HALP index in patients with metastatic clear-cell RCC treated with nivolumab.

e16523 Background: To evaluate the prognostic value of the index combining hemoglobin and albumin levels with lymphocyte and platelet counts (HALP) in patients with metastatic clear-cell RCC treated with nivolumab. Methods: We enrolled 149 subjects (38 females), median age 62 years, treated with nivolumab 240 mg biweekly or 480 mg each 28 days following progression on at least one TKI from 2016 to 2024. The study population was dichotomized based on the median of HALP index (24.12), which was calculated as hemoglobin (g/L) x albumin (g/L) x absolute number of lymphocytes / platelets (g/L) at initiation of immunotherapy. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method with differences analyzed by the log-rank test. Multivariate Cox proportional-hazards model was used to evaluate the prognostic value of the HALP, ECOG performance status and lactate dehydrogenase (LDH). Results: At the median follow up 17.4 months, 122 patients progressed on nivolumab and 87 died. ECOG 2 v ECOG 0 and 1 was associated with significantly worse PFS and OS ( P < 0.0001, HR 0.21 and P < 0.0001, HR 0.15, respectively). Both survivals were shorter in patients with serum LDH higher than 1.5-time of normal range compared to lower levels ( P = 0.0034, HR 0.47 for PFS and P < 0.007, HR 0.45 for OS). Low HALP correlated with worse PFS ( P = 0.0121, HR 0.62) and OS ( P = 0.0025, HR 0.50). The independent prognostic value of HALP index was showed in multivariate analysis. Conclusions: HALP index determined at initiation of nivolumab in second or third line was an independent prognostic factor for survival of metastatic clear-cell RCCs. A nomogram based on the HALP could accurately predict prognosis of these patients. Key Words: Blood Counts. Albumin. Metastatic Disease. Renal-Cell Carcinoma. Nivolumab.