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Soo Park, MD
Soo Park, MD
Posted: Tuesday, September 10, 2024
The presence of hypoalbuminemia in patients with metastatic melanoma, prior to treatment with anti–PD-1 monotherapy or anti–PD-1/anti–CTLA-4 combination therapy, emerged in recent study results as a strong predictor of poor outcome for both overall survival (hazard ratio [HR] = 4.01) and progression-free survival (HR = 3.72) in univariate analysis. Thus, a lack of albumin protein may prove to be a readily available biomarker for personalized immunotherapy in this patient population, said Alfons J.M. van den Eertwegh, MD, of Amsterdam UMC Location Vrije Universiteit, and colleagues in Scientific Reports.
In a multivariate analysis of this 178-patient multiomic study, the association of hypoalbuminemia with progression-free survival was independent of serum lactate dehydrogenase (LDH), interferon-gamma signature expression, tumor mutational burden, age, performance status, treatment line, treatment type (combination or monotherapy), and brain and liver metastasis (HR = 2.76; P = .0131). “Our results fit into a growing body of literature [that] positions hypoalbuminemia as a powerful predictor of immune checkpoint inhibitor outcome” in multiple malignancies, the authors added.
An independent validation cohort (n = 79) confirmed the prognostic power of hypoalbuminemia for overall survival (HR = 1.98; P = .0127). Hypoalbuminemia was complementary to serum LDH—with high LDH being a previously established biomarker—in analyses for both overall survival (LDH-adjusted HR = 2.12; P = .00925) and progression-free survival (LDH-adjusted HR = 1.91; P = .0261).
In melanoma, current clinical guidelines consider serum LDH levels for intensifying immune checkpoint inhibitor treatment from monotherapy to combination therapy, continued Dr. van den Eertwegh and co-investigators. If the presence of hypoalbuminemia is identified, they immune checkpoint inhibitor treatment might be intensified in patients with normal LDH levels.
The investigators believe that prospective follow-up studies should investigate whether patients with hypoalbuminemia plus elevated LDH levels would benefit from prioritizing other treatment modalities—such as BRAF/MEK-targeting agents—over immune checkpoint inhibitor treatment. These patients have notably poor outcomes.
Disclosure: For full disclosures of the study authors, visit nature.com.
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