ICI vs TKI Therapy Added to Cytoreductive Nephrectomy Ups Survival in mRCC

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WASHINGTON, DC—Among patients who undergo cytoreductive nephrectomy for metastatic renal cell carcinoma (mRCC), those receiving an immune checkpoint inhibitor (ICI) have improved survival outcomes compared with those receiving a tyrosine kinase inhibitor (TKI), according to study findings presented at the Society of Urologic Oncology’s 24th Annual Meeting.

Using data from the Registry of Metastatic RCC (REMARCC) database, investigators analyzed outcomes of 189 patients who received either an ICI or TKI as first-line therapy (148 and 41 patients, respectively) in addition to cytoreductive nephrectomy. The median follow-up duration for the study population was 23.2 months.

Compared with the TKI group, the ICI group had significantly greater 5-year rates of overall survival (51% vs 27%) and cancer-specific survival (83% vs 30%), Margaret Frances Meagher, MD, of the University of California, San Diego School of Medicine in La Jolla, and colleagues reported in a poster presentation. The overall survival benefit in the ICI group compared with the TKI group extended to patients with intermediate- to poor-risk disease (50% vs 30%).

On multivariable analysis, TKI therapy was significantly associated with an approximately 2.4-and 5.4-fold increased risk for all-cause and cancer-specific mortality, respectively, compared with ICI therapy.


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In addition, the study demonstrated that systemic therapy received after cytoreductive nephrectomy was independently associated with a 1.5- and 2.0-fold increased risk for all-cause and cancer-specific mortality.

“Our findings call into question the applicability of clinical trial data from cytoreductive nephrectomy in the TKI era to cytoreductive nephrectomy in the [immune-oncology] era,” the authors concluded.

The latest findings add to mounting evidence of improved survival associated with adding ICI therapy to cytoreductive nephrectomy for mRCC. For example, in a study published in 2022 in Urologic Oncology, investigators found that ICI therapy used in conjunction with cytoreductive nephrectomy was significantly associated with a 67% reduced risk for all-cause mortality compared with ICI therapy alone. Patients who received first-line ICI therapy followed by cytoreductive nephrectomy had an 81% lower risk for all-cause mortality compared with ICI therapy alone.

Disclosures: The current study was funded by the Stephen Weissman Kidney Cancer Fund.

Reference

Meagher MF, Saitta C, Minervini A, et al. Cytoreductive nephrectomy in patients receiving TKI therapy versus immune checkpoint inhibitor therapy: Analysis of the REMARCC Registry. Presented at: SUO 2023; November 28-December 1, Washington, DC. Poster 9.



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