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

Patrik Palacka Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute; Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia info_outline Patrik Palacka, Jana Obertova, Michal Chovanec, Zuzana Sycova-Mila, Katarina Stefanikova, Eva Slachtova, Monika Zak, Alexander Savka, Matej Hrncar, Michal Mego, Katarina Rejlekova

Authors Patrik Palacka Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute; Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia info_outline Patrik Palacka, Jana Obertova, Michal Chovanec, Zuzana Sycova-Mila, Katarina Stefanikova, Eva Slachtova, Monika Zak, Alexander Savka, Matej Hrncar, Michal Mego, Katarina Rejlekova Organizations Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute; Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia, Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia, Department of Oncology, East Slovak Cancer Institute, Kosice, Slovakia, Department of Oncology, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia, National Cancer Institute, Bratislava, Slovakia Abstract Disclosures Research Funding No funding sources reported 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.