Abstract
The emerging use of immunotherapy as a treatment option in metastatic renal cell carcinoma: Real-world evidence from a single UK tertiary cancer centre.
Author
person
Justin KH Liu
Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
info_outline
Justin KH Liu, Andrew F. Irvine, Mustafa Altarqane, Mariyam Arif, Vikram Bansal, Anne Boyle, Fiona C Campbell, Noha Elsayed, Mdehteshamul E. Hafiz, Ashraful Huda, Aye Soe, Anthony Maraveyas, John McGrane, Iqtedar A Muazzam
Full text
Authors
person
Justin KH Liu
Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
info_outline
Justin KH Liu, Andrew F. Irvine, Mustafa Altarqane, Mariyam Arif, Vikram Bansal, Anne Boyle, Fiona C Campbell, Noha Elsayed, Mdehteshamul E. Hafiz, Ashraful Huda, Aye Soe, Anthony Maraveyas, John McGrane, Iqtedar A Muazzam
Organizations
Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, University of Leeds, Leeds, United Kingdom, Royal Cornwall Hospital NHS Trust, Cornwall, United Kingdom
Abstract Disclosures
Research Funding
No funding received
None.
Background:
The landscape of systemic anticancer therapy (SACT) options for the treatment of metastatic renal cell carcinoma (mRCC) has recently evolved following results from the CheckMate 214 trial in 2018 which demonstrated improved overall survival in patients with International mRCC Database Consortium (IMDC) intermediate- and poor-risk mRCC clear cell histological subtype receiving combination immunotherapy (Ipilimumab/Nivolumab) in the first-line setting compared to Sunitinib. This is in addition to other treatment options including: vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) (e.g. Sunitinib, Pazopanib, Tivozanib, Cabozantinib, etc.), combination immunotherapy/TKI (e.g. Avelumab/Axitinib), VEGF/mammalian target of Rapamycin (mTOR) inhibitors (e.g. Lenvatinib/Everolimus) and single-agent immunotherapy (e.g. Nivolumab) in both first- and second-line settings.
Methods:
An audit of SACT prescribing practices in mRCC between 2019-2022 in a single UK tertiary cancer centre (Castle Hill Hospital, Hull, UK) was conducted as part of a national collaboration multi-centre UK audit looking into the real-world landscape and treatment choices in mRCC. Information was derived from the Somerset Cancer Registry and a dataset containing 87 patients with a coded diagnosis of ‘malignant neoplasm of kidney, except renal pelvis (CX64X)’ and ‘secondary malignant neoplasm of kidney & renal pelvis (C790)’ was generated.
Results:
Of the 81 patients included in the final analysis, 65% (n = 53) were male and 81% (n = 66) had a clear cell histological subtype. The main sites of metastases were lung (n = 58) and lymph nodes (n = 45). Most of the patients (n = 72) received either one or two lines of SACT. Of those with clear cell mRCC, 74% (n = 51/69) were classed as having IMDC intermediate- or poor-risk features with almost half (n = 34/69) receiving combination Ipilimumab/Nivolumab. Comparing overall survival (OS) and progression-free survival (PFS) to the published Kaplan-Meier curves in the CheckMate 214 trial, no significant differences in OS (p = 0.6) and PFS (p = 0.13) were observed, although there was an overall trend towards improved PFS in the first 6 months (82.4% vs 63.3%) in our local dataset.
Conclusions:
The results of our real-world evaluation of prescribing practices in mRCC favoured the use of combination immunotherapy in the first-line setting for the treatment of IMDC intermediate- and poor-risk clear cell mRCC with similar outcomes to the published data in the CheckMate 214 trial. The overall trend towards improved PFS in the first 6 months in our local dataset highlights the importance of patient selection when using immunotherapy.
3 organizations
10 drugs
6 targets
Organization
Hull University Teaching Hospitals NHS TrustOrganization
University of LeedsOrganization
Royal Cornwall Hospital NHS TrustDrug
ipilimumabDrug
nivolumabDrug
sunitinibDrug
pazopanibDrug
TivozanibDrug
cabozantinibDrug
avelumabDrug
axitinibDrug
lenvatinibDrug
everolimusTarget
CTLA-4Target
VEGFR-1Target
PD-1Target
PD-L1Target
mTORC1