Prognostic Impact of Early GNRI Sustainability in Metastatic Urothelial Carcinoma Receiving Pembrolizumab.

[BACKGROUND/AIM] To evaluate the prognostic significance of sustainability of the geriatric nutritional risk index (GNRI) in second-line chemotherapy in patients with metastatic urothelial carcinoma (mUC).

[PATIENTS AND METHODS] A total of 105 patients received pembrolizumab (PEM) therapy. GNRI calculations were based on the serum albumin level and body mass index, prior to and at the finish of the first cycle of PEM therapy. Patients showing a GNRI ≥92 at both time points formed the sustainable group (n=44), while the rest were in the unsustainable group (n=61). Clinical outcomes were compared. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier curves, and potential prognostic factors examined using univariate and multivariate Cox regression analyses.

[RESULTS] No significant differences in baseline characteristics were noted. Median PFS from the start of PEM therapy was 6.4 months [95% confidence interval (CI)=3.7-9.0) and 3.4 months (95%CI=2.0-4.1)] for sustainable and unsustainable groups, respectively (<0.01). The median OS was 24.8 months (95%CI=18.4-40.1) and 7.6 months (95%CI=3.8-12.6; <0.0001) for sustainable and unsustainable groups, respectively. Multivariate analysis identified sustained GNRI as an independent predictor of longer PFS [hazard ratio (HR)=0.54, 95%CI=0.30-0.96, <0.05] and longer OS (HR=0.40, 95%CI=0.19-0.86, <0.05).

[CONCLUSION] A high GNRI level during PEM therapy is an important prognostic indicator in patients with mUC. A sustained GNRI is a predictive biomarker for PFS and OS.