Noel Johanna, Jouinot Anne, Alexandre Jérôme, Ulmann Guillaume, Bretagne Marie, Castel-Ajgal Zahra, De Percin Sixtine, Vaquin-Villeminey Clémentine, Revel Marie-Pierre, Peyromaure Michael, Boudou-Rouquette Pascaline, Arrondeau Jennifer, Gataa Ithar, Durand Jean-Philippe, Goldwasser François, Huillard Olivier
Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of medical oncology, Hôpital Cochin, 75014 Paris, France.
Université de Paris, Institut Cochin, INSERM U-1016, CNRS UMR-8104, 75014 Paris, France.
Cancers (Basel). 2022 Jun 30;14(13):3214. doi: 10.3390/cancers14133214.
Background: Nivolumab improved patients’ survival in metastatic renal cell carcinoma (mRCC). We aimed to evaluate resting energy expenditure (REE) (i.e., patients’ basal metabolism) to predict efficacy. Methods: We conducted a monocentric, observational study of mRCC patients receiving nivolumab between October 2015 and May 2020. REE was measured prior to initiating immunotherapy using indirect calorimetry to determine hypo, normo and hypermetabolism. Primary endpoint was 6-month, progression-free survival (PFS), and secondary endpoints were response rate, PFS and overall survival (OS). Results: Of the 51 consecutive patients, 15 (29%) were hypermetabolic, 24 (47%) normometabolic, and 12 (24%) hypometabolic. The 6-month PFS was 15% for hypermetabolic patients and 65% for non-hypermetabolic patients (p < 0.01). In the multivariate analysis, hypermetabolism was the only baseline factor predicting 6-month PFS (OR 9.91, 95%CI [1.62−60.55], p = 0.01). Disease progression was noted as the best response in 73% of hypermetabolic patients and 26% of non-hypermetabolic patients (p = 0.02). Median PFS was 2.8 and 8.7 months (p < 0.01), and median OS was 20.2 and 35.1 months (p = 0.13) in the hypermetabolic and non-hypermetabolic groups, respectively. Conclusions: Our study identifies an association between mRCC patients’ energy expenditure and nivolumab efficacy. The measurement of REE by indirect calorimetry in routine practice could help identify patients at risk of nivolumab failure.
纳武利尤单抗可改善转移性肾细胞癌（mRCC）患者的生存率。我们旨在评估静息能量消耗（REE）（即患者的基础代谢）以预测疗效。方法：我们对2015年10月至2020年5月期间接受纳武利尤单抗治疗的mRCC患者进行了一项单中心观察性研究。在开始免疫治疗前，使用间接测热法测量REE，以确定低代谢、正常代谢和高代谢情况。主要终点是6个月无进展生存期（PFS），次要终点是缓解率、PFS和总生存期（OS）。结果：在51例连续患者中，15例（29%）为高代谢，24例（47%）为正常代谢，12例（24%）为低代谢。高代谢患者的6个月PFS为15%，非高代谢患者为65%（p<0.01）。在多变量分析中，高代谢是预测6个月PFS的唯一基线因素（OR 9.91，95%CI[1.62−60.55]，p = 0.01）。73%的高代谢患者和26%的非高代谢患者疾病进展被记录为最佳反应（p = 0.02）。高代谢组和非高代谢组的中位PFS分别为2.8个月和8.7个月（p<0.01），中位OS分别为20.2个月和35.1个月（p = 0.13）。结论：我们的研究确定了mRCC患者的能量消耗与纳武利尤单抗疗效之间的关联。在常规实践中通过间接测热法测量REE有助于识别有纳武利尤单抗治疗失败风险的患者。
