Background: Despite the success of immune checkpoint inhibitors (ICIs) in metastatic melanoma, many patients fail to derive meaningful benefit, underscoring the urgent need for accessible prognostic biomarkers. The C-reactive protein (CRP)–albumin–lymphocyte (CALLY) index, an immunonutritional index, has shown prognostic value in various cancers. Previous studies indicate that systemic inflammation and nutritional status influence ICI efficacy, suggesting the potential relevance of the CALLY index in metastatic melanoma. This study evaluates the CALLY index’s role in metastatic melanoma patients treated with anti-PD-1 therapy. Methods: This retrospective study analysed 92 patients with metastatic melanoma who were treated with anti-PD-1 monotherapy at Ege University’s Faculty of Medicine between 2015 and 2023. The CALLY index was calculated using the pre-treatment CRP, albumin and lymphocyte levels. Kaplan–Meier analysis was used to estimate survival outcomes, and univariate and multivariate Cox regression models were employed to identify independent prognostic factors. A predictive nomogram incorporating the CALLY index and other significant variables was then developed. Results: The optimal CALLY index cutoff was determined to be 2. Patients with a low CALLY index (≤ 2) had worse median overall survival (OS) and progression-free survival (PFS) when compared with those who had a high CALLY index (> 2) (median OS: 9.6 vs 31.3 months, p < 0.001; median PFS: 3.8 vs 10.6 months, p = 0.001). Multivariate analysis identified the CALLY index, lactate dehydrogenase above the upper limit of normal, Eastern Cooperative Oncology Group score ≥ 2, M1c/M1d staging and acral/mucosal melanoma subtypes to be independent predictors of OS. A nomogram was then constructed based on these factors, yielding a concordance index of 0.705 (95% confidence interval: 0.634–0.776). This model stratified patients into low-, intermediate- and high-risk groups, with the high-risk group showing significantly worse OS than the intermediate- and the low-risk groups (p < 0.001). Conclusion: The CALLY index is a cost-effective and independent prognostic biomarker that can aid in risk stratification and guide treatment decisions in patients with metastatic melanoma receiving anti-PD-1 therapy.

Background/Objectives: Nivolumab has been shown to be an effective treatment for metastatic renal cell carcinoma (mRCC); however, patient responses vary considerably. The objective of this study is to evaluate the prognostic value of the C-PLAN index in predicting survival outcomes for patients with mRCC treated with nivolumab. Methods: This retrospective cohort study included 81 mRCC patients previously treated with tyrosine kinase inhibitors who subsequently received nivolumab. The C-PLAN index, which includes C-reactive protein, performance status, lactate dehydrogenase, albumin, and derived neutrophil-to-lymphocyte ratio, was used to classify patients into “good” and “poor” prognostic groups. Results: The median overall survival (OS) was 22 months, and the median progression-free survival (PFS) was 6.7 months. Patients in the “poor” C-PLAN group exhibited significantly shorter OS and PFS than those in the “good” group (median OS: 13 vs. 31 months, p = 0.003; median PFS: 3 vs. 10 months, p = 0.007). The C-PLAN index was identified as an independent predictor of both OS (HR = 1.19, 95% CI: 1.11–3.43, p = 0.020) and PFS (HR = 1.71, 95% CI: 1.04–2.78, p = 0.032) in multivariate analysis. Conclusions: These findings suggest that the C-PLAN index may serve as a valuable prognostic tool, offering insights into survival outcomes for patients undergoing nivolumab therapy. Further prospective and multicenter studies are warranted to validate its clinical utility.

Pembrolizumab is an immune checkpoint inhibitor that acts via PD-1 blockade. Recent studies have shown its effectiveness in treating various solid organ tumours. However, unlike cytotoxic chemotherapeutic agents, pembrolizumab may cause immune-related adverse effects. These immune-related adverse effects are generally mild, although patients who experience grade-three or higher side effects may require hospitalisation. In particular, cardiopulmonary side effects are associated with high mortality rates. We report the case of a 24-year-old female patient with alveolar soft part sarcoma accompanied by rare and difficult-to-treat pulmonary hypertension induced by pembrolizumab.

Immune checkpoint inhibitors (ICIs) elicit strong antitumour responses but may cause immune-related adverse events (irAEs) requiring treatment interruption. Resuming ICIs after irAEs remains a clinical challenge. This single-center retrospective study included 97 patients with solid tumors treated with anti-PD-1 ± anti-CTLA-4 agents between January 2016 and September 2024. All patients developed irAEs that led to treatment interruption and subsequently resumed the same ICI regimen. Predictors of irAE recurrence were evaluated using LASSO regression followed by backward stepwise selection. The patient cohort had a median age of 60 years. 63.9% had received anti-PD-1 monotherapy and 36.1% had received combination therapy. Common first irAEs included colitis (37.1%) and hepatitis (24.7%), with 40.2% being grade ≥ 3. Upon resumption, 46.4% experienced recurrent irAEs. Overall survival did not differ significantly between patients with and without recurrence (84.3 vs. 74.6 months, p = 0.866). Younger age, high-grade irAE, colitis, elevated monocytes, and need for nonsteroidal immunosuppressants were independently associated with recurrence. A nomogram constructed using these factors demonstrated good discriminative ability (AUC = 0.818). Resuming ICI therapy after an irAE is generally feasible, although nearly 50% of patients experience recurrent toxicity. The developed nomogram may support risk-based clinical decisions.

Immune checkpoint inhibitors (ICIs) have significantly improved the five-year survival rate for advanced melanoma. However, many patients exhibit resistance to ICI therapy. This study evaluated the efficacy and prognostic factors of anti-PD-1 (Group A) and nivolumab–ipilimumab (Group B) therapy in patients with advanced melanoma who were resistant to prior ICI therapy. We conducted a retrospective analysis of 56 patients with advanced melanoma who had previously shown resistance to ICI therapy. In the Group A (who have previously shown resistance to anti-CTLA-4, n = 28), the objective response rate (ORR) was 42.9%, with a disease control rate (DCR) of 53%. In the Group B (previously shown resistance to anti-PD-1, n = 28), the ORR was 17.9%, and the DCR was 25%. The ORR was lower in two subgroups: patients who showed progression or relapse in the the initial radiological assessment of prior ICI therapy (ORR 10.5%) and patients who had previously received ICI in the adjuvant setting (ORR 8.3%). A Royal Marsden Hospital (RMH) score of 2–3 was a predictor of OS in both groups (Group A: HR 3.789, 95% CI 1.356–10.589, p = 0.011; Group B: HR 4.281, 95% CI 1.490–12.300, p = 0.007) and for PFS in the Group B (HR 3.167, 95% CI 1.062–9.442, p = 0.039). Anti-PD-1 therapy demonstrated efficacy following resistance to anti-CTLA-4, whereas combination ICI therapy showed lower response rates in patients resistant to anti-PD-1. Further studies are needed to confirm the RMH scores and other prognostic markers and to evaluate subgroups with lower efficacy of nivolumab-ipilimumab therapy.