ASCO 2017: Nivolumab treatment for patients with non-clear cell renal cell carcinoma: A multicenter retrospective analysis

Chicago, IL ( Immunotherapy trials assessing oncologic safety and efficacy among patients with metastatic renal cell carcinoma (mRCC) typically exclude patients with non-clear cell histology. However, there are limited second-line treatment options for patients with non-clear cell histology that fail targeted therapy. At today’s genitourinary cancer poster session at the 2017 ASCO annual meeting, Dr. Koshkin and colleagues presented their multi-center, retrospective analysis of patients with non-clear cell histology that were treated with nivolumab immunotherapy.

For this study the authors utilized patients with non-clear cell histology from three centers who received at least one dose of nivolumab for mRCC between 2015 and 2017. The main outcomes were objective response according to RECIST v1.1 and adverse events. Twenty-three patients met inclusion criteria with a median age of 59 years (range: 33-82), 78% were male, and 61% were Caucasian. There were 19% with MSKCC favorable risk, 67% with intermediate, and 14% with high risk disease. The most common histology was unclassified (48%) and papillary (44%) followed by collecting duct (4%) and mucinous tubular and spindle cell carcinoma (4%). At diagnosis, 65% of patients had metastatic disease, with the most common sites being the lung (57%), retroperitoneal lymph nodes (35%), and liver or bone (26% each). The majority of patients had received one (74%) or >1 (26%) prior systemic therapies, most commonly sunitinib (65%), pazopanib (30%) or axitinib (17%). Over a median follow-up of 6.5 months, the median number of nivolumab doses was eight, and the median progression free survival was 4.2 months. There were 6 patients (29%) that had partial response and 19% of patients with stable disease. The most common adverse events were fever (13%) and fatigue (13%); two of the 23 patients died of disease progression.

In conclusion, this multi-center, retrospective descriptive study demonstrated that nivolumab monotherapy resulted in a substantial objective response rate and was well tolerated in a heterogeneous population of treatment-refractory patients who had mRCC with non-clear cell histology. Given that clinical trials are unlikely to be designed specifically for patients in this setting with non-clear cell histology, it seems reasonable that in the second line these patients should be considered for nivolumab immunotherapy.

Presented By: Vadim S. Koshkin, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA

Co-Authors: Pedro C. Barata, Nicholas J. Vogelzang, Sumanta K. Pal, Joann Hsu, Kimberly D Allman, Timothy D. Gilligan, Brian I. Rini

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 ASCO Annual Meeting - June 2 - 6, 2017 – Chicago, Illinois, USA

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