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. Issue 4 (27th April 2023)

• Record Type: Journal Article
• Authors: Takemura, Kosuke; Navani, Vishal; Ernst, Matthew S.; Wells, J. Connor; Meza, Luis; Pal, Sumanta K.; Lee, Jae-Lyun; Li, Haoran; Agarwal, Neeraj; Alva, Ajjai S.; Hansen, Aaron R.; Basappa, Naveen S.; Szabados, Bernadett; Powles, Thomas; Tran, Ben; Hocking, Christopher M.; Beuselinck, Benoit; Yuasa, Takeshi; Choueiri, Toni K.; Heng, Daniel Y. C.
• Is Part Of: Journal of urology. Volume 209:Issue 4(2023)
• Page Start: 701
• Page End: 709
• Publication Date: 2023-04-27
• Subjects: immune checkpoint inhibitors -- prognosis -- remission induction -- carcinoma, renal cell -- receptors -- vascular endothelial growth factor; Genitourinary organs -- Periodicals; Urology -- Periodicals; Urology -- Periodicals; Urologie -- Périodiques; Urologie; 616.6
• DOI: 10.1097/JU.0000000000003132
• Languages: English
• ISSNs: 0022-5347

Abstract

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.