Review Article

Inflammatory Biomarkers as Predictors of Response to Immunotherapy in Urological Tumors

Table 1

Potential predictive biomarkers in urological tumors treated with ICIs.

HistologyBiomarkerTrial/authorDrugsSettingStudy results

UrothelialPD-L1 (CPS)KEYNOTE 052 (phase 2)Pembrolizumab1-line CDDP ineligible24% ORR, highest ORR in patients with CPS ≥ 10%
PD-L1 (CPS)KEYNOTE 045 (phase 3)Pembrolizumab vs CHTSecond line after platinum-based CHTHigher ORR in pembrolizumab group than CHT, regardless of tumor PD-L1 expression
PD-L1 (IHC)NCT02108652 (phase 2)Atezolizumab≥2-line after platinum-based CHT (cohort 2)ORR: 26% (PD-L1 ≥ 5%) vs 15% (all patients)
OS: 11.4 (PD-L1 ≥ 5%) vs 7.9 (all patients) months
PD-L1 (IHC)NCT02108652 (phase 2)AtezolizumabFirst-line CDDP ineligibleNo significant enrichment of response and OS by PD-L1 expression
PD-L1 (IHC)NCT01772004 (phase 1b)Avelumab≥2-line treatment after platinum-based CHTPatients with higher PD-L1 ≥ 5% showed higher response rates and longer PFS and OS
PD-L1 (IHC)CheckMate 275 (phase 2)Nivolumab≥2-line treatment after platinum-based CHTORR: 28.4% (PD-L1 ≥ 5%) vs 23.8% (PD-L1 ≥ 1%) vs 16.1 (PD-L1 < 1%); OS: 11.3 (PD-L1 ≥ 1%) vs 5.9 (PD-L1 < 1%) months
CXCL9, CXCL10 cytokinesCheckMate 275 (phase 2)Nivolumab≥2-line treatment after platinum-based CHTPositive predictors of response to nivolumab
CXCL9, CXCL10 cytokines PD-L1 rabbit SP142 (Ventana)IMvigor 210 (phase 2)Atezolizumab≥2-line after platinum-based CHT (cohort 2)Positive predictors of response to atezolizumab; PD-L1 expression on IC (>5% of cells) was significantly associated with response. In contrast, PD-L1 expression in tumor cells was not associated with response
PD-L1 (IHC)NCT01693562 (phase 2)Durvalumab≥2-line treatment after platinum-based CHTNo differences in PFS and ORR between high and low/negative PD-L1 patients
dMMR or MSI-HG. Iyer et al., J Clin Oncol 2017ICIsMetastatic settingdMMR caused a high mutation load and was associated to durable responses to ICIs

KidneyPD-L1 rabbit 28-8 (Dako)CheckMate 214 (phase 3)Nivolumab ipilimumab vs sunitinibFirst lineGreater benefit in ORR, PFS, and OS for patients with PD-L1 ≥ 1% treated with nivolumab and ipilimumab
PD-L1 (IHC)Javelin renal 101Avelumab plus axitinib vs sunitinibFirst lineGreater benefit in ORR and PFS in patients with treated with avelumab plus axitinib, independently from PD-L1
PD-L1 (IHC)KEYNOTE 423 (phase 3)Pembrolizumab plus axitinib vs sunitinibFirst lineGreater benefit in ORR, OS, and PFS in patients with treated with pembrolizumab plus axitinib, independently of PD-L1
PD-L1 (IHC) rabbit SP142 (Ventana)IMmotion 151 (phase 3)Bevacizumab/atezolizumab vs sunitinib1-linePFS in PD-L1 ≥ 1% patients: 11.2 mo (with atezolizumab plus bevacizumab) vs 7.7 mo (with sutent), HR 0.74, P = 0.0217
PD-L1 (IHC) rabbit 28-8 (Dako)CheckMate 025 (phase 3)Nivolumab vs everolimus≥2-line treatment after anti-VEGFR therapyNo differences in OS on the basis of PD-L1 status
SII rabbit 28-8 (Dako)De Giorgi et al., Clin Cancer Research 2019Retrospective analysis of EAP of nivolumab≥2-line treatment after anti-VEGFR therapyNormal body mass index combined with higher SII tripled the risk of death

ProstatedMMRLe DT et al., Science 2017PembrolizumabAdvanced dMMR cancersORR: 53% of patients and complete responses were achieved in 21% of patients

PD-L1 = programmed death-ligand 1; CPS = combined positive score; ICIs = immune-checkpoint inhibitors; ICH = immunohistochemistry; SII = systemic inflammation index; dMMR = mismatch repair genes deficiency; MSI-H = higher microsatellite instability; CHT = chemotherapy; EAP = expanded access program; ORR = overall response rate; PFS = progression-free survival; OS = overall survival.