Abstract
Background
Immune checkpoint inhibitor (ICI)-based combinations have become the first-line standard
of care in metastatic renal cell carcinoma (mRCC), but their activity on the primary
tumor is still one of the most debated issues.
Patients and Methods
The aim of our analysis was to evaluate the primary tumor's response to first-line
therapy with cabozantinib or nivolumab+ipilimumab, and its correlation with metastatic
response and with patient outcomes.
Results
Sixty-seven mRCC patients met the criteria for inclusion in the final analysis (30
treated with cabozantinib and 37 with nivolumab+ipilimumab). In the overall population,
the primary tumor control rate (PTCR) was 90.9%; no complete responses (CR) were achieved.
A significant correlation was found between the baseline size of the primary tumor's
longest diameter and its response according to RECIST v1.1 criteria at the time of
the second radiological assessment (rs = -0.351; P = .049). Moreover, a significant correlation between the type of primary tumor response
and the response of the metastases was observed in the overall population (rs = 0.50;
two-sided P < 0.001). There was also a significant correlation between primary tumor response
and 1-year survival rate (P = .002), even when adjusted for the IMDC prognostic group and type of therapy (HR = 8.70;
95%CI, 2.52-30.05; P = .001).
Conclusion
Extension of the primary tumor did not affect patient survival, while its response
was significantly related to the response on metastatic disease and survival. No significant
differences in terms of primary tumor shrinkage were identified between treatment
with nivolumab+ipilimumab or cabozantinib in this cohort.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2021.CA Cancer J Clin. 2021; 71: 7-33
- Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer.N Engl J Med. 2001; 345: 1655-1659
- Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial.Lancet. 2001; 358: 966-970
- Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis.J Urol. 2004; 171: 1071-1076
- Impaired activation of NFkappaB in Tcells from a subset of renal cell carcinoma patients is mediated by inhibition of phosphorylation and degradation of the inhibitor, IkappaBalpha.Blood. 1998; 92: 1334-1341
- Mechanisms of apoptosis in T cells from patients with renal cell carcinoma.Clin Cancer Res. 1999; 5: 1219-1229
- Role of cytoreductive nephrectomy in the targeted therapy era: a systematic review and metaanalysis.Investig Clin Urol. 2018; 59: 2-9
- Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the international metastatic renal cell carcinoma database consortium.Eur Urol. 2014; 66: 704-710
- Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma.Eur Urol. 2019; 75: 111-128
- Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial.JAMA Oncol. 2019; 5: 164-170
- Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma.N Engl J Med. 2018; 379: 417-427
- Cytoreductive nephrectomy (CN) in metastatic renal cancer (mRCC): update on carmena trial with focus on intermediate IMDC-risk population.J Clin Oncol. 2019; 37: 4508https://doi.org/10.1200/JCO.2019.37.15_suppl.4508
- Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study.J Clin Oncol. 2009; 27: 5794-5799
- Recent eUpdate to the ESMO clinical practice guidelines on renal cell carcinoma on cabozantinib and nivolumab for first-line clear cell renal cancer: renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2021; 32: 422-423
- Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma.N Engl J Med. 2018; 378: 1277-1290
- Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma.N Engl J Med. 2019; 380: 1103-1115
- Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma.N Engl J Med. 2021; 384: 829-841
Albiges L, Tannir N, Burotto M, et al. 711P Nivolumab + ipilimumab (N+I) vs sunitinib (S) for first-line treatment of advanced renal cell carcinoma (aRCC) in CheckMate 214: 4-year follow-up and subgroup analysis of patients (pts) without nephrectomy. doi:10.1016/j.annonc.2020.08.783.
- Costimulatory B7-H1 in renal cell carcinoma patients: indicator of tumor aggressiveness and potential therapeutic target.Proc Natl Acad Sci U S A. 2004; 101: 17174-17179
- Tumor B7-H1 is associated with poor prognosis in renal cell carcinoma patients with long-term follow-up.Cancer Res. 2006; 66: 3381-3385
- Identification of a soluble form of B7-H1 that retains immunosuppressive activity and is associated with aggressive renal cell carcinoma.Clin Cancer Res. 2011; 17: 1915-1923
- Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4-year follow-up of the phase III CheckMate 214 trial.ESMO Open. 2020; 5e001079
- Dual immune checkpoint inhibition in metastatic renal cell carcinoma: Editorial re.: Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced RCC: extended 4-year follow-up of the phase III CheckMate 214 trial.ESMO Open. 2021; 6100035
Article Info
Publication History
Published online: June 08, 2022
Accepted:
June 5,
2022
Received in revised form:
May 23,
2022
Received:
July 5,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
