prognostic biomarker is needed. We investigated the impact of mGPS on survival outcomes in mUC patients receiving ICI.\n\n\nMETHODS\nWe retrospectively reviewed mUC patients treated with ICI (PD-1 or PD-L1 inhibitors) at Winship Cancer Institute from 2015 to 2018. Overall survival (OS) and progression-free survival (PFS) were measured from the start date of ICI until death or clinical/radiographic progression, respectively. mGPS was defined as a summary score with one point given for CRP >\u200910 mg/L and/or albumin <\u20093.5 g/dL. Univariate (UVA) and multivariate (MVA) analyses were carried out using Cox proportional hazard model. These outcomes were also assessed by Kaplan-Meier analysis.\n\n\nRESULTS\nA total of 53 patients were included with a median follow up 27.1 months. The median age was 70\u2009years with 84.9% male and 20.8% black. Baseline mGPS was 0 in 43.4%, 1 in 28.3% and 2 in 28.3%. Increased mGPS at the time of ICI initiation was associated with poorer OS and PFS in UVA, MVA and K-M analyses.\n\n\nCONCLUSIONS\nThe mGPS may be a useful prognostic tool in mUC patients when treatment with ICI is under consideration. These results warrant a larger study for validation.\n\n\nIMPLICATIONS FOR PRACTICE\nThe ideal prognostic tool for use in a busy clinical practice is easy-to-use, cost-effective, and capable of accurately predicting clinical outcomes. There is currently no universally accepted risk score in metastatic urothelial cell carcinoma (mUC), particularly in the immunotherapy era. The modified Glasgow prognostic score (mGPS) incorporates albumin and C-reactive protein and may reflect underlying chronic inflammation, a known risk factor for resistance to immune checkpoint inhibitors (ICI). We found that baseline mGPS is associated with survival outcomes in patients with mUC treated with ICI and may help clinicians to prognosticate for their patients beginning immunotherapy.