This study aimed to assess the prognostic outcomes in mRCC patients receiving second-line TKI following first-line IO combination therapy.
This study retrospectively included 243 mRCC patients receiving second-line TKI after first-line IO combination therapy: nivolumab plus ipilimumab (n = 189, IO-IO group) and either pembrolizumab plus axitinib or avelumab plus axitinib (n = 54, IO-TKI group). Oncological outcomes between the two groups were compared, and prognostication systems were developed for these patients.
In the IO-IO and IO-TKI groups, the objective response rates to second-line TKI were 34.4% and 25.9% (p = 0.26), the median PFS periods were 9.7 and 7.1 months (p = 0.79), and the median OS periods after the introduction of second-line TKI were 23.1 and 33.5 months (p = 0.93), respectively. Among the several factors examined, non-CCRCC, high CRP, and low albumin levels were identified as independent predictors of both poor PFS and OS by multivariate analyses. It was possible to precisely classify the patients into 3 risk groups regarding both PFS and OS according to the positive numbers of the independent prognostic factors. Furthermore, the c-indices of this study were superior to those of previous systems as follows: 0.75, 0.64, and 0.61 for PFS prediction and 0.76, 0.70, and 0.65 for OS prediction by the present, IMDC, and MSKCC systems, respectively.
There were no significant differences in the prognostic outcomes after introducing second-line TKI between the IO-IO and IO-TKI groups, and the histopathology, CRP and albumin levels had independent impacts on the prognosis in mRCC patients receiving second-line TKI, irrespective of first-line IO combination therapies.
International journal of urology : official journal of the Japanese Urological Association. 2024 Jan 19 [Epub ahead of print]
Yuto Matsushita, Takahiro Kojima, Takahiro Osawa, Tomokazu Sazuka, Shingo Hatakeyama, Keisuke Goto, Kazuyuki Numakura, Kazutoshi Yamana, Shuya Kandori, Kazutoshi Fujita, Kosuke Ueda, Hajime Tanaka, Ryotaro Tomida, Toshifumi Kurahashi, Yukari Bando, Naotaka Nishiyama, Takahiro Kimura, Shimpei Yamashita, Hiroshi Kitamura, Hideaki Miyake, Japanese Urological Oncology Group
Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan., Department of Urology, Aichi Cancer Center, Nagoya, Aichi, Japan., Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Hokkaido, Japan., Department of Urology, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Chiba, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan., Department of Urology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Hiroshima, Japan., Department of Urology, Akita University Graduate School of Medicine, Akita, Akita, Japan., Department of Urology and Molecular Oncology, Niigata University Graduate school of medical and dental sciences, Niigata, Niigata, Japan., Department of Urology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan., Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan., Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan., Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan., Department of Urology, Hyogo Prefectural Cancer Center, Akashi, Hyogo, Japan., Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan., Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Wakayama Medical University, Wakayama, Wakayama, Japan.