Outcomes of Patients with Metastatic Renal Cell Carcinoma Treated with Targeted Therapy After Immuno-oncology Checkpoint Inhibitors

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Jeffrey Graham, Univ Manitoba, University of Manitoba, Ctr Earth Observat Sci
  • ,
  • Amishi Y Shah, MD Anderson Cancer Center Orlando
  • ,
  • J Connor Wells, University of Calgary, Calgary, Canada.
  • ,
  • Rana R McKay, Department of Dermatology, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California.
  • ,
  • Ulka Vaishampayan, Karmanos Cancer Institute, Southfield, Michigan
  • ,
  • Aaron Hansen, Princess Margaret Cancer Centre
  • ,
  • Frede Donskov
  • Georg A Bjarnason, University of Toronto, Sunnybrook Health Sciences Centre
  • ,
  • Benoit Beuselinck, Univ Hosp Leuven, KU Leuven, University Hospital Leuven, Dept Otorhinolaryngol
  • ,
  • Guillermo De Velasco, University Hospital "12 Octubre
  • ,
  • Marco Iafolla, Princess Margaret Cancer Centre
  • ,
  • Mei S Duh, Analysis Group, Inc., Boston, MA
  • ,
  • Lynn Huynh, Analysis Group, Inc., Boston, MA
  • ,
  • Rose Chang, Analysis Group, Inc., Boston, MA
  • ,
  • Giovanni Zanotti, Pfizer Oncology, Pfizer Inc., New York, NY, USA.
  • ,
  • Krishnan Ramaswamy, Pfizer Oncology, Pfizer Inc., New York, NY, USA.
  • ,
  • Toni K Choueiri, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA.
  • ,
  • Nizar M Tannir, MD Anderson Cancer Center Orlando
  • ,
  • Daniel Y C Heng, University of Calgary, Calgary, Canada.

BACKGROUND: Immuno-oncology (IO) therapies have changed the treatment standards of metastatic renal cell carcinoma (mRCC). However, the effectiveness of targeted therapy following discontinuation of IO therapy in real-world settings has not been well studied.

OBJECTIVE: To describe treatment sequence and assess clinical effectiveness of targeted therapy for mRCC patients who received prior IO therapy.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective, longitudinal cohort study using data from eight international cancer centers was conducted. Patients with mRCC were ≥18yr old, received IO therapy in any line, and initiated targeted therapy following IO therapy discontinuation.

INTERVENTION: Patients were treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) or mammalian target of rapamycin inhibitors (mTORIs).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Outcomes were time to treatment discontinuation (TTD), overall survival (OS), and objective response rate (ORR). Crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. Models were adjusted for age, sex, therapy line, and International Metastatic RCC Database Consortium risk group.

RESULTS AND LIMITATIONS: Among 314 patients, 276 (87.9%) and 38 (12.1%) were treated with VEGFR-TKI and mTORI therapy, respectively. The most common tyrosine kinase inhibitor treatments were axitinib, cabozantinib, and sunitinib following IO therapy. In adjusted models, patients treated with VEGFR-TKI versus mTORI therapy had lower hazard of TTD after IO treatment (aHR=0.46; 95% CI: 0.30-0.71; p < 0.01). One-year OS probability (65% vs 47%, p < 0.01) and proportion of ORR (29.8% vs 3.6%, p < 0.01) were significantly greater for patients treated with VEGFR-TKIs versus those treated with mTORIs.

CONCLUSIONS: Targeted therapy has clinical activity following IO treatment. Patients who received VEGFR-TKIs versus mTORIs following IO therapy had improved clinical outcomes. These findings may help inform treatment guidelines and clinical practice for patients post-IO therapy.

PATIENT SUMMARY: Patients may continue to experience clinical benefits from targeted therapies after progression on immuno-oncology treatment.

OriginalsprogEngelsk
TidsskriftEuropean urology oncology
Vol/bind4
Nummer1
Sider (fra-til)102-111
Antal sider10
ISSN2588-9311
DOI
StatusUdgivet - feb. 2021

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Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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