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Gastroenterology

GNRI May Help to Identify Unresectable HCC Patients on Immunotherapy at High Risk for Immune-mediated Adverse Events

Sep 08, 2025

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AT A GLANCE

A new study published in the Journal of Gastroenterology reports that the Geriatric Nutritional Risk Index (GNRI) could be used to identify patients with unresectable hepatocellular carcinoma (uHCC) on immunotherapy at high risk for immune-mediated adverse events (imAEs).1

“Immune-mediated adverse events (imAEs) are a significant concern in patients with unresectable hepatocellular carcinoma (uHCC) undergoing combination immunotherapy with durvalumab and tremelimumab (Dur/Tre),” explain study authors Ohama et al. “This study aimed to investigate the potential association of risk factors, particularly nutrition and immune markers, associated with the development of imAEs.”

A total of 312 patients with uHCC treated with Dur/Tre were enrolled and retrospectively analyzed. The authors recorded clinical characteristics, inflammatory markers, and nutritional indices (GNRI, body mass index, Prognostic Nutritional Index—Onodera, C-reactive protein–to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio) to identify predictors for imAE development.

According to the authors, imAEs occurred in 122 participants (39.1%), most commonly affecting the dermatological, gastrointestinal, and endocrine systems. On multivariate analysis, only a normal GNRI (≥98 points) was independently associated with a greater incidence of imAE, and patients with GNRI ≥ 98 points also showed better overall survival (OS) than those with GNRI < 98 points. Among those patients who developed imAEs, no significant difference in the imAE type or high-dose steroid use was observed between the GNRI ≥ 98 group (n = 66) and the GNRI < 98 group (n = 56).

“Normal GNRI status (≥ 98) was associated with an increased risk of imAE development and improved OS in patients with uHCC receiving Dur/Tre therapy. GNRI may be a useful clinical factor for identifying patients at higher risk of developing imAEs” conclude the authors.

Reference

1.     Ohama H, Hiraoka A, Tada T, et al. Potential role of Geriatric Nutritional Risk Index as a risk factor for immune-mediated adverse events during durvalumab plus tremelimumab therapy in unresectable hepatocellular carcinoma (online ahead of print August 20, 2025). J Gastroenterol.