CRP Flare Response and Response to Nivolumab in Kidney Cancer
Posted: Tuesday, May 18, 2021
Yasuhisa Fujii, MD, PhD, of Tokyo Medical and Dental University, Bunkyo-ku, Japan, and colleagues conducted a study to determine the impact of early C-reactive protein (CRP) kinetics on the effectiveness of nivolumab in patients with metastatic renal cell carcinoma. Published in the Journal for ImmunoTherapy of Cancer, their results showed that CRP flare response was associated with significant tumor reduction and improved survival outcomes, suggesting these early kinetics may be beneficial in determining the efficacy of nivolumab.
This retrospective analysis focused on 42 patients with metastatic renal cell carcinoma treated with nivolumab as at least a second-line therapy; all patients previously underwent tyrosine kinase inhibitor therapy, and 88% had undergone nephrectomy. Participants were separated into three groups depending on their early CRP kinetics: CRP flare responders (n = 11), CRP responders (n = 15), and non-CRP responders (n = 16). According to the investigators: “CRP levels increased to more than double compared with baseline within 1 month after initiation of nivolumab (flare) and then decreased to a lower value than baseline within 3 months (CRP flare response); CRP levels decreased by at least 30% within 3 months without “flare” (CRP response); and the remaining patients were non-CRP responders.” Nivolumab was administered until clinical or radiographic disease progression, intolerable adverse events, or death.
The median follow-up was 8 months, with a median baseline CRP level of 23 mg/L. Partial response was achieved in 13 patients, 20 had stable disease, 9 experienced progressive disease, and 13 died of metastatic renal cell carcinoma. The median progression-free survival and overall survival for the entire cohort were 8.7 and 25.4 months, respectively.
CRP flare responders, CRP responders, and non-CRP responders had median progression-free survival of not reached, 12 months, and 24 months, respectively; median overall survival was not reached, not reached, and 12 months. The objective response rates for these cohorts were 73%, 27%, and 6%, respectively. Of note, the size of target lesions in CRP flare responders (−38%) and CRP responders (−13%) was reduced, but it increased 16% in non-CRP responders (P < .001).
Disclosure: For full disclosures of the study authors, visit jitc.bmj.com.