# Prognostic impact of FAN score in patients receiving nivolumab plus ipilimumab for metastatic renal cell carcinoma

## TL;DR

This study shows that a high FAN score before treatment predicts worse outcomes for patients with kidney cancer treated with nivolumab and ipilimumab.

## Contribution

The study is the first to show the prognostic value of FAN score in metastatic RCC patients treated with nivolumab plus ipilimumab.

## Key findings

- High FAN score (≥2) was significantly linked to worse second progression-free survival.
- FAN score ≥2 predicted poorer cancer-specific and overall survival in multivariable analysis.
- FAN score was an independent predictor of poor prognosis in metastatic RCC patients.

## Abstract

FAN score is reportedly associated with prognostic outcomes in patients with urothelial carcinoma being treated with immune check point inhibitors. However, the prognostic impact of pre-treatment FAN score in patients with metastatic renal cell carcinoma (RCC) treated with nivolumab plus ipilimumab remains unclear. We retrospectively evaluated the association between pre-treatment FAN score and prognostic outcomes in 154 patients with metastatic RCC treated with nivolumab plus ipilimumab. The pre-treatment FAN score was ‘0’ in 56 patients (36%), ‘1’ in 60 patients (40%), ‘2’ in 37 patients (24%) and ‘3’ in one patient (1%). Progression-free survival was not significantly different between patients with different FAN scores, but second progression-free survival (PFS2), cancer-specific survival (CSS) and overall survival (OS) were significantly different. In multivariable Cox proportional hazard analyses, FAN score ≥ 2 was a significant predictor of poor PFS2 (vs. FAN score 0, HR: 2.43, 95% CI 1.21–4.87, P = 0.01), poor CSS (vs. FAN score 0, HR: 2.71, 95% CI 1.13–6.47, P = 0.02) and poor OS (vs. FAN score 0, HR: 2.42, 95% CI 1.11–5.25, P = 0.02). High pre-treatment FAN score could be a significant independent predictor of poor prognosis in patients receiving nivolumab plus ipilimumab for metastatic RCC.