The role of eosinophils in patients with cancer receiving systemic therapy based on immune checkpoint inhibitors (ICIs) has become a subject of increasing interest. The aim of the present study was to assess the prognostic role of absolute eosinophil count (AEC) and neutrophil-to-eosinophil ratio (NER) in patients with metastatic renal cell carcinoma (mRCC) receiving nivolumab. The associations of AEC and NER at baseline and their relative changes (Δ) after one month of nivolumab therapy with progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analyzed. In total, 458 patients were included. Baseline AEC ≥ 70 cells/µL (PFS: HR: 0.663, p = 0.009; OS: HR: 0.583, p = 0.002), AEC one month after nivolumab initiation ≥ 70 cells/µL (PFS: HR: 0.544, p = 0.001; OS: HR: 0.331, p < 0.001) and NER < 65 one month after nivolumab initiation (PFS: HR: 0.552, p < 0.001; OS: HR: 0.326, p < 0.001) was associated with superior PFS and OS, and baseline NER < 65 was associated with superior OS (HR: 0.664, p = 0.014). Regarding early dynamics, ΔNER ≥ 125% was associated with inferior PFS (HR: 1.950, p = 0.001) and OS (HR: 2.680, p < 0.001), and ΔAEC <-30% was associated with inferior OS (HR: 2.132, p < 0.001). Higher ORR was associated with baseline AEC ≥ 70 cells/µL (p = 0.048), baseline NER < 65 (p = 0.010); and NER one month after nivolumab initiation < 65 (p = 0.025). The results of the present study suggest that eosinophil-based blood parameters including AEC and NER and their early dynamics during the course of treatment with nivolumab are promising and readily available prognostic biomarkers in patients with mRCC.

2nd Department of Oncology Faculty of Medicine Comenius University and National Cancer Institute Bratislava Slovakia

ARON Research Foundation ETS Macerata Italy

Biomedical Center Faculty of Medicine in Pilsen Charles University Alej Svobody 76 Pilsen 304 60 Czech Republic

Cancer Research Institute Biomedical Research Center of the Slovak Academy of Sciences Bratislava Slovakia

Department of Comprehensive Cancer Care Faculty of Medicine Masaryk University Kamenice 5 Brno 625 00 Czech Republic

Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute Zluty Kopec 7 Brno 656 53 Czech Republic

Department of Oncology 1st Faculty of Medicine Charles University and General University Hospital U Nemocnice 499 2 Prague 128 08 Czech Republic

Department of Oncology 1st Faculty of Medicine Charles University Thomayer University Hospital Videnska 800 Prague 140 59 Czech Republic

Department of Oncology 2nd Faculty of Medicine Charles University and Motol University Hospital 5 Úvalu 84 Prague 150 06 Czech Republic

Department of Oncology and Radiotherapeutics Faculty of Medicine and University Hospital in Pilsen Charles University Alej Svobody 80 Pilsen 304 60 Czech Republic

Department of Oncology East Cancer Slovak Institute Kosice Slovakia

Department of Oncology F D Roosevelt University General Hospital Banská Bystrica Slovakia

Department of Oncology Palacký University Medical School and Teaching Hospital 1 P Pavlova 6 Olomouc 775 20 Czech Republic

Department of Oncology University Hospital in Hradec Králové Sokolská 581 Hradec Králové 50005 Czech Republic

Department of Urology Faculty of Medicine and University Hospital in Pilsen Charles University Edvarda Beneše 1128 13 Pilsen 301 00 Czech Republic

Institute of Biostatistics and Analyses Ltd Poštovská 68 3 Brno 602 00 Czech Republic

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