Application of the Meet-URO score to metastatic renal cell carcinoma patients treated with second- and third-line cabozantinib.

Background: The addition of neutrophil-to-lymphocyte ratio (NLR) and bone metastases to the International Metastatic RCC Database Consortium (IMDC) score (by the Meet-URO score) has been shown to better stratify pretreated metastatic renal cell carcinoma (mRCC) patients receiving nivolumab. This study aimed to validate the Meet-URO score in patients receiving cabozantinib to assess its predictivity and prognostic role.
Methods: A multicenter retrospective analysis evaluated mRCC patients receiving ⩾second-line cabozantinib. NLR, IMDC score and bone metastases were assessed before the start of cabozantinib. The primary endpoint was overall survival (OS). Harrell's c -index was calculated to compare the accuracy of the prediction of the two scores.
Results: Overall, 174 mRCC patients received cabozantinib as second and third line (51.7% and 48.3%, respectively) with a median follow-up of 6.8 months. A shorter median overall survival (mOS) was observed for the IMDC poor-risk group, NLR ⩾3.2 and the presence of bone metastases, while the IMDC intermediate-risk group had a similar mOS to the favourable-risk one. Applying the Meet-URO score, three risk groups were identified: group 1 (55.2% of patients) with a score of 0-3, group 2 (38.5%) with a score of 4-8 and group 3 (6.3%) with a score of 9. Compared to group 1 (mOS: 39.4 months), a statistically significant worse mOS was observed in group 2 (11.2 months) and group 3 (3.2 months) patients, respectively. The Meet-URO c -index score was 0.640, showing a higher discriminative ability than the IMDC score ( c -index: 0.568).
Conclusion: This analysis showed that the Meet-URO score provides a more accurate prognostic stratification than the IMDC score in mRCC patients treated with ⩾second-line cabozantinib besides nivolumab. Moreover, it is an easy-to-use tool with no additional costs for clinical practice (web-calculator is available at: https://proviso.shinyapps.io/Meet-URO15_score/). Future investigations will include the application of the Meet-URO score to the first-line immunotherapy-based combination therapies.
Competing Interests: Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: S.E.R. received honoraria as speaker at scientific events and advisory role by Bristol-Myers Squibb and Astellas. U.D.G. serves as advisory/board member of Astellas, Bayer, Bristol-Myers Squibb, IPSEN, Janssen, Merck, Pfizer and Sanofi; received research grant/funding to the institution from AstraZeneca, Roche and Sanofi; and received travel/accommodations/expenses from Bristol-Myers Squibb, IPSEN, Janssen and Pfizer. G.P. serves as advisory boards/consulting for Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Janssen, IPSEN, Merk, MSD, Novartis and Pfizer. G.L.B. reports personal fees from AstraZeneca, Janssen-Cilag, Boehringer Ingelheim and Roche and non-financial support from Bristol-Myers Squibb, AstraZeneca, MedImmune, Pierre Fabre and IPSEN, outside the submitted work. S.B. received honoraria as speaker at scientific events and advisory role by BMS, Pfizer, MSD, Ipsen, Roche, Eli Lilly, AstraZeneca, Pierre Fabre and Novartis. G.F. serves as advisory boards for Astellas, Janssen, Pfizer, Bayer, MSD and Merck and received travel accommodation from Astellas, Janssen and Bayer. The other authors have no conflicts of interest to disclose.
(© The Author(s), 2022.)