| Resum: |
Do contemporary first-line therapy options for metastatic renal cell carcinoma (mRCC) have different likelihoods of objective imaging response (complete or partial response), and is objective imaging response associated with overall survival? In this cohort study involving 899 patients with mRCC, treatment with immune checkpoint blockade plus vascular endothelial growth factor receptor inhibitor combination therapies was more likely to be associated with objective imaging response than doublet immune checkpoint blockade therapy after adjustment for baseline demographic and clinical characteristics, including International Metastatic Renal Cell Carcinoma Database Consortium risk criteria. Objective imaging response was associated with improvement in overall survival among patients receiving both types of therapy. This study's findings suggest that combination therapies with first-line immune checkpoint blockade plus vascular endothelial growth factor receptor inhibitor were more likely to be associated with objective imaging response than doublet immune checkpoint blockade therapy. The association between treatment with first-line immuno-oncology (IO) combination therapies and physician-assessed objective imaging response among patients with metastatic renal cell carcinoma (mRCC) remains uncharacterized. To compare the likelihood of objective imaging response (ie, complete or partial response) to first-line IO combination ipilimumab-nivolumab (IOIO) therapy vs approved IO with vascular endothelial growth factor inhibitor (IOVE) combination therapies among patients with mRCC. This multicenter international cohort study was nested in routine clinical practice. A data set from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) was used to identify consecutive patients with mRCC who received treatment with IO combination therapies between May 30, 2013, and September 9, 2021. A total of 899 patients with a histologically confirmed diagnosis of mRCC who received treatment with a first-line IOVE or IOIO regimen and had evaluable responses were included. Best overall response to first-line IO combination therapy based on Response Evaluation Criteria in Solid Tumors, version 1. 1. The primary outcome was the difference in treating physician-assessed objective imaging response based on the type of first-line IO combination therapy received. Secondary outcomes included the identification of baseline characteristics positively associated with objective imaging response and the association of objective imaging response with overall survival. Among 1085 patients with mRCC who received first-line IO combination therapies, 899 patients (median age, 62. 8 years [IQR, 55. 9-69. 2 years]; 666 male [74. 2%]) had evaluable responses. A total of 794 patients had information available on IMDC risk classification; of those, 127 patients (16. 0%) had favorable risk, 442 (55. 7%) had intermediate risk, and 225 (28. 3%) had poor risk. With regard to best overall response among all participants, 37 patients (4. 1%) had complete response, 344 (38. 3%) had partial response, 315 (35. 0%) had stable disease, and 203 (22. 6%) had progressive disease. Corresponding median overall survival was not estimable (95% CI, 53. 3 months to not estimable) among patients with complete response, 55. 9 months (95% CI, 44. 1 months to not estimable) among patients with partial response, 48. 1 months (95% CI, 33. 4 months to not estimable) among patients with stable disease, and 13. 0 months (95% CI, 8. 4-18. 1 months) among patients with progressive disease (log rank P < . 001). Treatment with IOVE therapy was found to be independently associated with an increased likelihood of obtaining response (OR, 1. 89; 95% CI, 1. 26-2. 81; P = . 002) compared with IOIO therapy. The presence of lung metastases (odds ratio [OR], 1. 49; 95% CI, 1. 01-2. 20), receipt of cytoreductive nephrectomy (OR, 1. 59; 95% CI, 1. 04-2. 43), and favorable IMDC risk (OR, 1. 93; 95% CI, 1. 10-3. 39) were independently associated with an increased likelihood of response. In this study, treatment with IOVE therapy was associated with significantly increased odds of objective imaging response compared with IOIO therapy. The presence of lung metastases, receipt of cytoreductive nephrectomy, and favorable IMDC risk were associated with increased odds of experiencing objective imaging response. These findings may help inform treatment selection, especially in clinical contexts associated with high-volume multisite metastatic disease, in which obtaining objective imaging response is important. This cohort study uses data from the International Metastatic Renal Cell Carcinoma Database Consortium to assess the likelihood of objective imaging response to first-line immuno-oncology therapies among patients with metastatic renal cell carcinoma. |
visitant ::
identificació
(City of Hope Comprehensive Cancer Center)
