The prognostic efficacy of a sustainable geriatric nutritional risk index for avelumab switch maintenance therapy in metastatic urothelial carcinoma

Abstract

Abstract Background Metastatic urothelial carcinoma (mUC) has a poor prognosis. Avelumab is approved for mUC maintenance therapy and prolongs overall survival. However, real-world data, including the prognostic analysis of maintenance therapy, is limited. In this study, we explore trends related to avelumab treatment of mUC patients. Methods A total of 72 mUC patients treated with first-line chemotherapy, from January 2019 to November 2022, at Nagoya City University Hospital or its seven affiliated institutions, were analyzed. We retrospectively compared clinical parameters and the prognosis of avelumab (Ave)-suitable and treated patients (n = 43) and those untreated (Ave-unsuitable; n = 29) because of progression during first-line chemotherapy. Kaplan–Meier curves displayed survival and recurrence rates. Potential prognostic factors, including the geriatric nutritional risk index (GNRI) for determining patients suitable for Ave, were evaluated using univariate and multivariate Cox regression analyses. Results Basic clinical parameters of patients when first-line treatment was initiated were not statistically different between the two groups. The Ave-suitable group (median 26.6 months, 95% confidence interval [CI]: 18.8–not reached [NR]) showed significantly longer median overall survival (OS) after first-line treatment than the Ave-unsuitable group (median 12.0 months, 95% CI: 7.5–NR) with tolerable adverse events. The cut-off values of prognostic factors were set by receiver operating characteristic curve. Multivariate analysis revealed GNRI sustainability as the only significant prognostic factor for being Ave-suitable (95% CI: 1.14–20.6, hazard ratio: 4.83). Conclusion Avelumab switch maintenance therapy for mUC prolonged OS and showed tolerable safety profiles. GNRI sustainability may be an excellent biomarker for predicting being Ave-suitable.