While these combinations have improved overall survival and response rates compared to sunitinib, complete response rates have varied between 10% and 18%. Until now, the impact of treating residual disease post-immunotherapy combinations has not been thoroughly explored. This study involved a detailed examination of patients with metastatic renal cell carcinoma who had been treated with immunotherapy-based combinations. The study included 80 patients with clear cell mRCC treated in first-line with immunotherapy-based combination. For 11 patients, the strategy included initial treatment with immunotherapy-based combinations, followed by targeted treatment of residual disease after a median of 19.1 months from the start of immunotherapy (Table 1). Specific local treatments included surgical resection and liver ablation of residual disease sites. Pathological analysis showed viable renal cell carcinoma in 7 out of 10 patients, specifically in 5 nephrectomy and 2 lung metastasectomy specimens, with no cancer cells found in lymph node ablation. Additionally, sarcomatoid features were present in 3 out of 10 samples.
Key findings of the study include a dramatic increase in complete response rates from 11% to 24%, cessation of systemic therapy for all patients who underwent residual disease treatment (Table 1), and the importance of a dual-phase treatment strategy—initial immunotherapy-based combinations followed by targeted treatment of residual disease—leading to enhanced long-term outcomes.
Table 1: Patient’s Outcomes. NR = Not Reach
Written by: Fabien Moinard-Butot, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
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