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Using C-Reactive Protein Kinetics to Predict Immunotherapy Response in Metastatic Urothelial Carcinoma

By: Emily Rhode
Posted: Thursday, July 21, 2022

The novel C-reactive protein (CRP) flare response strongly predicted immunotherapy response and outcomes in patients with metastatic urothelial carcinoma, regardless of PD-L1 status, according to a multicenter observational study published in the European Journal of Cancer. Markus Eckstein, MD, of the Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany, and colleagues observed prolonged progression-free and overall survival in patients with CRP flare response.

“We demonstrated that, in particular, the occurrence of long-flare kinetics predicts long-term treatment success and prolonged [overall survival] in a multicenter [metastatic urothelial carcinoma] cohort,” wrote the authors.

The multicenter study observed 154 patients with metastatic urothelial carcinoma who were treated with immune checkpoint blockade. Of these patients, 80% received anti–PD-1–targeted treatment (nivolumab/pembrolizumab), and 20% received an antibody against PD-L1 (atezolizumab/durvalumab). The cohort consisted of 25 patients classified as CRP flare responders (16.3%), 35 as CRP responders (22.7%), and 94 as CRP nonresponders (61.0%). PD-L1 expression was evaluated using the combined positive score.

Objective responses were observed in 57.1% of CRP responders and 45.8% of CRP flare responders. However, 17.9% of CRP nonresponders had an objective response (P < .001). The median progression-free survival in the three CRP kinetics groups were 11.4 months, 7.6 months, and 2.8 months for CRP flare responders, CRP responders, and CRP nonresponders, respectively. Median overall survival was 20.1 months and 19.9 months, versus 9.0 months for CRP flare responders, CRP responders, and CRP nonresponders, respectively.

“The assessment of CRP kinetics represents a promising easy-to-implement and cost-efficient on-treatment biomarker that outperforms PD-L1 status,” the authors concluded.

Disclosure: For full disclosures of the study authors, visit

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