Nivolumab plus ipilimumab (nivo/ipi) is an approved therapy for patients with intermediate- or poor-risk metastatic renal cell carcinoma (mRCC). Clinical factors that guide the selection of this regimen for patients with mRCC are urgently needed. We retrospectively analyzed medical records of patients with mRCC who were hospitalized at MD Anderson Cancer Center because of cancer-related symptoms and received their first cycle of nivo/ipi in the inpatient setting. Clinical parameters, including demographics, histology, clinical history, response, and survival, were collected. The four-month survival probability, progression-free survival (PFS), and overall survival (OS) were calculated using Kaplan-Meier methods. Between November 2017 and June 2020, 21 patients were identified that fit the search: 19 patients (91%) had poor-risk disease based on the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score; 17 patients (81%) had ≥4 risk factors; and 9 patients (43%) had sarcomatoid features on histology. Shortness of breath (28%) and abdominal pain (19%) were the two most common reasons for hospitalization. Partial response was achieved in 14% (3/21) of patients. Median PFS for all patients was 1.7 months (95% CI 0 - 3.9); median OS for all patients was 1.7 months (95% CI 0 - 4.2); and the 4-month survival probability was 36% (95% CI 25% - 47%). In this retrospective study, patients with intermediate- or poor-risk mRCC who are hospitalized at a large tertiary referral center for cancer-related symptoms derive limited clinical benefit from nivo/ipi when started in the inpatient setting. Alternative, more effective systemic therapies should be considered for these patients. This article is protected by copyright. All rights reserved.
International journal of cancer. 2021 Mar 19 [Epub ahead of print]
Omar Alhalabi, Elshad Hasanov, Nathaniel R Wilson, John Araujo, Jianbo Wang, Matthew Campbell, Sangeeta Goswami, Amishi Shah, Jianjun Gao, Pavlos Msaouel, Nizar M Tannir
Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX., Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Internal Medicine, University of Texas Houston, Houston, TX.