To investigate responses in the primary tumour to different systemic treatment regimens in patients with metastatic renal cell carcinoma (mRCC).
A single-centre retrospective analysis of treatment-naive mRCC patients without prior nephrectomy receiving VEGF tyrosine kinase inhibitors (VEGF only), immune checkpoint inhibitors (IO only), or combinations thereof (IO + VEGF). The primary outcome was the rate of partial response in the primary tumour (primary tumour PR, ≥ 30% diameter reduction). Secondary outcomes were time to best primary tumour diameter change, overall survival (OS) and progression-free survival (PFS) by Kaplan-Meier analysis. Predictors of survival outcomes were explored by Cox proportional hazards regression analysis.
The rate of primary tumour PR was 14% for VEGF only (4/28 patients), 22% for IO only (5/23) and 50% for IO + VEGF (7/14), with median best primary tumour diameter change of - 8.0%, + 5.1%, and - 31.1% respectively, and median time to best primary tumour diameter change of 3.2, 3.0 and 6.9 months respectively. Median OS was significantly greater with IO + VEGF compared to VEGF only (HR 0.45, p = 0.04) and non-significantly greater compared to IO only (HR 0.46, p = 0.06). In multivariable analysis, primary tumour PR was the only response variable significantly associated with both OS (adjusted HR 0.32, p = 0.01) and PFS (adjusted HR 0.29, p < 0.01).
mRCC patients without prior nephrectomy receiving first-line IO + VEGF regimens showed the greatest primary tumour responses, suggesting further prospective evaluation of this combination in the neoadjuvant and deferred cytoreductive nephrectomy settings.
World journal of urology. 2024 Jul 24*** epublish ***
Leo Jurascheck Bickley, Yu-Hsuen Yang, Francesca Jackson-Spence, Charlotte Toms, Christopher Sng, Lucy Flanders, Axel Bex, Thomas Powles, Bernadett Szabados
Barts Health NHS Trust, St Bartholomew's Hospital, West Smithfield, London, UK. ., Barts Health NHS Trust, St Bartholomew's Hospital, West Smithfield, London, UK., Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London, UK., Department of Urology, The Royal Free London NHS Foundation Trust, London, UK.