Immune checkpoint inhibitors such as nivolumab have brought meaningful benefits to patients with advanced non-small cell lung cancer (NSCLC), yet many patients still experience limited responses. Vitamin D is a key modulator of immune function, and deficiency is common in individuals with cancer. Given its potential role in shaping immunotherapy response, we retrospectively assessed whether baseline vitamin D levels were associated with clinical outcomes in advanced NSCLC patients treated with nivolumab. We retrospectively analyzed patients with stage IV NSCLC treated with nivolumab across multiple centers, predominantly as second-line therapy. Prior to nivolumab initiation, all patients were confirmed to be negative for common driver mutations, including EGFR, ALK, ROS1, and other actionable genomic alterations. Baseline serum 25-hydroxyvitamin D levels were measured prior to nivolumab initiation, and patients were categorized as having severe deficiency (< 10 ng/mL), deficiency (10–20 ng/mL), or sufficient levels (≥ 20 ng/mL). The presence of liver metastases was recorded at baseline. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared with log-rank tests. Multivariable Cox proportional hazards models adjusted for age, sex, ECOG performance status, liver metastasis, and other metastatic sites were used to evaluate the independent prognostic value of vitamin D status. Objective response rates (ORR) were assessed in patients with available radiologic data. A total of 890 patients were screened, and after excluding those with missing baseline vitamin D data, 305 patients were included in the analysis. The median age was 64 years (range 34–85), and 68% of patients were male. Vitamin D levels were < 10 ng/mL in 30%, 10–20 ng/mL in 44%, and ≥ 20 ng/mL in 26% of patients. Patients with severe vitamin D deficiency were numerically older (median age 65 vs. 63 years) and had higher rates of ECOG PS ≥ 2 (15.1% vs. 7.5%) and squamous histology (37.6% vs. 27.5%), though these differences were not statistically significant (p > 0.05 for all). Liver metastases were present in 54 patients (17.7%), and the distribution was similar across vitamin D groups (p = 0.92). Median PFS was shortest in patients with severe vitamin D deficiency (3.4 months), intermediate in the 10–20 ng/mL group (5.2 months), and longest in patients with sufficient levels (8.1 months). Median OS ranged from 8.6 months in the < 10 ng/mL group to 15.8 months in the ≥ 20 ng/mL group. Patients with liver metastases had significantly shorter OS compared to those without (median OS 9.8 vs. 13.6 months, HR 1.48, p = 0.006). Vitamin D deficiency was associated with significantly worse PFS and OS on univariate analysis. In multivariable analysis, vitamin D levels < 20 ng/mL remained independently associated with poorer OS. ORR was numerically higher in patients with sufficient vitamin D levels (30% vs. 14%). Lower baseline vitamin D levels were associated with inferior clinical outcomes in advanced NSCLC patients treated with nivolumab. Patients with vitamin D levels ≥ 20 ng/mL demonstrated longer PFS and OS and a trend toward higher response rates. These findings support a prognostic role for vitamin D status in immunotherapy-treated NSCLC; however, prospective studies are required to determine whether vitamin D optimization can causally enhance immunotherapy efficacy.

Nivolumab is currently widely used in the treatment of lung cancer. Studies have been conducted using flat doses of 240 mg and 3 mg/kg. In fact, studies involving a small number of patients have begun to explore low-dose immunotherapies. The literature on the optimal dose of immunotherapy, the use of weight based, or fixed doses is very recent and has become a one of the subject of ongoing research. This multicenter study included 716 patients with NSCLC. Patients receiving standard doses of 3 mg/kg and 240 mg of nivolumab were divided into subgroups based on their weight. Patients weighing 80 kg have already received a flat dose. However, patients weighing < 80 kg who received a flat dose were considered to be receiving high-dose therapy. Conversely, patients weighing more than 80 kg who received a flat dose were maintained on a low dose. Therefore, overall survival, progression-free survival, and toxicity were examined according to weight-based usage. The median progression free survival (PFS) for those receiving a 3 mg/kg dose was 6 months, whereas it was 9.8 months for those receiving a flat dose (p < 0.001). The median (metastatic overall survival) OS for those receiving a 3 mg/kg dose was 12 months, whereas it was 14 months for those receiving a 240 mg dose (p = 0.03). This study was based on real-world data. Therefore, our results may be instructive regarding the nivolumab dose, which is a commonly used treatment for NSCLC patients. Our results suggest that a flat dose may be preferred in all groups and as a subgroup, especially in patients weighing < 80 kg.

Background/Objectives: Non-small-cell lung cancer (NSCLC) is a common disease with a high mortality rate and is often treated with immunotherapies; however, prognostic markers are required to identify patients who are most likely to benefit from these treatments. Therefore, we designed this study to assess the prognostic significance of the C-PLAN index, which includes performance status (PS) and C-reactive protein (CRP). Methods: A total of 560 patients were included in this multicenter study. Patients had been diagnosed with NSCLC and had received nivolumab therapy. The C-PLAN index, defined in 2022, is a score derived from the combination of PS, CRP, lactate dehydrogenase (LDH), albumin, and neutrophil–lymphocyte ratio (NLR). Patients were classified into good-, moderate-, and poor-prognosis groups according to the C-PLAN score. Results: The median metastatic overall survival was 25 months in the group with a C-PLAN score < 2 and 6 months in the group with a C-PLAN score ≥ 2 (p < 0.001). The median metastatic progression-free survival was 11 months in the group with a C-PLAN score < 2 and 3 months in the group with a C-PLAN score ≥ 2. Conclusion: This is the first comprehensive study demonstrating that the C-PLAN index can be used for prognostic purposes in immunotherapy. This score, which can be easily, economically, and practically calculated in outpatient clinics, can predict patient prognosis and determine who should receive longer durations of immunotherapy.

Background/objectives Patients with metastatic prostate cancer (mPC) represent a population with a higher proportion of elderly patients compared to other patient groups. Androgen receptor pathway inhibitors (ARPISs) are frequently used in current treatment regimens. Although the Prognostic Nutritional Index (PNI) is widely utilized, its stand alone capacity to accurately predict overall survival (OS) and progression-free survival (PFS) remains limited. This study aimed to evaluate the prognostic value of PNI in mPC patients treated with ARPIs and to optimize survival predictions by developing integrated multivariable logistic and Cox regression models. Methods PNI was calculated at baseline and third month after treatment initiation. To assess cross-sectional predictive capability, multivariable logistic regression models were developed for OS and PFS events, and their diagnostic performance was evaluated using Receiver Operating Characteristic (ROC) curve analysis. Subsequently, time-to-event dynamics and hazard ratios were analyzed using univariable and multivariable Cox proportional hazards regression. Results The multivariable logit model demonstrated robust predictive performance for survival outcomes. Utilizing the model-derived optimal probability cutoff of 0.343, patients were successfully stratified into distinct prognostic cohorts. The high-probability risk group (≥ 0.343, n = 86) exhibited a significantly worse prognosis, with accelerated curve decline and earlier, more frequent mortality. In contrast, the low-probability group (< 0.343, n = 51) showed a favorable prognosis, maintaining an approximate 30% survival rate up to the 75th month (Log-rank p = 0.009). Conclusion Evaluating nutrition alone is not enough to predict how mPC patients will progress. By tracking PNI changes over time and combining them into multivariable logistic model, we can much better predict overall survival and progression-free survival. In practice, using our model's 0.343 cutoff score allows us to easily catch high-risk patients early on, helping physician step in with personalized nutritional and medical support.

Background/Objectives: Sunitinib and pazopanib are administered at fixed doses in patients with metastatic renal cell carcinoma (mRCC), without adjustment for body composition. This study aimed to investigate the association between body mass index (BMI) and treatment-related toxicity and treatment discontinuation in patients with mRCC receiving first-line sunitinib or pazopanib. Methods: A total of 136 patients with mRCC treated with sunitinib (n = 90) or pazopanib (n = 46) were retrospectively evaluated. BMI was compared according to toxicity grade (1–2 and 3–4) and treatment discontinuation using Student’s t-tests and chi-square/Fisher’s exact tests. Given the limited number of grade 3–4 toxicity events, Firth’s penalized logistic regression was used for multivariable analysis, with adjustment for age, sex, and treatment type. BMI was evaluated as a continuous variable in the primary model and categorically in a supportive analysis. p < 0.05 was considered statistically significant. Results: Higher BMI was significantly associated with grade 1–2 (p < 0.001) and grade 3–4 toxicity (p < 0.001). In the Firth penalized multivariable analysis, higher BMI remained independently associated with grade 3–4 toxicity (OR per 1 kg/m² increase, 1.160; 95% CI, 1.057–1.283; p = 0.0015). Increasing age (OR per 1-year increase, 1.061; 95% CI, 1.021–1.106; p = 0.0022) and sunitinib treatment (OR, 2.629; 95% CI, 1.104–6.785; p = 0.028) were also independently associated with grade 3–4 toxicity. In the supportive categorical analysis, obesity (BMI ≥ 30 kg/m²) was associated with higher odds of grade 3–4 toxicity compared with BMI < 25 kg/m² (OR, 4.173; 95% CI, 1.533–11.982; p = 0.005). Conclusions: A higher BMI was associated with a greater likelihood of grade 3–4 TKI-related toxicity in patients with mRCC receiving fixed-dose sunitinib or pazopanib. BMI may represent a practical clinical marker for identifying patients who warrant closer toxicity monitoring.