Characterization of Patients With Metastatic Renal Cell Carcinoma Experiencing Complete Response to First-line Therapies: Results From the International Metastatic Renal Cell Carcinoma Database Consortium

Takemura, K; Navani, V; Ernst, MS; Wells, JC; Meza, L; Pal, SK; Lee, JL; Li, H; Agarwal, N; Alva, AS; Hansen, AR; Basappa, NS; Szabados, B; Powles, T; Tran, B; Hocking, CM; Beuselinck, B; Yuasa, T; Choueiri, TK; Heng, DYC

Author(s): Takemura, K; Navani, V; Ernst, MS; Wells, JC; Meza, L; Pal, SK; Lee, JL; Li, H; Agarwal, N; Alva, AS; Hansen, AR; Basappa, NS; Szabados, B; Powles, T; Tran, B; Hocking, CM; Beuselinck, B; Yuasa, T; Choueiri, TK; Heng, DYC;
Details: Publication Year 2023-04,Volume 209,Issue #4,Page 701-709
Journal Title: Journal of Urology
Publication Type: Research article
Abstract: PURPOSE: Clinical trials have demonstrated higher complete response rates in the immuno-oncology-based combination arms than in the tyrosine kinase inhibitor arms in patients with metastatic renal cell carcinoma. We aimed to characterize real-world patients who experienced complete response to the contemporary first-line therapies. MATERIALS AND METHODS: Using the International Metastatic Renal Cell Carcinoma Database Consortium, response-evaluable patients who received frontline immuno-oncology-based combination therapy or tyrosine kinase inhibitor monotherapy were analyzed. Baseline characteristics of patients and post-landmark overall survival were compared based on best overall response, as per RECIST 1.1. RESULTS: A total of 52 (4.6%) of 1,126 and 223 (3.0%) of 7,557 patients experienced complete response to immuno-oncology-based and tyrosine kinase inhibitor therapies, respectively (P = .005). An adjusted odds ratio for complete response achieved by immuno-oncology-based combination therapy (vs tyrosine kinase inhibitor monotherapy) was 1.56 (95% CI 1.11-2.17; P = .009). Among patients who experienced complete response, the immuno-oncology-based cohort had a higher proportion of non-clear cell histology (15.9% and 4.7%; P = .016), sarcomatoid dedifferentiation (29.8% and 13.5%; P = .014), and multiple sites of metastases (80.4% and 50.0%; P < .001) than the tyrosine kinase inhibitor cohort. Complete response was independently associated with post-landmark overall survival benefit in both the immuno-oncology-based and tyrosine kinase inhibitor cohorts, giving respective adjusted hazard ratios of 0.17 (95% CI 0.04-0.72; P = .016) and 0.28 (95% CI 0.21-0.38; P < .001). CONCLUSIONS: The complete response rate was not as high in the real-world population as in the clinical trial population. Among those who experienced complete response, several adverse clinicopathological features were more frequently observed in the immuno-oncology-based cohort than in the tyrosine kinase inhibitor cohort. Complete response was an indicator of favorable overall survival.
Publisher: Wolters Kluwer
Keywords: Humans; *Carcinoma, Renal Cell/drug therapy/pathology; *Kidney Neoplasms/drug therapy; Treatment Outcome; Proportional Hazards Models; Immunotherapy; Retrospective Studies; Protein Kinase Inhibitors/therapeutic use; carcinoma, renal cell; immune checkpoint inhibitors; prognosis; receptors; remission induction; vascular endothelial growth factor
Department(s): Medical Oncology
PubMed ID: 36573926
Publisher's Version: https://doi.org/10.1097/JU.0000000000003132
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-08-07 07:16:18

Last Modified: 2023-08-07 07:17:40